Breast Flashcards
What is meant by mammary duct ectasia? [1]
How does this present? [3]
Dilatation in breast ducts
- There is inflammation in the ducts, leading to intermittent discharge from the nipple.
-. As the ducts shorten and dilate a degree of symmetrical slit like retraction occurs.
Presentation:
* Thick, green discharge
* Nipple retraction or inversion
* Tenderness or pain
**
Ectasia means dilation
Which population does mammary duct ectasia typically present in? [1]
What is another major risk factor? [1]
Perimenopausal women
Smoking is significant RF
How does mammary duct ectasia present on mammogram? [1]
Microcalcifications are a key finding to remember on a mammogram, although they are not specific to mammary duct ectasia.
How do you treat mammary duct ectasia? [1]
Mammary duct ectasia may resolve without any treatment. It is not associated with an increased risk of cancer.
Management depends on the individual patient:
Reassurance after excluding cancer may be all that is required
Symptomatic management of mastalgia (supportive bra and warm compresses)
Antibiotics if infection is suspected or present
Surgical excision of the affected duct (microdochectomy) may be required in problematic cases
Triple assessment of a breast lump is standard practice to exclude or diagnose cancer. This involves: [3]
Clinical features that may suggest breast cancer are: [4]
Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Histology (fine needle aspiration or core biopsy)
? cancer
* Lumps that are hard, irregular, painless or fixed in place
* Lumps may be tethered to the skin or the chest wall
* Nipple retraction
* Skin dimpling or oedema (peau d’orange)
The NICE guidelines (updated January 2021) recommend a two week wait referral for suspected breast cancer for [2]
- An unexplained breast lump in patients aged 30 or above
- Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
NB:
The NICE guidelines recommend also considering a two week wait referral for:
An unexplained lump in the axilla in patients aged 30 or above
Skin changes suggestive of breast cancer
Describe what is meant by firbocystic breast changes [2]
The connective tissues (stroma), ducts and lobules of the breast respond to the female sex hormones (oestrogen and progesterone), becoming fibrous (irregular and hard) and cystic (fluid-filled).
These changes fluctuate with the menstrual cycle.
Fibroadenoma - how / when do you treat? [1]
If >3cm surgical excision is usual, Phyllodes tumours should be widely excised (mastectomy if the lesion is large)
Management of fibrocystic breast changes is to exclude cancer and manage symptoms. Options to manage cyclical breast pain (mastalgia) include: [4]
- Wearing a supportive bra
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- Avoiding caffeine is commonly recommended
- Applying heat to the area
- Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance
The most common cause of breast lumps is? [1]
Breast cysts
How do breast cysts present on examination? [4]
Smooth, discreet lump
Mobile
Possibly fluctuant
How do you treat a breast cyst? [2]
- Cysts should be aspirated
- Those which are blood stained or persistently refill should be biopsied or excised
What is fat necrosis? [1]
What is fat necrosis caused by? [1]
Fat necrosis causes a benign lump formed by localised degeneration and scarring of fat tissue in the breast. It may be associated with an oil cyst, containing liquid fat
Fat necrosis is commonly triggered by localised trauma, radiotherapy or surgery, with an inflammatory reaction resulting in fibrosis and necrosis (death) of the fat tissue. It does not increase the risk of breast cancer.
On examination, fat necrosis can be:
[5]
On examination, fat necrosis can be:
- Painless
- Firm
- Irregular
- Fixed in local structures
- There may be skin dimpling or nipple inversion
How do you investigate ?fat necrosis of breast [1]
Imaging and core biopsy
- Ultrasound or mammogram can show a similar appearance to breast cancer. Histology (by fine needle aspiration or core biopsy) may be required to confirm the diagnosis and exclude breast cancer.
[] occur in women that are lactating (producing breast milk), often after stopping breastfeeding
Galactoceles occur in women that are lactating (producing breast milk), often after stopping breastfeeding
Describe what a galactocele is [1]
Where/how do they usually occur? [1]
They are breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk
They present with a firm, mobile, painless lump, usually beneath the areola.
Where does breast cancer met. to? [4]
Metastasis – 2B2L = brain, bones, lung, liver
Describe what is meant by a phyllodes tumour [1]
Phyllodes tumours are rare tumours of the connective tissue (stroma) of the breast, occurring most often between ages 40 and 50.
They are large and fast-growing. They can be benign (~50%), borderline (~25%) or malignant (~25%).
Malignant phyllodes tumours can metastasise.
How do you treat a phyllodes tumour? [1]
Treatment involves surgical removal of the tumour and the surrounding tissue (“wide excision”). They can reoccur after removal
.
.
Describe the difference between cyclical and non-cyclical breast pain
Cyclical breast pain:
- is more common and is related to hormonal fluctuations during the menstrual cycle.
- The pain typically occurs during the two weeks BEFORE menstruation (the luteal phase) and settles during the menstrual period.
- There may be other symptoms of premenstrual syndrome, such as low mood, bloating, fatigue or headaches.
Non-Cyclical Breast Pain:
- Non-cyclical breast pain is more common in women aged 40 – 50 years
- It is more likely to be localised than cyclical breast pain. Often no cause is found. However, it may be caused by: Medications (e.g., hormonal contraceptive medications); Infection (e.g., mastitis); Pregnancy
Diagnosis:
A [] can help diagnose cyclical breast pain.
The three main things to exclude when someone presents with breast pain are:
Diagnosis
A breast pain diary can help diagnose cyclical breast pain.
The three main things to exclude when someone presents with breast pain are:
* Cancer (perform a thorough history and examination)
* Infection (mastitis)
* Pregnancy (perform a pregnancy test)
Describe what is meant by an intraductal papilloma [1]
- An intraductal papilloma is a warty lesion that grows within one of the ducts in the breast.
- It is the result of the proliferation of epithelial cells.
- The typical presentation is with clear or blood-stained nipple discharge.
Describe the presentation of an intraductal papilloma [4]
Intraductal papillomas are often asymptomatic. They may be picked up incidentally on mammograms or ultrasound.
They may present with:
- Nipple discharge (clear or blood-stained)
- Tenderness or pain
- A palpable lump
Describe how you investigate an intraductal papilloma [2]
Patients require triple assessment with:
* Clinical assessment (history and examination)
* Imaging (ultrasound, mammography and MRI)
* Histology (usually by core biopsy or vacuum-assisted biopsy)
Microdochectomy
- Ductography may also be used. This involves injecting contrast into the abnormal duct and performing mammograms to visualise that duct. The papilloma will be seen as an area that does not fill with contrast (a “filling defect”).
Which is the most common type of breast cancer
Invasive ductal carcinoma.
Invasive lobular carcinoma
Ductal carcinoma-in-situ (DCIS)
Lobular carcinoma-in-situ (LCIS)
Which is the most common type of breast cancer
Invasive ductal carcinoma.
- This is the most common type of breast cancer. To complicate matters further this has recently been renamed ‘No Special Type (NST)’. In contrast, lobular carcinoma and other rarer types of breast cancer are classified as ‘Special Type’
Invasive lobular carcinoma
Ductal carcinoma-in-situ (DCIS)
Lobular carcinoma-in-situ (LCIS)
Describe the different types of surgery [2] for breast cancer and why they might be given to patients,
Give the reasons you would choose one / other [4]
Women either have a wide-local excision or a mastectomy:
- Around two-thirds of tumours can be removed with a wide-local excision.
Describe the treatment regime for breast abscesses [3]
