Breast Flashcards
Mastitis
Inflammation of breast tissue
RF - breastfeeding (milk stasis, 2nd infection with staph aureus)
= painful, tender, red, hot breast, fever
-> continue BF, analgesia, warm compress, PO fluclox 10-14d if not better 24hrs/ fissure/ systemically unwell
Intraductal Papilloma
Warty lesion within one duct of breast, due to proliferation of epithelial cells
= 35-55yrs, clear/ bloody discharge, mass if large
Mammary Duct Ectasia
Dilatation and shortening of terminal duct, inflammation
RF - smoking, perimenopause
= creamy discharge (yellow/ green), nipple retraction
Paget’s Disease of the Nipple
Eczematoid change of the nipple associated with underlying breast malignancy
= mostly nipple (spares areola unlike eczema)
Inv - urgent referral, punch biopsy, mammography, US
Breast Cancer Screening
50- 70yrs, mammogram every 3 years
After 70 can make own appointments
Axillary Lymphadenopathy Pre-op
Palpable -> axillary node clearance in first surgery
Not-palpable -> pre-op axillary US, if negative then do sentinel node biopsy to assess nodal burden
Sentinel node biopsy: during surgery, inject dye into tumour, travels to nearest node, biopsy it
Chemo post-surgery if nodal disease
Breast Referral
Non urgent:
<30yrs with unexplained breast lump
2WW:
Aged 30+ with unexplained breast lump (consider if axilla lump)
Ages 50+ with one of; nipple discharge, retraction, concerning change
Breast Cancer Drugs
Tamoxifen
MOA - SERM, oestrogen receptor antagonist and partial agonist
SE: PV bleeding, amenorrhea, hot flushes, VTE, endometrial cancer
Raloxifene
MOA - pure oestrogen receptor antagonist (v endo Ca)
Anastrozole
MOA - aromatase inhibitor, v peripheral synthesis of oes
SE: osteoporosis, hot flushes, insomnia
Fibroadenoma
Common benign tumours of stromal/ epithelial duct tissue, hormone responsive
= 20-40yrs, mobile firm smooth lump
-> excise >3cm, often regress after menopause
Fibrocystic breast changes: lumpiness, fluctuates with cycle
Fat Necrosis
Local degeneration and scarring of fat tissue
Causes - trauma, radiotherapy, surgery
= painless, firm, irregular lump, fixed, dimpling, nipple inversion, may grow initially
Galactocele
Occlusion of a lactiferous duct, recently stopped BF
= firm, mobile, painless lump, ^beneath areola
Phyllodes
Rare tumour of the stroma, 25% malignant
= 40-50yrs, large, fast-growing
Breast Abscess
Collection of pus, usually caused by bacteria infection, related or unrelated to BF
RF - smoking, lactating
= red hot, tender, swelling
-> referral to on call surgery
Breast Cancer: RF
Female
BRCA1/2 (^ovarian)
^Oes - earlier menarche, late menopause, nulliparous, no BF
1st degree premenopausal relative
COCP/ combined HRT
Obesity
Smoking
p53 mutations
Breast cancer: Imaging
US more useful <30yrs
Mammograms better in older women
Chronic Lymphoedema
Impaired lymphatic drainage of an area, swelling
RF - axillary node clearance
Breast Cancer: Follow Up
Yearly mammograms for 5 years
Subtypes of Breast cancer
Invasive ductal carcinoma (no special type): 80%
Invasive lobular: 10%, may not be visible on mammogram
Ductal carcinoma in situ
Lobular carcinoma in situ: ^pre-menopausal, can’t see on mammogram
Inflammatory: presents like mastitis/ abscess, worst prog
Breast Cancer: Management
Mastectomy:
Multifocal
Central
Large lesion in small breast
DCIS >4cm
Choice
Wide Local Excision:
Solitary
Peripheral
Small lesion in large breast
DCIS <4cm
Radiotherapy after wide local excision or T3/4 mastectomy
Chemo neoadjuvant or if axillary nodes
Positive for hormone receptors -> tamoxifen, anastrozole
Biological therapy if HER2 positive -> trastuzumab
Cyclical Mastalgia
Common cause of breast pain in young F
= varying intensity with phase of cycle
-> supportive bra, PO/ top analgesia, consider hormonal agents after 3m (bromocriptine)
Non-cyclical more likely to be meds, infection, pregnancy or idiopathic
