Breast Flashcards
Breast hx associated sx
Relationship to LMP + sx Pain Nipple - discharge: amount, colour, consistency - bleeding - inversion Skin changes FLAWS Back pain/ breathlessness Any other lumps/gland swelling
Breast hx RFs
FHx of breast/ovarian cancer PMHx of breast disease/malignancy DHx; OCP, HRT Age of menarche + menopause; date of LMP Previous pregnancies; number, age of 1st one, breastfeeding
What to assess when examining a breast lump?
S he C uts T he F ish
S => site, size, skin, single
C => colour, contour, consistency, compressibility
T => tenderness, temperature, transilluminable
F => fluctuance, fixity (tethering), free to move
Fibroadenoma summary card
Benign neoplasm of a lobule from stroma and globular epithelium
= single, well demarcated, firm consistency, smooth, often painless, mobile lump
= breast ‘mouse’ of young women of child-bearing age
= USS/mammography
= observe, surgical excision lumpectomy or cryoblation if needed
Breast cysts summary card
Fluid filled sacs in breast
= simple/multiple, unilateral/bilateral, well demarcated, clear nipple discharge sometimes, painless mainly, transilluminable, fluctuant, mobile
= occurs in peri-menopausal women (40-50s)
= USS/mammography + FNA
= observe, FNA to drain fluid if needed
Duct ectasia summary card
Dilation of milk ducts due to blockage/non-lactational mastitis
= sub-areolar mass, nipple inversion, form consistency, thick and yellow/green nipple discharge, tender, fixed
= occurs in smokers, peri-post menopausal women
= USS/mammography
= Reassure and discharge, surgical incision if needed
Fat necrosis summary card
Occurs at any age secondary to traume
= painful, irregular hard lump with overlying bruising/redness of skin
Intraductal papilloma summary card
Benign neoplasm growing within ducts of breast
= small subareolar mass with bloody/clear nipple discharge
= peri/post menopausal women
Mastitis summary card
Inflammation of breast due to milk-stasis/overproduction
= generalised swelling of skin, inflamed skin, cracked nipple, redness and firm, very tender and uncomfortable to touch, flu-like sx
= Staphylococcus aureus most common pathogen
= Mx: encourage breast-feeding, analgesia, Abx if required
What can mastitis lead to?
Abscess
= Ix + mx: surgical incision and drainage, FBC, blood cultures, US guided FNA, IV/oral Abx
= complications: mammary fistula, rarely overlying skin may undergo necrosis
Sx + signs of breast cancer
S
= increased size, lump, skin changes (dimpling, discharge, peu d’orange)
C
= hard lumps, irregular, redness, non-compressible
T
= generally painless, inflammatory breast
F
= tethered to underlying tissue, not free to move
Mets
= bone pain, breathlessness, neuro sx (rare)
Ix for breast cancer
- Triple assessment
1. clinical examination
2. imaging (<35: USS, >35 mammogram)
3. tissue diagnosis (FNA, core biopsy)
Bloods
- ESR, bone profile, LFTs, Ca2+, U&Es, FBC
Staging
- CXR, liver USS, CT brain/chest, bone scan
- mets to liver, bone, lungs common
Types of breast cancer
Non-invasive
- ductal carcinoma in situ
Invasive
- infiltrative ductal carcinoma (most common)
- infiltrative lobular carcinoma
- Paget’s disease of the breast
Mx of breast cancer
Radiotherapy
- reduce recurrence post-surgery
Monoclonal antibodies
Chemo
- neo-adjuvant/adjuvant
Meds
- ER antagonists (tamoxifen)
- aromatase inhibitors (letrozole)
Surgery
- total masectomy
- lumpectomy
- sentinel LN biopsy/axillary LN clearance
*treatment based on type, staging and grade of tumour
Neck lump ddx
Infection - lymphadenopathy, fever, fatigue = glandular fever, HIV Malignancy - lymphadenopathy, FLAWS, growing lump = thyroid cancer, salivary gland cancer Endocrine - goitre = hyper/hypothyroidism Derm = sebaceous cyst; blocked hair follicle = lipoma; benign tumour of fat tissue Vascular = carotid body aneurysm Congenital/developmental = bronchial cyst = thyroglossal cyst; persistent duct-embryonic structure
Midline lump ddx
Moves on tongue protrusion = thyroglossal cyst Moves on swallowing = thyroid gland Superficial = lipoma, epidermal cyst, dermoid cyst, abcess Deep = thyroid
Anatomy of anterior and posterior neck triangles
Anterior
= SCM, midline of neck, mandible
Posterior
= SCM, trapezius, clavicle
A 36-year-old woman presents to the urgent care centre with a small
tender mass under her left nipple. The area is tender to touch and she’d
noticed a small amount of yellow-green discharge from the nipple. She
mentions to you that she’s smoked since her early 20s.
What is the most likely diagnosis?
A – Breast cyst B – Lobular carcinoma C – Non-lactational mastitis D – Duct ectasia E – Breast abscess
D – Duct ectasia
A 22-year-old woman presents to the GP with a lump in her right breast.
