Breast

Question 1

Red flags for gynaecomastia

Answer 1

Testicular mass

Suspicion of breast ca: rapidly enlarging, > 5cm, hard or irregular breast tissue

Question 2

Ix for gynaecomastia

Answer 2

May not need if obvious cause/ physiological

Bloods: U&Es, LFTs, TFTs, LH/FSH, hCG, oestradiol, testosterone, prolactin

Karyotype

US: testes, breast - FNA/ biopsy
CXR

Question 3

Breast screening

Answer 3

Age 50-70 every 3 years

Above 70 every 3-yearly on request

Question 4

Mx mastalgia

Answer 4

NSAIDs - evening primrose oil - reduce caffeine - danzol - bromocriptine

Question 5

If non-cyclical mastalgia, what could be cause?

Answer 5

Tietze’s syndrome (costochondritis)

Question 6

Who is affected by periductal mastitis?

Answer 6

Smokers, caused by anaerobes

Abscess may form, that can discharge spontaneously to form fistula discharging to areolar margin

Question 7

Mx periductal mastitis

Answer 7

abx

may need total duct excision and fistulectomy for recurrent discharge

Question 8

Green, black or cream d/c from nips usually caused by what?

Answer 8

Duct ectasia
(shortening and dilatation of ducts)
Reassurance or duct excision if copious

Question 9

What sort of nipple d/c needs investigating?

Answer 9

Bloodstained from single duct

?duct ectasia, ?ductal CIS

Question 10

Differential for nipple eczema

Answer 10

Paget’s

Question 11

Breast mouse

Answer 11

Fibroadenoma

Question 12

Benign breast lump in older women, similar to breast lump

Answer 12

Phyllode’s tumour

has potential to develop into sarcoma

Question 13

Examples of cystic lummps

Answer 13

Cyst!

Galactocoele

Question 14

Breast trauma lump

Answer 14

Fat necrosis (looks craggy)

Question 15

how many women will get breast ca?

Answer 15

1 in 10

Question 16

Risk factors for breast ca

Answer 16

BRCA1 and BRCA2 (account for 5% cases)
first-degree premenopausal relative with breast ca
early menarche
late menopause
nulliparity or late pregnancy
prolonged use (5 years+ HRT)
benign breast pathology

Question 17

how many cancers not seen on mammogram?

Answer 17

10%

Question 18

what are the prognostic factors for breast ca?

Answer 18

tumour size, grade, axillary node status

Question 19

Definition of DCIS. How many convert to invasive ca?

Answer 19

Pre-invasive ca - has not invaded BM

in 10 years 50% will have become invasive

Question 20

Commonest type of breast ca

Answer 20

Invasive ductal carcinoma

Question 21

What breast ca did you think you had?

Answer 21

Invasive lobular carcinoma

Question 22

Where does breast ca metastasise to?

Answer 22

lymph nodes, liver, lungs, bones, and brain