breast Flashcards
What is pagets disease of the breast?
rare condition of the nipple which is associated with underlying cancer.
How does pagets present?
Features commonly affect the nipple first before spreading to the areola and the rest of the breast.
- Eczema-like rash on the skin of the nipple and areola. This is may be itchy, red, crusty and inflamed
- Nipple discharge which may be bloody
- Burning sensation, increased sensitivity or pain
- Nipple changes such as nipple retraction or inversion
- In some cases there may be a palpable breast lump
- There may be a skin ulcer which does not heal
How does ductal ectasia present?
- Redness around nipple
- Nipple discharge
- breast lump
How does a fibroadenoma present?
smooth well demarcated lump which is highly mobile and painless
What is the most common cause of mastitis?
Staph aureus
When is breast cancer screening?
It involves a 3 yearly mammogram (x-ray) in the caudal-cranial (CC) and mediolateral oblique (MLO) views for all women aged 50-70. Women over the age of 70 are able to self-refer for screening every 3 years if they wish.
What the most common form of breast cancer?
Ductal carcinoma
What drugs cause gynaecomastia
spironolactone, 5 alpha reductase
When is an urgent referral made?
They are ≥30 with an unexplained breast mass (regardless of whether there is pain present or not)
They are ≥50 or older presenting with nipple discharge, retraction or other concerning symptoms.
Treatment of oestrogen receptor positive vs HER2 receptor positive breast cancer?
Oestrogen: letrozole + tamoxifen (pre/peri menopausal) + Anastrozole (post-menopausal)
HER2: Trastizumab
What is fat necrosis?
Can vary from a firm, round lump to a hard, irregular lump
Usually found following trauma to the breast
Overlying skin inflammation/bruising
What presents as a star shaped pattern of scarring on mammogram?
Radial scar
What are the benign breast conditions?
Fibroadenoma: highly mobile, encapsulated breast masses that arise from the breast lobule stroma. Common in younger women and may be described as a “breast mouse” due to its highly mobile and smooth appearance.
Breast cysts are common in women from age 35 years to menopause. Overgrowth of glandular and connective tissue in fibrocystic disease blocks breast ducts leading to filling of the lobules with fluid and distension.
Mastitis is an infection of the breast, commonly caused by bacteria entering the duct through a break in the nipple of the skin. Associations include the puerperal period and smoking. This presents with redness of the breast, mastalgia, malaise and fever.
Intraductal papilloma is a benign papillary tumour which commonly presents with bloody discharge from the nipple. There is usually no palpable mass.
What are the benign breast conditions? (continued)
Radial scar is a benign sclerosing breast lesion which presents as a stellate pattern of central scarring surrounded by proliferating glandular tissue on mammogram.
Fat necrosis is an inflammatory reaction to adipose tissue damage. It may present with a painless breast mass or skin thickening or may be seen on routine mammography. Common causes include physical trauma to the breast, radiotherapy and breast surgery.
Fibrocystic breast disease or fibroadenosis is inflammation, fibrosis, cyst formation or adenosis of the breast which is thought to be caused by an exaggerated response to the body’s hormones.
Mammary duct ectasia is a palpable, peri-areolar breast mass caused by inflammation and dilation of the large breast ducts. It commonly presents with thick, white nipple discharge. It may mimic the appearance of cancer on mammography.
Complication of axillary lymph node clearance?
Lymphedema
