Breast Flashcards
From what does a breast abscess arise?
Severe mastitis
What organism is most common in breast infection?
Staph aureus
What usually causes mastitis?
Milk stasis during lactation
What would be the treatment of a breast abscess?
- Antibiotics e.g. flucloxacillin or erythromycin
- Incision and draining of abscess
- Needle aspiration of abscess every other day
Should lactating women with a breast abscess continue to breastfeed?
Yes
How common is fibrocystic disease amongst women of childbearing age?
50%
How does fibrocystic disease of the breast present?
- Lumpiness and tenderness
- itchy nipples
What kind of trend do the symptoms of fibrocystic disease follow?
Periodic trend of the menstrual cycle
Usually worse before period
What does the breast look and feel like on examination of fibrocystic disease?
- lumpy, cobblestone appearance
- smooth lumps with defined edges that are moveable
- most commonly in upper, outer sections of breast
What investigations would you do on someone presenting with fibrocystic disease (depending on their age)?
- Mammography for older patients
- Ultrasound for younger patients
What is thought to cause fibrocystic disease?
Hormone levels - oestrogen, progesterone, prolactin
These hormones cause breast cells to grow and multiply
Fluctuations of hormones over years cause small cysts and dense tissue
What is a ductal papilloma?
A benign growth that occurs in breast ducts with finger-like fronds that can block the duct
Which type of ductal papilloma is more common near menopause?
Central type - near nipple and solitary
Which type of ductal papilloma is more common in younger women
Peripheral type
Which type (central or peripheral) of ductal papilloma has higher risk of malignancy?
Peripheral type
What changes occur in the breast in ductal papilloma i.e. how does it present?
- Bloody nipple discharge
- Wart-like growth
What is the name for the removal of a breast duct?
Microdochectomy
What investigation do you do for ductal papilloma?
Galactogram = radiography of ducts after injection of an agent
Why is ultrasound scan used over mammography for ductal papilloma?
They are too small to be seen on mammography
What genes predisposes you to breast cancer?
BRCA1 and BRCA2
What chromosomes are the BRCA1 and BRCA2 genes found on?
BRCA1 = Chromosome 17 BRCA2 = Chromosome 13
What 2 types of breast carcinoma are there?
Ductal carcinoma = epithelial lining of ducts
Lobular carcinoma = epithelium of terminal ducts of lobules
What is Paget’s disease of the breast?
Infiltrating carcinoma of nipple epithelium
What growth factor receptor gene is commonly over-expressed in breast cancer?
HER2 growth factor receptor gene
Does the presence of HER2 mean it is a more/less aggressive disease?
More aggressive disease if HER2
Other than BRCA1 genes, family history and age, what are some risk factors for breast cancer?
- Nullparity
- First child after 30
- Early menarche or late menopause
- HRT
- Obesity and alcohol
All breast lumps must undergo ‘triple assessment’. What does this mean?
Clinical examination
Histology/cytology
Mammography/ultrasound
What lymph nodes are commonly affected in breast cancer?
Axillary nodes
What would the lump be like on examination in breast cancer?
Hard, painless lump with irregular margins
Fixed to skin/chest wall
What skin changes would you see on the breast in breast cancer?
Peau d’orange = oedema due to lymphatic invasion from tumour
Skin dimpling
What is the current screening programme for breast cancer?
All 50-70 year old women
Every 3 years
Mammography
What is the surgical treatment of breast cancer?
Either wide local excision or mastectomy +/- axillary node clearance
