breast Flashcards
breast abscess:
- condition which leads to it?
- who gets this condition?
- most common causative organism?
- other risk factors? 8
severe complication of mastitis (though may occur without mastitis)
10-33% of lactating women get mastitis
- though can have it when not lactating
normally staph aureus (or poss MRSA)
- poor infant attachment to breast
- reduced no or duration of feeds
- smoking
- nipple damage (piercing, eczema, infection, raynauds)
- immunosuppression
- shaving/plucking areolar hair
- foreign body (implants)
- poor hygiene
breast abscess:
- clinical presentation?
- investigations? 2
- history of recent mastitis
- fever or general malaise (may have gone if already on Abx for mastitis)
- painful, swollen lump in the breast
- w redness, heat + swelling of overlying skin
- ultrasound
- aspirate + culture fluid from abscess
breast abscess:
- non-pharm treatment? 1
- pharm treatment? 1
- surgical treatment? 1
continue breast feeding if possible (if not, continue expressing milk by hand/pump until able to again)
- Abx
- US-guided needle aspiration or surgical drainage
differential diagnosis for breast abscess:
- breast pain with lactation? 4
- breast pain without lactation? 6
- nipple pain? 4
breast pain w lactation:
- full/engorged breast
- blocked duct
- galactocele
- infection of mammary duct
breast pain without lactation:
- breast cancer
- fibroadenosis
- ruptured breast cyst
- duct ectasia*
- cellulitis
- necrotising fasciitis or fat necrosis of breast
nipple pain:
- poor infant attachment
- candida or bacterial infection of nipple
- blanching of the nipple
- raynaud’s of nipple
fibrocystic breast disease:
- prevalence?
- cause?
- risk factors? 2
aka fibrocystic breast condition (FBC)
30-60% of women (70-90% lifetime prevalence)
not fully understood, could be dt hormone levels as condition becomes rarer post-menopause
- age (30-50 highest risk)
- HRT may increase risk (contraceptive pills may decrease risk)
fibrocystic breast disease:
- clinical presentation?
- mobile/tethered?
- where on breast?
breast lump(s)
can cause discomfort (in a cyclical menstural pattern)
- intermittent/persistent breast aching or tenderness
- breast skin/nipples may be tender/itchy
- smooth (norm mobile) lumps w defined edges
- most often in upper, outer section of breast
fibrocystic breast disease:
- investigation? 1
- non-pharm treatment? 2
- pharm treatment? 1
possibly mammogram or MRI if really suspicious
- well-fitting, supportive bra (to reduce pain)
- hot or cold compress
- OTC pain killers
nb most don’t require invasive treatment
ductal papilloma:
- age affected?
- main symptom?
- other symptoms?
- women late childbearing/early menopausal age
- bloody or serous discharge from nipple
- may feel a small lump
- may have discomfort/pain
nb often too small to be palpated or felt
ductal papilloma:
- investigations?
- treatment?
- likelihood of getting cancer?
- tripple assessment (to exclude cancer)
partial excision is often performed (microdochectomy) - but argument that this may not be necessary/beneficial
- women with this are 1.5-2times more likely to develop breast cancer later
breast carcinoma
- risk factors? 13
- % of breast cancers that are found in men?
nb most related to increased unopposed oestrogen
- nulliparity (or 1st preg >30years old)
- NOT breastfeeding
- early menarche
- late menopause
- oestrogen containing contraceptives
- HRT
- increased age
- high BMI
- high alcohol intake
- lots of chest radiation
- FH
- BRCA 1 + 2 genes
- PMH of breast cancer
1% of breast cancers are found in men
nb 1 in 9 women will get breast cancer in their life
- a quarter are picked up by mammography screening
breast carcinoma:
- symptoms/signs? 4
- lump in breast (often tethered + poorly demarcated)
nb malignant lumps are often painless
- nipple changes (shape, nipple bleeding)
- skin changes (tethering, peau d’orange)
- enlarged axillary lymph nodes
breast carcinoma:
- investigations? 4
triple assessment (for all breast lumps!)
- clinical examination
- radiology (US if <35, mammography + US if >35)
- histology/cytology (norm from US guided core biopsy)
if found to be malignant, sentinel node biopsy
breast carcinoma:
- specific pharm treatment? 3
- surgical treatment?
- chemo/radiation treatment?
- tamoxifen (for oestrogen receptor +ve tumours)
- herceptin (for Her +ve tumours)
- aromatase inhibitors (eg anastrozole) reduce peripheral oestrogen synthesis, only used in post-menopausal women
depending on stage:
- wide local excision
- total mastectomy +/- breast reconstruction
- axillary node clearance (if sentinel node +ve)
adjunct chemo used in all but those with best prognosis
radiotherapy used in many
- can also radiate axilla if don’t want surgical clearance
nb tamoxifen increases risk of uterine cancer, warn patients!
