Breast Flashcards
What is assessed during inspection in a breast examination ?
Check for any masses, scars or asymmetry
Skin changes or ulceration
Nipple Discharge or inversion
Inspect axillae
What is assessed for in palpation in a breast exam ?
Examine each quadrant of breast including axillae tail
Press the breast against the chest wall
Palpate any lumps
Examine both axillae
Assess for lymphadenopathy
Palpate the spine for tenderness, abdomen for hepatomegaly
Percuss and auscultate the lungs
How would you complete a breast exam ?
Mammography and / or USS if necessary
Biopsy if necessary
What is galactorrhoea ?
Defined as copious bilateral multi-ductal milky discharge not associated with pregnancy or lactation.
What is the physiology of lactation ?
It is predominantly regulated by the hormone prolactin which is produced and secreted by the anterior pituitary gland.
Prolactin secretion is controlled by dopamine and released by the hypothalamus acting to inhibit prolactin.
What are some causes of galactorrhoea ?
Idiopathic
Pituitary adenoma
Drug induced - SSRI’s, anti-psychotics
Neurological
Hypothyroidism
Renal failure
What are some investigations for galactorrhoea and their results ?
Exclude pregnancy
Serum prolactin levels - raised
TFT’s - hypothyroidism
Renal tests
MRI head with contrast
What is the management of galactorrhoea ?
Treat underlying cause
Pituitary tumours - dopamine agonist ( Cabergoline and bromocriptine )
What is mastitis ?
Inflammation of the breast tissue both acute and chronic.
Most commonly caused by infection - staph aureus
What are the classes of mastitis ?
Lactational mastitis
Non-Lactational mastitis
What is a risk factor for non-Lactational mastitis ?
Tobacco smoking
What are some clinical features of mastitis ?
Tenderness
Swelling
Erythema
What is the management of mastitis ?
Simple analgesia and warm compress
For Lactational mastitis continue milk drainage
If symptoms dont improve after 12-24 hours start abx
What is a complication of mastitis and how is it treated ?
Breast abscess - needle aspiration
What is a breast cyst ?
Epithelial lined fluid filled cavities which form when lobules become distended due to blockage - usually in Perimenopause.
What are the clinical features of breast cysts ?
Singularly or with multiple lumps
Distinct smooth masses
Tender
What investigations are performed when suspecting breast cysts ?
Mammography - halo shape
Aspiration
What is the management of breast cysts ?
No management and resolve by themselves
What are some complications of breast cysts ?
Carcinoma
Fibroadenosis
What is mammoth duct ectasia ?
Dilation and shortening of the major lactiferous ducts
What are some clinical features of mammary duct ectasia ?
Coloured green / yellow nipple discharge
Palpable mass
Nipple retraction
What are some investigations for mammary duct ectasia ?
Mammography - dilated calcified ducts
Biopsy
What is the treatment of mammary duct ectasia ?
Manage conservatively
What is fat necrosis ?
Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules.
What are the clinical features of fat necrosis ?
Asymptomatic or presents as a lump
Solid irregular lump if chronic fibrotic changes
What are some investigations for fat necrosis ?
Positive traumatic history
Hyper echoic mass on USS
What is the management of fat necrosis ?
Self limiting
Analgesia
Reassurance
What are some types of benign breast lumps ?
Fibroadenoma
Adenoma
Papilloma
Lipoma
Phyllodes tumour
What is a Fibroadenoma ?
Common benign growth in the breast
Usually occurs in women of reproductive age
They are proliferations of stromal and epithelial tissue of the ductal lobules.
What is found of examination of Fibroadenomas ?
Highly mobile lesions that are well defined and rubbery
What is an adenoma of the breast ?
Benign glandular tumour
Nodular and mimic malignancy
What are some differences between being and malignant breast lumps ?
Benign - more mobile, smoother borders, single mass
Malignant - craggy, firm and fixed, may have multiple lumps
What are some investigations for benign lumps ?
Triple assessment - examine, imaging and histology
Reassurance and routine check up
What is gynaecomastia ?
A condition by which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity.
What is the pathophysiology of physiological gynaecomastia ?
Most commonly occurs in adolescence resulting from delayed testosterone surge relative to oestrogen in puberty.
What are some causes of pathological gynaecomastia ?
Lack of testosterone - Klinefelter’s syndrome, androgen insensitivity
Increased oestrogen - liver disease, hyperthyroidism and obesity
Medication - digoxin, Spironolactone
Idiopathic
What are some clinical features of gynaecomastia ?
Insidious onset
Rubbery or firm mass
Starts from under the nipple
What investigations should be performed when suspecting gynaecomastia ?
Tests are only necessary if the cause is unknown
U&E’s
LFTs
Hormone profile
What is given if gynaecomastia to relieve symptoms ?
Tamoxifen
What are the 2 types of breast carcinoma in situ ?
Ductal carcinoma in situ
Lobular carcinoma in situ
What is ductal carcinoma in situ ?
Malignancy of the ductal tissue of the breast that is contained within the basement membrane.
What is seen on mammography in someone with ductal carcinoma in situ ?
Suspicious microcalcifications
What is the management of ductal carcinoma in situ ?
Surgical excision - breast conserving surgery or mastectomy
What is lobular carcinoma in situ ?
Non-invasive lesion of the secretory lobules of the breast that is contained within the basement membrane.
When is lobular carcinoma in situ usually diagnosed ?
Incidental finding on biopsy
What is the management of lobular carcinoma in situ ?
Low grade - monitoring
If the patient has BRCA1 and BRCA2 genes - bilateral prophylactic mastectomy
What are the 2 common types of breast cancer ?
Invasive ductal carcinoma
Invasive lobular carcinoma
What are some risk factors for breast cancer ?
Female
Age
Family history - BRCA1 or BRCA2 gene
Early menarche, late menopause
Nullparity
Long term use of HRT
Obesity
Previous breast disease
Alcohol consumption
Smoking
What are some clinical features of breast cancer
Can be asymptomatic
Breast and axillary lump
Asymmetry or swelling
Abnormal nipple discharge
Nipple retraction
Skin changes
Mastalgia
What are some investigations for breast cancer ?
Triple assessment - examine, imaging and histology
Surgery, radiotherapy, chemotherapy, hormonal therapy
At what age are you invited to the breast cancer screening programme ?
50 -71 mammogram every 3 years
When is breast conserving treatment used ?
Localised operable disease with no evidence of metastatic disease
Focal smaller cancers
What is a mastectomy ?
Removal of all the tissue of the affected breast along with a significant portion of overlying skin.
When are hormonal treatment used in treating breast cancer ?
In malignant non-metastatic disease as an adjuvant after surgery
How does tamoxifen work ?
It acts through blockade of oestrogen receptors and therefore also has a role in prophylaxis of breast cancer
What are some complications of tamoxifen ?
Risk of VTE
Increases risk of uterine carcinoma
How does immunotherapy work ?
It is used in patients whose cancer express specific growth factor receptors
What is herceptin and what does it target ?
It is a monoclonal antibody that targets the human epidermal growth factor receptor ( HER-2 positive malignancies ).
