Breast Flashcards
In the assessment of breast lumps, what is the acronym and what factors are in each domain?
She Cuts The Fish
S: size, site, skin, single
C: Colour, consistency, contour, compressibility
T: Trans-illuminable, tenderness, temperature
F: fixation (tethering), fluctuance
What is a fibroadenoma?
What demographic of women does it occur in?
- Benign neoplasm of a lobule- arising from stroma (fibre) and glandular (adenoma) epithelium
- young women of child-bearing age, 20s-30s. Most common type of benign breast lump
What is the first line investigation for all benign breast lumps?
What is second line investigation for Fibroadenoma/ breast cyst?
USS <40> mammography
- Fibroadenoma: fine needle aspiration
- Breast cyst: fine needle aspiration
What is the SCTF for fibroadenoma?
S: single, 1-5cm
C: well demarcated, firm consistency, smooth
T: painless
F: mobile, “breast mouse”
What is the SCTF for fibrocystic/ fibroadenosis?
S: Single or multiple “lumpy”, unilateral or bilateral
C: well demarcated, clear nipple discharge sometimes
T: usually painless/ sometimes painful, transilluminable
F: Fluctuant, mobile
What is the SCTF for duct ectasia?
S: sub-areolar mass, nipple inversion
C: Firm, thick yellow-green discharge
T: Tender
F: Fixed
When does breast fat necrosis usually occur?
How does it present?
- Secondary to trauma
- Painful, irregular hard lump with overlying bruising/ redness of skin
What is intraductal papilloma?
What demographic of women?
How does it present?
- Benign neoplasm growing within ducts
- Peri-post menopausal women
- Subareolar mass (usually small), bloody or clear discharge
Give the aetiology of mastitis. What can it lead to if untreated?
Give 2 at risk women of mastitis.
Which organism is the most common cause?
- breast inflammation caused by milk stasis/ over production
- if untreated can rarely lead to abscess
Breast-feeding, smoker >30
Staphylococcus aureus- can enter through cracked skin, e.g. nipple
What is the SCTF of mastitis?
S: general swelling, inflamed skin, nipple may be cracked
C: redness, firm
T: tender and uncomfortable, warm to touch
F: Flu like symptoms: fever, aches, chills, generally unwell
Non-lactational presents with history of previous infections, less pronounced systemic upset.
Give 3 management steps of mastitis
- If lactational, encourage breastfeeding
- analgesia
- Antibiotics sometimes required
Give 4 steps in management of breast abscess following mastitis.
- IV or oral Abx
- US guided FNA
- FBC+ blood cultures if systemic infection
- Surgical incision + drainage
Give 2 complications of breast abscess
- Mammary fistula
- Rarely overlying skin may undergo necrosis
Untreated may discharge onto skin surface. Non-lactational breast abscesses tend to re-occur
Breast cancer is the most common cancer in the UK. 1 in 7 females. What is the most common type of breast cancer?
-Invasive ductal carcinoma
What is the difference between staging and grading?
- Staging- analyses the spread: TNM staging
- Grading: analyses the differentiation: Nottingham grading system .
Give 1 non-invasive and 3 invasive breast cancers
non invasive: DCIS
Invasive: Infiltrative ductal carcinoma, infiltrative lobular carcinoma, Paget’s disease of the breast.
Give 8 risk factors for developing breast cancer.
- Oestrogen exposure:- early menarche, late menopause, HRT/OCP
- Nulliparity: not having any children
- Previous radiation to the chest
- Familial breast cancer- 5% of cases: BRCA1/2: harmful mutation gives 60-80% chance lifetime risk of Bca. Mutation also has associations with ovarian and pancreatic cancers.
- Age, Obesity, EtOH consumption, Fatty diet
Give the presenting SCTF of breast cancer.
S: increased size, lump, skin changes
C: hard lump, irregular margins, redness, non-compressible
T: Generally painless, inflammatory breast Ca: painful, warm
F: tethered to underlying tissue, not free to move.
Symptoms of metastases: bone pain, SOB, rarely neuro
Give 6 skin changes associated with breast cancer
- Peau d’orange
- Armpit skin thickening
- Nipple discharge
- Nipple inversion
- Crust- Paget’s
skin dimpling
What is the investigation structure for breast cancer?
Triple assessment
- Clinical examination
- Imaging: USS<35>mammogram
- Tissue diagnosis: FNA, core biopsy
In staging a breast cancer, where are the 3 likely metastasis locations? What investigations are necessary for them? (4)
Liver, lungs, bone
- Liver USS
- CXR
- CT brain/ chest
- Bone scan
Bloods: FBC, U&E, calcium, bone profile, LFTs, ESR
Management of breast cancer depends on the stage and grade. Give two types of medication used and an example of each.
- ER antagonists: tamoxifen
- Aromatase inhibitors: letrozole
How does the likelihood of a lateral neck lump being malignant change with age?
- Children, >75% lateral neck lumps are benign
- Adults, >75% lateral neck lumps are malignant.
What are the differentials for the following presentations for a midline neck lump:
- Deep lump (1)
- Superficial (4)
- Moves on swallowing(1)
- Moves on tongue protrusion (1)
- Deep: thyroid
- Superficial: lipoma, epidermal cyst, dermoid cyst, abscess
- Moves on swallowing: thyroid gland
- Moves on tongue protrusion: thyroglossal cyst
