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Year 3 - Diseases > Breast > Flashcards

Breast Flashcards

1
Q

Define fibroadenoma

A
  • A benign breast lump most common in young women

- Arise in breast lobules, composed of fibrous and epithelial tissue

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2
Q

Describe epidemiology of fibroadenoma

A
  • Most common type of breast cancer below age 30
  • Generally arise age 20-24
  • 68% of breast masses
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3
Q

List risk factors for fibroadenoma

A
  • Thought to occur because of increased sensitivity to oestrogen
  • Young age
  • Obesity
  • Consumption of oral contraceptives before age 20
  • Family history
  • Increase in size during pregnancy, breastfeeding, and HRT but become smaller afterwards
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4
Q

List signs and symptoms of fibroadenoma

A
  • Firm, non-tender, highly mobile lumps
  • Simple are 1-3cm
  • Complex have different types of cells
  • Giant or juvenile are more than 5cm
  • Normal overlying skin, not fixed to surrounding parenchuma
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5
Q

List investigations for fibroadenoma

A
  • Triple assessment
  • Examination
  • Imaging (ultrasound below 40 - well circumscribed, round to ovoid or macrolobulated mass with uniform hypoechogenicity)
  • Needle biopsy (not required over age of 25)
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6
Q

Describe management of fibroadenoma

A
  • Most can be left
  • If they get bigger (giant or juvenile, or complex fibroadenoma) then they are removed
  • May be vacuum assisted, this can be done under local anaesthetic
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7
Q

Describe prognosis of fibroadenoma

A
  • Does not increase risk of breast cancer for most women

- If complex, risk is slightly increased

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8
Q

Describe complications of fibroadenoma

A
  • Rare
  • Slightly increased risk of breast cancer in some cases
  • Giant fibroadenomas continue growing and can become large
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9
Q

Define duct ectasia

A

A benign (non-cancerous) breast condition that occurs when a milk duct in the breast widens and its walls thicken. This can cause the duct to become blocked and lead to fluid build-up.

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10
Q

Describe epidemiology of duct ectasia

A
  • Occurs in perimenopausal women (age 45-55)

- Duct ectasia 5-9% of non-lactating women

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11
Q

List signs and symptoms of duct ectasia

A
  • Often causes no symptoms
  • May cause a thick nipple discharge
  • Red tender nipple and nearby breast tissue
  • Nipple may be pulled inward
  • Scar tissue around the abnormal duct causing a hard lump (firm, stable, painful, under nipple)
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12
Q

List risk factors for duct ectasia

A

Smoking, close to menopause, obesity

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13
Q

Describe investigation for duct ectasia

A
  • Mammogram
  • Ultrasound
  • Biopsy
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14
Q

Define intraductal papilloma

A

Solitary or multiple benign lesions that arise from the epithelium of the lectiferous breast ducts

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15
Q

Describe epidemiology of intraductal papilloma

A
  • Peak incidence 40-50 years
  • Multiple lesions more common when younger
  • Solitary lesions more common when older
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16
Q

List signs and symptoms of intraductal papilloma

A

Solitary lesion (central)

  • Bloody or serous nipple discharge (most common cause)
  • Palpable lump close to or behind the nipple or areola
  • Large central lesion

Multiple lesions

  • Usually asymptomatic, rarely discharge
  • Peripheral lesions which are smaller than solitary lesions
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17
Q

Describe investigations of intraductal papilloma

A
  • Core needle biopsy if lesion is palpable, rule out malignancy (fibroepithelial tumour, with papillary cells and fibrovascular core covered by epithelial and myoepithelial cells
  • Ductogram (mammogram with contrast, non specific findings such as ectasia and filing defects)
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18
Q

List examples of benign ductal disease

A
  • Duct ectasia

- Papilloma

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19
Q

Define mastitis and breast abscess

A
  • Inflammation of the breast with or without infection.
  • Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia).
  • Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions (e.g., foreign body reaction).
  • A breast abscess is a localised area of infection with a walled-off collection of pus. It may or may not be associated with mastitis.
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20
Q

Describe epidemiology of mastitis and breast abscess

A
  • Global prevalence of mastitis in lactating women up to 10%
  • Breast abscess in 2-11% of women with mastitis, with incidence of 0.1-3.0% in breastfeeding women
  • 50% of infants with neonatal mastitis will develop breast abscess
  • Tubecular mastitis is rare 0.1-3% incidence
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21
Q

Describe aetiology of mastitis and breast abscess

A
  • With or without infection
  • Infectious mastitis and breast abscesses are usually caused by bacteria colonising the skin.
  • Cases due to Staphylococcus aureus are by far the most common, followed by those due to coagulase-negative staphylococci.
  • Breast infections may sometimes be polymicrobial (up to 40% of abscesses), with isolation of aerobes as well as anaerobes
  • Non-infectious mastitis may result from underlying duct ectasia (peri-ductal mastitis or plasma cell mastitis) and infrequently foreign material (e.g., nipple piercing, breast implant, or silicone).
  • Clogged ducts with milk stasis
22
Q

