Breast

Question 1

2 week wait criteria for breast cancer

Answer 1

• >30y with unexplained breast lump
• >50y with change in 1 nipple- discharge, retraction, other concern
• ? Suggestive skin changes
• ? 30y with unexplained lump in axilla

Question 2

Key features of Fibroadenosis (fibrocystic change)

Answer 2

• Most common benign breast lump
• Women 20-50y. Due to hormonal changes with cycle.
• Sx:
  
  • Pain
  • Lumpiness in upper outer quadrant
• Ix: Triple assessment
• Tx: ?Excision

Question 3

Key features of Fibroadenoma

Answer 3

• Usually <30y. Cause= hormonal.
• Sx:
  
  • Firm
  • Non-tender
  • ++ Mobile (breast mouse)
• Ix: ?Triple assessment
• Tx: Refer to breast surgeon. ?excision if >40y and suspicious

Question 4

Key features of breast fat necrosis

Answer 4

• Trauma –> fibrosis + calcification –> firm
• DDx of breast cancer
• Tx: Self resolving

Question 5

Key features of breast seroma

Answer 5

• = Collection of serous fluid. Common after breast surgery.
• Sx- non-tender, fluctuant, discharge fluid
• Tx- drainage

Question 6

Key features of breast abscess

Answer 6

• RF- Breast feeding, DM, smoking, steroids, trauma
• Sx-
  
  • Single red/hot/tender lump
  • Fluctuant
  • Discharge
  • Fever
• Tx- ABx, drainage

Question 7

Key features of a breast cyst

Answer 7

• 30-60y. Perimenopausal.
• Sx- smooth, firm, lump
• Ix- Image to exclude cancer
• Tx- leave/ drain

Question 8

Breast clinic triple assessment

Answer 8

1. Clinical exam
2. Imaging- USS in <35y, mammogram in >35y
3. Sampling- Solid biopsy/FNA

Question 9

Breast cancer risk factors

Answer 9

• Age
• FHx (BRCA)
• Oestrogen exposure- OCP/HRT, nulliparity, early menarche, late menopause
• PMH
• Obesity
• Alcohol

Question 10

Breast cancer red flags

Answer 10

• Fixed
• Hard
• Enlarged
• Skin changes/ tethering
• Lymphadenopathy
• Peau d’orange
• Paget’s (eczema)
• Retracted nipple
• Red/ hot
• Bloody discharge

Question 11

Who recieves breast screening in UK and what does it involve?

Answer 11

• All women 50-70y
• Mammogram every 3 years
• Separate screening programme if high risk/ FHx of BRCA. Screening <50y

Question 12

Where does breast cancer metastacise to?

Answer 12

• Blood –> lung, bone, liver, brain
• Lymph –> LNs

Question 13

What investigations might you do for ?breast cancer

Answer 13

• Bedside- exam
• Bloods- LFTs, Ca2+, Ca15.3
• Imaging- Mammography/ USS, USS liver/ axilla, CT, bone scan, CXR
• Biopsy/ FNA

Question 14

Staging of breast cancer

Answer 14

1. Breast, mobile
2. • axillary LNs
3. Fixed to muscle, LNs, skin involvement
4. Fixed to chest wall. Mets

Question 15

Treatment of breast cancer

Answer 15

• Conservative- Symptomatic control
• Medical- chemotherapy, radiotherapy, hormonal therapy, monoclonal Ab
• Surgical- breast/LNs. Lumpectomy/ mastectomy. Consider in stage 1/2.
• Oestrogen receptor positive –> tamoxifen
• HER2 receptor positive –> herceptin

Question 16

Nipple discharge DDx

Answer 16

• Duct ectasia- perimenopausal. green discharge.
• Papilloma- lump in milk duct. Blood stained discharge.