Breast Flashcards
What are 4 most common diagnoses for a breast lump
Benign cystic change
Fibroadenoma
Cyst
Carcinoma
Most common breast lumps in under 30s
Physiologically normal lumpy breast Benign cystic change Fibroadenoma Abscess Galactocele if breast feeding
Most common breast lumps 30-45s
Benign cystic changes
Cyst
Abscess
Carcinoma
Most common breast lump in 45-60
Cyst
Abscess
Carcinoma
Who are breast abscesses especially prevelant in
Smokers
In what ages do fibroadenomas occur
Teenagers to mid 30s mainly
In what ages do breast cysts occur
Any age but peak at 55
What breast lump do you get after cessation of lactation
Galactocele
Where do galactoceles tend to appear on breasts
Subareolar
How do galactoceles form
Caused by obstruction in duct which leads to build up of milk and epithelial cells
How can galactoceles become complicated
Secondary abscess
What do galactoceles appear like
Cysts
What is mastitis
Superficial infection of breast by commensal staph aureus and staph epididermis
What is periductal mastitis
Inflammation of periductal ducts under the skin
Who is at risk of mastitis
Breast feeding
Difference in infective cause mastitis vs periductal mastitis
Periductal will include anaerobic bacteria
What are main risk factors for breast cancer
Previous breast cancer Family history of breast cancer Any previous endometrial cancer, bowel or ovarian Irradiation to chest wall Increased exposure to oestrogens
Risk factors where get increased exposure to oestrogen
Early menarche Late menarche Having first child after 30 Not breast feeding HRT COCP
Difference in onset of breast lumps
Abscess or cyst rapid
Fibroadenoma or cancer insidious
What would trauma or iatrogenic to breast suggest
Abscess or fat necrosis
What does breast lump that changes shape or size cyclically suggest
Benign cystic change
Which breast lumps tend to be more painful
Abscess
Benign cystic changes
Acute mastitis
Carcinoma rarely painful
Tender breast lumps
Abscess
Benign cystic changes
Acute mastitis
Potentially a cyst
What does warm skin above lump suggest
Inflammatory or infection
Mastitis
Abscess
What is peau d’orange
Skin resembling an orange where looks like holes in skin
What is peau d’orange indicative of
Cancer
What does change in nipple appearance suggest
Cancer
What does milky discharge with lump suggest
Galactocele
What does green or yellow discharge suggest about breast lump
Preductal mastitis
What does bloody discharge from nipple suggest
Cancer
What does serous discharge from nipple suggest
Intraductal papilloma
What is intraductal papilloma
Benign lump that grows inside ducts close to nipple
What does recent distortion of nipple suggest
Cancer
Do breast cancer tend to present with b sx
No
What other symptoms should you ask about in breast lumps
Back pain or any other common met site
What to look for in inspection of breasts on examination
Asymmetry Contours Skin changes Nipple changes or discharge Radiotherapy tattoos
What radiation is particularly relevant for breast cancer
Mantle radiotherapy seen in Hodgkins lymphoma
What does highly mobile breast lump suggest
Fibroadenoma
What does solitary cyst feel like
Smooth
Distinct borders
Firm to lax
What does fibroadenoma feel like
Smooth
distinct borders
Rubbery
What lumps are very mobile
Fibroadenomas
What does cancer lump feel like in breast
Irregular
Indistinct
Hard
What does fixation to skin always suggest
Cancer
What assessments must be done if breast lump pt presents
Full examination
Imaging depending on age
FNA or core biopsy
How does age affect imaging of breast
Under 35 do US
Over do mammogram
Why cant mammograms be done on under 35s
Breast tissue too thick
Treatment options for fibroadenoma
Harmless so ideally watchful waiting
Excision
What are indications for removal of fibroadenoma
Patient choice
Growing in size
Beginning to cause discomfort
What does term breast mouse refer to
Fibroadenomas
4 most common sites of breast mets
Liver
Bone
Lung
Brain
What breast mets are always investigated regardless of clinical signs and how are they investigated
Liver- CT
Bone- bone scintilligraphy, calcium ALP etc can be good adjunct
Which breast mets are sometimes only investigated based on clinical presentation
Brain
Lungs
What are the majority of breast cancers
Infiltrating duct carcinoma
What are some local treatment options for breast cancer
Surgery
Radiotherapy
What treatment is always given to ladies whos tumours are ER positive
Hormonal
80% are ER positive which means that mutation on ER leads to growth of these lobule cells themselves whereas they should just act as beacon
How to differentiate between lobular and medullary breast cancer histologically
Lobular – the tumour has some resemblance of the architecture of the gland (there are tubules of some form)
Medullary – the tumour cells don’t look anything like the epithelial cells from the mammary gland
Systemic treatments for breast cancer
Hormonal therapy
Chemotherapy
Monoclonal antibodies
Examples of hormonal therapy for breast cancer
Aromatase inhibitors
ER blockers
What is ER blocker used in breast cancer and what is its main side effect
Tamoxifen
Increased risk of endometrial cancer
Monoclonal antibody therapy used in breast cancer
Herceptin
How does breast abscess present and appear on examination
Painful sudden onset lump Skin tethering Erythema Fever May also be lymphadenopathy
Management of breast abscess
ABx with anaerobic cover
Surgical drainage
If there is a mass left over will require triple assessment
How does a cyst appear on US
Hypoechoic (solid mass will be hyperechoic)
Are cysts painful in breast
Yes
What colour is fluid if drain the cyst
Normally green
After draining breast cyst what should be done if mass persists
Triple assessment again as tumour can be present within the cyst
Presentation of benign cystic change
Diffuse nodularity
Cyclical variance in prominence and tenderness
Management of benign cystic changes
Triple assessments as are signs of nodularity
What percentage of breast cancers occur in men
10%
When is gyaecomastia common in men
Occurs at times of hormonal fluctuation
Neonatal, puberty and old age
Most common causes of gynaecomastia in men
Liver disease Primary testicular therapy Acquired testicular failure Secondary testicular failure Endocrine tumours Ectopic production from other tumours
Drugs causing gynaecomastia
Spironalactone
Finasteride
Anabolic steroids
Cimetidine
What are fibroadenomas caused by
Increased sensitivity to oestrogen
Who do fibroadenomas normally appear in
Under 30s
What causes cysts in breasts
Proliferation of terminal ducts
How does mastitis with lactation present
Erythema streaking away from the nipple
Breast tenderness
Axillary lymphadenopathy
Can also have fever and malaise
Management of mastitis with lactation
10 day course of flucoloxacillin
What is an intraductal papilloma
Wart like lump that is normally found behind nipple
It is a benign growth
Difference in presentation of intraductal papilloma with age
Older women likely to have just 1 whereas under 40s can have many
Examination finding from intraductal papilloma
Sticky or bloody discharge that can be spontaneous
Small lump
What is atypical duct hyperplasia
Genetic condition that leads to hyperplasia of cells in ducts and lobes which comes with increased risk of carcinoma- must be screened regularly
What does fat necrosis feel like on examination
Tender firm lump
Skin changes- red, bruised and dimpled
Who does fat necrosis occur in
People with bigger breasts and obese
Always post trauma