List risk factors of mastitis and breast abscess

A
  • Female sex
  • Women aged >30 years
  • Poor breastfeeding technique
  • Lactation
  • Milk stasis
  • Nipple injury
  • Previous mastitis
  • Prolonged mastitis (breast abscess)
  • Prior breast abscess (breast abscess)
  • Shaving or plucking areola hair
  • Anatomical breast defect, mammoplasty, or scar
  • Other underlying breast condition
  • Nipple piercing
  • Foreign body
  • Skin infection
  • Staphylococcus aureus carrier
  • Immunosuppression
  • Hospital admission
  • Breast trauma
  • Primiparity
  • Overabundant milk supply
  • Post-maturity (breast abscess)
  • Complications of delivery
  • Maternal fatigue
  • Tight clothing
  • Antifungal nipple cream
  • Fibrocystic breast disease
  • Cigarette smoking
  • Vaginal manipulation (breast abscess)
  • Poor nutrition
  • Antiretroviral therapy
23
Q

List signs and symptoms of mastitis and breast abscess

A
  • Fever
  • Decreased milk outflow
  • Breast warmth
  • Breast tenderness
  • Breast firmness
  • Breast swelling
  • Breast erythema
  • Flu-like symptoms, malaise, and myalgia
  • Breast pain
  • Breast mass
  • Fistula
  • Nipple discharge
  • Nipple inversion/retraction
  • Lymphadenopathy
  • Extra-mammary skin lesions
24
Q

Describe investigations for mastitis and breast abscess

A
  • Breast ultrasound (hyperechoic lesion, well circumscribed, macrolobulated, irregular, ill defined)
  • Diagnostic needle aspiration drainage (purulent fluid indicates breast abscess)
  • Cytology of nipple discharge or sample from fine-needle aspiration
  • Milk, aspirate, discharge, or biopsy tissue for culture and sensitivity
  • Histopathological examination of biopsy tissue (infection, granulomatous inflammation or malignancy)
  • Pregnancy test
  • Blood culture and sensitivity
  • Mammogram
  • Milk for leukocyte counts and bacteria quantification
  • Culture from swab/aspirate from infant’s and mother’s oral cavity and nasopharynx
  • FBC
  • Tuberculin skin test (purified protein derivative)
25
Q

Describe treatment of mastitis and breast abscess

A

Lactational mastitis

  • Effective milk removal and supportive care (paracetamol and ibuprogen)
  • Antibiotic therapy (flucloxacillin 10-14 days) if pain and severe symptoms, or lasting more than 12-24 hours. Continue breastfeeding bilaterally, as this reduces chance of abscess formation
  • Antifungal therapy for candidiasis
  • If systemic signs or prolonged, non beta-lactam antibiotic
  • For breast abscess, surgical intervention (needle aspiration with local anaesthesia with or without ultrasound guidance to drain an abscess) + IV or oral antibiotics (flucloxacillin) + paracetamol

Non lactating - co-amoxiclav for 10-14 days

26
Q

List complications of breast abscess and mastitis

A
  • Cessation of breastfeeding
  • Abscess (complicating mastitis)
  • Sepsis
  • Scarring
  • Functional mastectomy
  • Breast hypoplasia
  • Necrotising fasciitis
  • Extra-mammary skin infection
  • Fistula
27
Q

Describe prognosis of breast abscess and mastitis

A
  • When treated promptly most resolve within 2-3 days with appropriate antibiotic therapy
  • Lactational abscess easier to treat than non-lactational
  • Most patients can continue to breastfeed
  • Recurrence in delayed or inappropriate therapy, candidiasis, poor breastfeeding technique
  • Granulomatous mastitis 50% recurrence
28
Q

Define breast cyst

A

Fluid filled lump in the breast

29
Q

Describe epidemiology of breast cyst

A
  • Common over 35 years, especially in perimenopausal women

- Affect 7% of western women (common)

30
Q

List risk factors for breast cysts

A
  • Postmenopausal women taking HRT

- Perimenopausal

31
Q

List symptoms and signs of breast cysts

A
  • Fluid filled
  • Not fixed to the surrounding tissue
  • Occasionally painful
  • May be soft or hard
32
Q

Describe investigation of breast cysts

A
  • Mammogram or ultrasound
  • Identifies a fluid filled lump
  • Fine needle aspiration confirms diagnosis (brown, green, tan or clear fluid)
33
Q

Define breast cancer

A
  • Malignant neoplasm of the breast

- Commonly adenocarcinomas. These may be invasive ductal (70-80%) or invasive lobular