She found the lump incidentally and has not experienced any symptoms.
On examination, the lump is located in the upper outer quadrant and is 2cm.
It feels firm, smooth and well demarcated and is mobile.
What is the most likely diagnosis?
A – Phyllodes tumour B – Fibroadenoma C – Breast cyst D – Ductal carcinoma in situ E – Mastitis
B – Fibroadenoma
A 32-year-old woman comes to the GP complaining of a painful left
breast. She gave birth a few weeks ago and has been breast-feeding every
few hours. On examination, the breast is tender, there is marked erythema
and her nipple is cracked. You do not suspect there are any abscesses
present.
Given the likely diagnosis, which of the following is NOT a recommended
treatment option?
A – Stopping breast feeding B – Antibiotics if symptoms are severe C – Analgesia D – Anti-fungals if nipple candidiasis suspected E – FNA to rule out an abscess
A – Stopping breast feeding
A 55-year-old is referred for an urgent mammogram after noticing a lump
in her right breast.
Which of these is NOT a recognised risk factor for breast cancer?
A – Increased age B – Use of the combined oral contraceptive pill C – Obesity D – Having more than 1 child E – Family history of ovarian cancer
D – Having more than 1 child
A 60-year-old woman presents to the GP after noticing some changes in
her right nipple. On examination, the nipple is erythematous and crusty with
some apparent scaliness of the skin.
What is the most likely diagnosis?
A – Eczema B – Paget’s disease of the breast C – Intraductal papilloma D – Ductal carcinoma E – Phyllodes tumour
B – Paget’s disease of the breast
A 56-year-old lady presents to the GP with a lump on her neck. She doesn’t
report any other symptoms, apart from being a bit more anxious and tired
than usual, and some infrequent diarrhoea. On examination, the lump is
2x3 cm and appears to be in the mid-line of the neck. The lump does not
move when the patient sticks out her tongue however does move when she
swallows.
What is the most likely diagnosis?
A – Thyroglossal cyst B – Goitre C – Thyroid nodule D – Lipoma E – Dermoid cyst
C – Thyroid nodule
A 60 year old obese woman presents to her GP with a
lesion on her breast. The lesion is red, crusted, around her
right nipple. The most likely diagnosis is
A. Breast cyst B. Breast abscess C. Paget’s disease of the breast D. Fibroadenoma E. Fibrocystic disease
C. Paget’s disease of the breast
22 year old woman presents to clinic with a single lump in
her right breast. Examination reveals a mobile, firm, smooth
and non-tender lump of 2cm in the lower outer quadrant that
is not attached to the overlying skin. No axillary lymph nodes
are palpable. The most likely diagnosis is:
A. Acute mastits B. Breast abscess C. Breast cyst D. Fibroadenoma E. Periductal mastitis
D. Fibroadenoma
A 21 year old woman presents to her GP with pain in her
right breast. She has just given birth to her first child. On
examination, right breast appears swollen, red and there is
tenderness on palpation. You do not suspect there are any
abscesses present. The most appropriate management
plan would be:
A. Antibiotics
B. Refer to surgeon for incision and drainage
C. Refer to breast feeding support group and prescribe
analgesia
D. Watch and wait
E. Confirm diagnosis with USS
C. Refer to breast feeding support group and prescribe
analgesia
Risk factors for developing breast cancer include:
A. Having only one child B. Early menarche C. Early menopause D. Anaemia E. HIV/AIDS
B. Early menarche
A 56 year old woman presents to her GP after noticing a
breast lump 3 weeks ago. On examination, the lump is 3 cm
in diameter, firm and tethered to the skin and immobile.
There are no overlying skin changes. The next most
appropriate investigation is:
A. Total mastectomy B. Urgent mammogram C. Urgent USS D. FNAC E. Core biopsy
B. Urgent mammogram
A 22 year old medical student presents to her GP
complaining of ‘lumpiness’ in her breasts and nipple
discharge for 2 weeks. She is concerned as her mother,
who had breast cancer, had the same symptoms before she was diagnosed. What is the next most appropriate
investigation?
A. Refer for urgent mammogram B. Refer for urgent USS C. Blood hCG levels D. Reassure and discharge E. CT Head
C. Blood hCG levels
BRCA gene mutations are associated with breast and
which other type of cancer?
A. Biliary B. Uterine C. Gastric D. Ovarian E. Colon
D. Ovarian
A 30 year old female presents with a bruise on her
breast. O/E The underlying tissue is tender and lumpy.
When asked about trauma, she says she was injured whilst
playing a rugby match. What is the most likely diagnosis?
A. Fibroadenoma B. Fat necrosis C. Paget’s disease of the breast D. Mastitis E. Duct ectasia
B. Fat necrosis
Which of the following statements regarding breast
disease is FALSE?
A. Orange peel skin may be a sign of inflammatory breast
cancer
B. Ulcerated breast lumps are generally not concerning
C. Alcohol intake is a modifiable risk factor for breast cancer
D. Women ages 50-70 are offered routine screening every
3 years
E. USS are more suitable for women aged <35 years
B. Ulcerated breast lumps are generally not concerning
