Breast Cancer

Question 1

What are the clinical features of breast disease Could be a hormonal problem eg galactohrrea due to hormonal disturbances. But unilateral nipple discharge can be presentation of breast aver or a tumour in the duct itself

Answer 1

Physiological swelling and tenderness.
Nodularity.
Breast pain (not usually associated with malignancy)
Palpable breast lumps.
Nipple discharge including galactorrhoea.
Breast infection and inflammation - usually associated with lactation.

Question 2

What can breast disease be histologically divided into

Answer 2

Histologically they can be divided into three groups which provide an idea regarding potential future cancer risk:
• Non-proliferative disorders - no increased risk.
• Proliferative disorders without atypia - mild to moderate increase in risk.
• Atypical hyperplasias - substantial increase in risk (relative risk in the order of 4.1-5.3).

Question 3

Describe physiological swelling and tenderness

Answer 3

• Puberty
• Breast enlargement, sometimes initially unilateral, is the first obvious sign of puberty in girls. Breast buds may initially be unilateral. Pubertal breast development is known as thelarche.

Question 4

What is fibrocystic change

Answer 4

He most common benign breast disorder. • This usually affects women aged 20-50 and appears to be hormonal in aetiology. Most often presents with pain and nodularity.

Question 5

What is a characteristic presentation os modularity

Answer 5

• The symptoms are greatest about one week before menstruation and decrease when it starts.
• Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper outer quadrant of the breast.
• If the changes are bilaterally symmetrical, they are rarely pathological. If there is asymmetry it is acceptable to review the patient after one of two menstrual cycles, seeing her mid-cycle.

Question 6

What is cyclical mastalgia

Answer 6

The breasts are active organs that change throughout the menstrual cycle and some degree of tenderness and nodularity in the premenstrual phase is so common that it may be considered as normal, affecting up to two thirds of all menstruating women. It rapidly resolves as menstruation starts.

Question 7

What is the exper option on when w person presents with a breas lump

Answer 7

• This recommendation is based on expert opinion in a review article which suggests that as long as malignancy has been excluded as a cause, usually cyclical breast pain can be managed by watchful waiting without treatment [Amin et al, 2013].
• Expert opinion in a textbook: ABC of breast diseases describes reassurance as the ‘mainstay of treatment’ for mastalgia [Iddon and Dixon, 2012].

Question 8

Descrbe a benign breast lump

Answer 8

Most benign lumps will be either cysts or fibroadenomas.
A benign mass is usually three-dimensional, mobile and smooth, has regular borders and is solid or cystic in consistency
But sometimes cant tell without US and biopsy

Question 9

Decribe cysts

Answer 9

Cysts are most common between the ages of 35 and 50. They are palpable as discrete lumps and may be recurrent. They cannot be reliably distinguished from solid tumours on clinical examination. Can start to form an opinion - genetic predisposition, fh, but cannot fully say 100% on clinical examination

Question 10

What are fibrooademomas

Answer 10

• These are benign tumours that are common in young women, with incidence peaking at 20-24 years of age.
• They are the most common type of breast lesion.
• Fibroadenomas arise in breast lobules and are composed of fibrous and epithelial tissue. They present as firm, non-tender, highly mobile palpable lumps. Hormones seem to be involved in aetiology, and hormone replacement therapy (HRT) increases the incidence.

Question 11

Describe nipple discharge

Answer 11

Could be a hormonal problem eg galactohrrea due to hormonal disturbances. But unilateral nipple discharge can be presentation of breast aver or a tumour in the duct itself

Question 12

What is dct ex=ctasia

Answer 12

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Question 13

What is mastitis

Answer 13

Swollen red breast. In breastfeeding women the ducts get blocked -> inflammation ->infection . Staph aureus is. Common. In a breastfeeding women can become a medical emergency. Pain, inability to breastfeed, temperature, rigours, admission to postnatal unitfor treatment, possibly iexision and drainage.

Question 14

When should women with a breast lump be referred

Answer 14

Unilateral breast lump. Most ppl ->r refer . Undergo some investigation eg us, aspiration. I under 30 - might watchfully wait but might refer if it persists.
• Refer people via the suspected cancer pathway referral (to be seen within two weeks) to a specialist breast clinic if they are:
• Aged ≥30 and have an unexplained breast lump with or without pain; or
• Aged ≥50 with any of the following symptoms in one nipple only:
• Discharge
• Retraction
• Other changes of concern

• Consider a suspected cancer pathway referral (for an appointment within 2 weeks) people:
• With skin changes that suggest breast cancer or
• Aged 30 and over with an unexplained lump in the axilla (new NICE recommendation for 2015).
• Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain (new NICE recommendation for 2015).