Breast Flashcards
How do you describe a breast lump?
- Location
- Size
- Shape
- Consistency
- Margins
- Mobile or fixed
- Tenderness
- Skin colour
- Nipple discharge
What is involved in triple assessment of a breast lump?
- Hx and ex
- Imaging - mammogram/USS
- Histology - fine needle aspiration/core biopsy
What clinical features suggest breast cancer?
- 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)
NICE recommend a 2ww referral for suspected breast cancer for…
- Women >30 with unexplained breast lumps
- Women >50 with unilateral nipple changes
NICE recommend considered a 2ww referral for breast cancer for…
- Women >30 with an unexplained lump in the axilla
- Skin changes suggestive of breast cancer
NICE suggest considering non-urgent referral for breast cancer for…
- Women <30 with unexplained breast lumps
What are side effects of tamoxifen?
- Increased risk of endometrial cancer
- Increased risk of VTE
- Menopausal symptoms
What is the most common type of biological therapy used in breast cancer? When is it indicated? What is a contraindication?
- Trastuzumab (Herceptin)
- Tumours that are HER2 positive
- History of heart disorders
When is chemotherapy used for breast cancer?
- 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
When is radiotherapy used for breast cancer?
- 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
What are breast lump differentials?
- Breast cancer
- Fibroadenoma
- Breast cyst
- Fat necrosis
- Lipoma
- Galactocele
What are the most common causes of breast lumps?
Breast cysts
How do breast cysts present?
- Smooth
- Well-circumscribed
- Mobile
- Possible fluctuant
What is fibroadenoma?
Benign tumours of the stromal/epithelial breast duct tissue
How does fibroadenoma present?
- Firm
- Smooth
- Well-circumscribed
- Mobile
- Painless
What is the management of fibroadenoma?
- No management requires - over 2yrs 30% will get smaller
- If >3cm surgical excision
What are lipomas?
- Benign tumours of adipose tissue
- Can occur almost anywhere on the body
How do breast lipomas present?
- Soft
- Mobile
- Painless
- Do not cause skin changes
What is duct ectasia?
Dilation and shortening of the terminal breast ducts within 3cm of the nipple
How does duct ectasia present?
- Nipple retraction
- Cream nipple discharge (occasionally)
What is mastitis?
Inflammation of the breast tissue
How does mastitis present?
- Painful, tender, red hot breast
- Fever, general malaise
What is the management of mastitis?
- Continue breast feeding
- Analgesia
- Warm compresses
When is treatment indicated for mastitis? What is the treatment?
- If systemically unwell/nipple fissure present/symptoms don’t improve after 12-24 hrs
- Oral flucloxacillin for 10-14 days
- Continue breastfeeding/expressing
What is a complication of mastitis?
Development into breast abscess
What is the inheritance of BRCA?
AD