34
Q

Describe epidemiology of breast cancer

A
  • Affects 1 in 8 women, most common malignancy of women
  • 60000 new cases per year UK with incidence rising
  • Rare in men, men make up 1% of all breast cancers
  • 2nd most common cancer worldwide
35
Q

List risk factors for breast cancer

A
  • Family history (BRCA gene, li fraumeni syndrome - 5-10% genetic)
  • Age
  • Uninterrupted oestrogen exposure (nulliparity or 1st pregnancy over 30, early menarche/late menopaise and taking HRT therefore all risk factors)
  • Not breastfeeding
  • Past breast cancer
  • Lifestyle factors : low fibre, high fat diet, smoking, alcohol, obesity in postmenopausal women
36
Q

Describe aetiology of breast cancer

A
  • BRCA1 or BRCA2 gene mutations are autosomal dominant
  • Associated with increased risk of breast (70%) and ovarian cancer
  • BRCA positive women develop cancer 15-20 years earlier. Found in 5-10% of all women with breast cancer
37
Q

List types of breast cancer

A
  • Non-invasive ductal carcinoma in situ is premalignant, seen as a microcalcification on mammogram, 25% of all newly diagnosed breast cancers.
  • Non-invasive lobar carcinoma in situ is rarer, tends to be multifocal
  • Invasive ductal carcinoma 70% invasive breast carcinomas
  • Invasive lobar carcinoma 10-15% invasive breast carcinomas
  • Medullary cancers (5%) tend to affect younger women, and colloid/mucoid (2%) the elderly
  • Others include papillary, tubular, adenoid cystic and pagets (ductal which infiltrates the nipple)
  • 60-70% oestrogen receptor positive, better prognosis
  • 30% express HER2 (more aggressive)
38
Q

List symptoms and signs of breast cancer

A
  • Developed late at advanced tumour stages
  • Changes in breast size or shape (asymmetric breasts)
  • Palpable mass (single, non-tender, firm mass with poorly defined margins, most commonly in the upper outer quadrant)
  • Skin changes (retractions or dimpling, peu d’orange due to obstruction of lymphatic system - reddness, oedema and pitting of hair follicles)
  • Nipple changes (inversion/blood-tinged discharge)
  • Axillary lymphadenopathy (firm, enlarged lymph nodes fixed to the skin or surrounding tissues
  • Ulcerations if advanced
  • Pagets disease of breast
  • Thrombophelbitis
39
Q

Describe investigations of suspected breast cancer

A
  • Triple assessment - clinical examination, histology/cytology and mammogram if over 35/ultrasound if under 35
  • Core biopsy of solid lump
  • Aspiration of cystic lump, if bloody cytology (if suspicious core needle biopsy needed to confirm diagnosis)
  • Malignant: focal mass with poorly defined margins, clustered microcalcifications
  • Determine whether oestrogen/ progestrone/ HER2 positive (via immunohistochemistry - best prognosis oestrogen+progresterone positive, HER2 negative)
40
Q

Define fine needle aspiration

A
  • A procedure where a thin needle is used to draw out cells or fluid from a lump or mass under the skin.
  • This is then analysed to look for any cancer cells
  • Often guided by ultrasound
41
Q

List indications for fine needle aspiration

A
  • Investigate and diagnose breast lumps where the nature is uncertain
  • Monitor breast cancer response to treatment
  • Also has use in thyroid, lymph nodes, lung, bone, liver, GI samples
42
Q

List complications of fine needle aspiration

A
  • Bleeding
  • Infection
  • Lung biopsy: pneumothorax
43
Q

Define fibrocystic change

A

Benign breast condition encompassing fibrous changes, cysts and adenosis that occurs bilaterally

44
Q

Describe epidemiology and risks of fibrocystic change

A
  • Premenopausal 30-50
  • Obesity
  • Nulliparity
  • Late menopause
  • Increased E2
45
Q

List symptoms and signs of fibrocystic change

A
  • Multiple lumps
  • Smooth, regular, bilateral, symmetrical
  • Normal nipples, fluctuates with periods
  • Tender, rubbery, fluctuant, mobile, slow growing
  • Fibrous lumps hard and rubbery while cysts are oval or round and fluctuant
46
Q

List investigations for fibrocystic changes

A
  • US or mammogram

- FNA (straw coloured)

47
Q

Define fat necrosis

A

Fat tissue is damaged secondary to trauma. Occurs at any age, though it is rare

48
Q

List symptoms and signs of fat necrosis

A
  • Skin retraction/thickening. May be bruised or irregular

- Hard, tender, fixed

49
Q

List risk factors for fat necrosis

A
  • larger breasts

- Previous FNA, biopsy or surgery

50
Q

List investigations for fat necrosis

A
  • US or mammogram

- FNA

51
Q

Describe breast cancer screening

A
  • All women age 50-71 who register for a GP are eligible for screening every 3 years using a mammogram
  • If at high risk, age 40-50 annual mammography is used

Year 3 - Diseases (27 decks)

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