Breast Flashcards
How common is breast carcinoma?
20% of women affected
Very rare in males
What are the causes of breast carcinoma?
Genetic mutations in ductal or normal breast cells
What are the risk factors for breast carcinoma?
Smoking Early menstruation and late menopause Family history Hormone replacement therapy Obesity BRCA gene Oral Contraceptive Pill
What are the symptoms of breast carcinoma?
Hard breast lump
Indrawn nipple
Pain (rare)
What are the signs of breast carcinoma on examination?
Tethered lump Peau d'orange Puckered skin Inverted nipple (+/- bloody discharge) Axillary lymph nodes Paget's disease of the nipple (eczema on nipple/areolar) Ulceration
What are the possible differential diagnoses for breast carcinoma?
Fibrocystic changes (fibroadenima + cyst)
Abscess
Mastitis
What investigations are necessary to diagnose breast carcinoma?
Triple assessment
1) clinical examination
2) imaging (ultrasound/mammography)
3) Biopsy (FNA cytology/core/punch biopsy)
Staging
- CT/MRI
- CXR
- Bone Scan
Oestrogen receptor +ve
HER2 +ve = more aggressive, treat with herceptin
What are the treatments for breast carcinoma?
Drugs/Endocrine - Tamoxifen, Herceptin
Radiotherapy
Chemotherapy
Surgery
- lumpectomy
- mastectomy and reconstruction
- axillary clearance
- total ductal excision
What are fibrocystic changes?
Fibroadenoma - fibrous tissue, benign lump
Cysts - fluid filled sacs
How common are fibrocystic changes?
30-60% of women
50% of childbearing age
Accounts for 60% of all breast lumps in females
What are the causes of fibrocystic changes?
Monthly hormonal changes
What are the risk factors for fibrocystic changes?
Hormone therapy exacerbates
Oral Contraceptive Pill relieves symptoms
What are the symptoms of fibrocystic changes?
Swelling or thickening
Lumps
Cysts enlarge and become more painful during menstruation
What are the signs of fibrocystic changes?
Fibroadenoma = smooth, mobile lump, painless, multiple Cysts = mobile lump, +/- pain, multiple
What are the differential diagnoses of fibrocystic changes?
Dense, normal breast tissue
Carcinoma
What investigations are necessary to diagnose fibrocystic changes?
Triple Assessment
What are the treatments for fibrocystic changes?
100% benign = no treatment needed
Exclude carcinoma
Cysts aspirate if big
Surgery - excise a large fibroadenoma
What is a breast abscess?
Fluid filled sac in the breast
Who is affected by breast abscesses?
Breastfeeding women
What are the causes of breast abscess?
Unresolved infection of mammary duct
- associated with lactation ➡️ bacteria introduced through child’s mouth
What are the risk factors for breast abscess?
Nipple fissures, cracks + sores
Maternal age, previous history of mastitis, improper nursing technique
Smoking/obesity
What are the symptoms of a breast abscess?
Hot, painful swelling of breast segment
- unilateral, one quadrant = hot + painful to touch
What are the signs of breast abscess on examination?
Unilateral oedema Wedge shaped erythema Pus on aspiration Breast mass Axillary lymphadenopathy
What investigations are necessary to diagnose breast abscess?
Triple assessment
Culture aspirate
