Breast

Question 1

How do you describe a breast lump?

Answer 1

1. Location
2. Size
3. Shape
4. Consistency
5. Margins
6. Mobile or fixed
7. Tenderness
8. Skin colour
9. Nipple discharge

Question 2

What is involved in triple assessment of a breast lump?

Answer 2

• Hx and ex
• Imaging - mammogram/USS
• Histology - fine needle aspiration/core biopsy

Question 3

What clinical features suggest breast cancer?

Answer 3

• Lumps that are hard, irregular, painless, fixed in place
• Lumps tethered to the skin or chest wall
• Nipple retraction
• Skin dimpling/oedema (peau d’orange)

Question 4

NICE recommend a 2ww referral for suspected breast cancer for…

Answer 4

• Women >30 with unexplained breast lumps
• Women >50 with unilateral nipple changes

Question 5

NICE recommend considered a 2ww referral for breast cancer for…

Answer 5

• Women >30 with an unexplained lump in the axilla
• Skin changes suggestive of breast cancer

Question 6

NICE suggest considering non-urgent referral for breast cancer for…

Answer 6

• Women <30 with unexplained breast lumps

Question 7

What are side effects of tamoxifen?

Answer 7

• Increased risk of endometrial cancer
• Increased risk of VTE
• Menopausal symptoms

Question 8

What is the most common type of biological therapy used in breast cancer? When is it indicated? What is a contraindication?

Answer 8

• Trastuzumab (Herceptin)
• Tumours that are HER2 positive
• History of heart disorders

Question 9

When is chemotherapy used for breast cancer?

Answer 9

• Prior to surgery to downstage a primary lesion
• After surgery depending on the stage of the tumour e.g. if there is axillary node disease

Question 10

When is radiotherapy used for breast cancer?

Answer 10

• Women who have had a wide-local excision (reduces risk of recurrence by 2/3rds)
• Women who have had a mastectomy with T3-4 tumours/with 4 or more positive axillary nodes

Question 11

What are breast lump differentials?

Answer 11

• Breast cancer
• Fibroadenoma
• Breast cyst
• Fat necrosis
• Lipoma
• Galactocele

Question 12

What are the most common causes of breast lumps?

Answer 12

Breast cysts

Question 13

How do breast cysts present?

Answer 13

• Smooth
• Well-circumscribed
• Mobile
• Possible fluctuant

Question 14

What is fibroadenoma?

Answer 14

Benign tumours of the stromal/epithelial breast duct tissue

Question 15

How does fibroadenoma present?

Answer 15

• Firm
• Smooth
• Well-circumscribed
• Mobile
• Painless

Question 16

What is the management of fibroadenoma?

Answer 16

• No management requires - over 2yrs 30% will get smaller
• If >3cm surgical excision

Question 17

What are lipomas?

Answer 17

• Benign tumours of adipose tissue
• Can occur almost anywhere on the body

Question 18

How do breast lipomas present?

Answer 18

• Soft
• Mobile
• Painless
• Do not cause skin changes

Question 19

What is duct ectasia?

Answer 19

Dilation and shortening of the terminal breast ducts within 3cm of the nipple

Question 20

How does duct ectasia present?

Answer 20

• Nipple retraction
• Cream nipple discharge (occasionally)

Question 21

What is mastitis?

Answer 21

Inflammation of the breast tissue

Question 22

How does mastitis present?

Answer 22

• Painful, tender, red hot breast
• Fever, general malaise

Question 23

What is the management of mastitis?

Answer 23

• Continue breast feeding
• Analgesia
• Warm compresses

Question 24

When is treatment indicated for mastitis? What is the treatment?

Answer 24

• If systemically unwell/nipple fissure present/symptoms don’t improve after 12-24 hrs
• Oral flucloxacillin for 10-14 days
• Continue breastfeeding/expressing

Question 25

What is a complication of mastitis?

Answer 25

Development into breast abscess

Question 26

What is the inheritance of BRCA?

Answer 26

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