Breast Flashcards
Breast: Cancer, cancer screening
Breast Lumps
Clinical Features: Smooth margins
First Investigation:
1. PE.
2. US (<35yo)
3. Mammography (>35yo)
Best Investigations:
1. FNAC
2. Core Biopsy
Management:
1. Observation.
2. Excision
Fibroadenoma
Clinical Features: Mobile, non-tender
First Investigation: US
Best Investigations:
1. FNAC.
2. Core Biopsy
Management: Reassure/Review in 3 months
Breast cysts
Clinical Features: Smooth, mobile, painful (sometimes)
First Investigation:
1. PE.
2. US (<35yo)
Mammography (>35yo)
Best Investigations:
1. FNAC.
2. Core Biopsy
Management:
1. Aspiration under US.
2. Excisional biopsy if the fluid has blood
Clinical Features:
First Investigation:
Best Investigations:
Management:
Fibrocystic disease
Clinical Features:
- 1 or > lumps <1cms
- watery/bloody discharge
First Investigation:
1. PE.
2. US (<35yo)
Mammography (>35yo)
Best Investigations:
>1cm: FNAC/Biopsy
Management:
1. Primrose oil, Vitamin B1, B6, B12
2. NSAIDS
3. Danazol/Tam
Fat Necrosis
Clinical Features: Previous trauma
First Investigation:
1. PE
2. US (<35yo)
Mammography (>35yo)
Best Investigations: FNAC
Management:
1. Observation
2. Excision
Intraductal Papilloma
Clinical Features:
1. Watery/Bloody discharge
2. Just 1 duct compromised
First Investigation:
1. PE.
2. US (<35yo)
Mammography (>35yo)
Best Investigations:
1. FNAC
2. Core Biopsy
3. Breast Ductography (specific)
Management: Surgery
Mammary Duct Ectasia
Clinical Features:
- Discharge: Sticky, toothpaste-like green
- Multiple points
First Investigation: Mammography
Best Investigations: Ductal lavage (Cytology)
Management: Excisional biopsy
Phyllodes Tumour
Clinical Features: Mobile mass that grows rapidly
First Investigation: Mammography
Best Investigations: US with core biopsy
Management:
Benign: Wide local excision
Malignant: Simple total mastectomy w/wo axillary node dissection
Breast Cancer
Management of px with breast cancer spread to one area of bone
- Radiotherapy
Management of px with breast cancer spread to several places in bones
- anticancer therapy with hormonal treatment
- chemotherapy
Investigation of choice for breast symptoms under the age of 35
US
Investigation of choice for breast symptoms over the age of 35
US as well as mammography
Protective factors of breast cancer in pre-menopausal women
- Obesity
Increased risk of Breast Cancer is in pre-menopausal women
- Avoiding breastfeeding
- Smoking
- Family history of breast cancer
- Decreased fruits and vegetables in diet
Breast cancer screening age group
- 50-74 (mammograms every two years)
- Woman 40 years of age specifically asking due to family history of risk BC
Features of Paget’s disease
- eczematous-looking
- dry scabbing nipple rash
- nipple ulceration
- nipple skin thickening
- dilated duct of the breast
Paget’s disease differential dx
- Ductal carcinoma in situ
Paget’s disease management
- lumpectomy (breast conserving surgery)
- partial mastectomy or wide local incision
- Total mastectomy only if indication of disease is severe
Breast cancer prognosis
- 2nd most common cancer to cause death in women (after lung cancer)
- 40% of women with recurrent or metastatic breast cancer survive at
> 5 years - survival for patients with metastatic (stage IV) breast cancer is 18 to 24 months
Px in high risk of breast cancer (Jewish, bilateral breast cancer in family, below 50 y/o) management
-Advise referral to a cancer specialist or family cancer clinic for risk assessment,
possible genetic testing and management plan.
-Ongoing surveillance strategies may include regular clinical breast examination, and annual breast imaging with mammography, MRI or ultrasound.
BRCA gene testing would be required after thorough assessment at family cancer
clinic in the area.
NOTE: all of these have to be done together
Breast disease caused by Vitamin A deficiency
Periductal mastitis
Periductal mastitis causes
- Smoking
- Vitamin A deficiency
Periductal mastitis features
- separate entity from duct ectasia
- affects young women
- dilated ducts
- sticky toothpaste-like
discharge
Treatment of breast cancer and ovarian cancer in postmenopausal women
Aromatase inhibitor (Arimidex)
Side effects of aromatase inhibitors
- symptoms of menopause (hot flashes, night sweats, and vaginal dryness)
- muscle and joint pain
- raised cholesterol
– Deep vein thrombosis (less than tamoxifen).
– Stroke (less than tamoxifen).
– Endometrial cancer (less than tamoxifen).
– Osteoporosis (more than tamoxifen)
Referral to breast surgeon indications
– Inflammatory breast conditions that are not resolving after two weeks of antibiotics treatment.
– Eczematoid changes of the nipple-areolar skin which persists longer than two weeks and does not respond to topical treatment.
– Spontaneous unilateral bloody or serous discharge from a single duct in women over 60 years of age.
– Bloody aspirate from a cyst in breast
– A woman with a positive triple test with any one of the three components
Triple test refers to
– Medical history and clinical breast examination.
– Imaging such as mammography and or breast ultrasound.
– Non-excisional biopsy-Core biopsy and or Fine needle biopsy
NOTE: If the triple test is negative, there is no need to refer the patient to the
breast surgeon
Causes of galactorrhoea
Physiologic or pathologic
Hormonal imbalance
- hyperprolactinemia
- hypothyroidism
Drugs
- OCP
- Phenothiazines
- antihypertensives
- tranquilisers
Chest trauma
Physiological nipple discharge
Serous bilateral discharge usually cause by stimulation of the nipple
Drugs
- oestrogen
- tranquilisers
Pathological nipple discharge
Unilateral spontaneous discharge can be bloody, grey-green or serous,
Breast lesions
- duct ectasia (discharge in many duct)
- papilloma (discharge in 1 duct)
- fibrocystic disease
Cancer
Approach to lumps
- physical examination
- imaging (FNAC, US, mammography depending on age)
- if indicated, biopsy and histological
studies
Malignant lesion clinical findings
- stony-hard consistency of the lesion - irregular borders
- being non-tender
- immobility
- and skin changes (dimpling, oedema). Ulceration of the skin is seen in advanced disease.
Lymphadenopathy but it could be absent in early disease
Malignant lesion findings on US
- Hypoechogenicity
- Irregular and ill-defined borders
- Spiculated margins
- Being taller than broader
- Posterior acoustic shadowing
- Microcalcifications
Fibroadenoma features
- Most common benign breast lump
- 20-30 years
- Well defined, round with even surface,
regular margins, rubbery or soft in
consistency, freely mobile, non-tender - Does not increase the risk of cancer
Fibroadenoma management
Depends on patient’s preference
- Can be safely left behind with
reassurance and periodic review.
- Surgery – excision done usually under
GA if patient wants.
Vitmain D deficiency can cause what type/s of cancer?
colon
prostate
breast (Ductal carcinoma in situ)
H/o Non proliferative breast lesions in a female (Fibrocystic diseases)
No risk of Ca breast
