Breast conditions Flashcards

1
Q

Define/causes of mastitis? What is it called if it occurs in postpartum women lactation?

A

Inflammation of the breast tissue +/- infection.

If associated with lactation in postpartum women, then this condition is called puerperal mastitis.

Caused by milk stasis that may occur due to:
- inadequate milk removal (poor breastfeeding technique or infrequent feeding)
- entry of bacteria through cracked or sore nipples (Staph aureus)

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2
Q

Presentation of mastitis?

A

Localised pain, tender, red, and hot breast, nipple discharge purulent. “wedge shaped”

Systemic: fever, rigors, myalgia, fatigue, nausea, headache.

Unilateral breast

May present within first week postpartum.

Can lead to breast abscess
- fluctuant tender mass with redness.

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3
Q

Diagnosis/IVx of mastitis?

A

Clinical diagnosis

Consider nipple discharge culture and sensitivity if severe/recurrent.

Consider US (to identify potential abscess)

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4
Q

Management of mastitis?

A

Consider 2ww referral if associated mass.

Lactational:
- more frequent feedings, breast pumping
- analgesia
- flucloxacillin (offered if infected nipple fissure, symptoms not improving after 12-24hrs and/or breast milk culture positive)

Non-lactational:
- analgesia
- warm compresses
- treat predisposing factors (e.g. eczema, candida)
- co-amoxiclav prescribed

Consider IV abx or incision and drainage, especially if a breast abscess develops.

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5
Q

Define breast abscess. Cause, presentation, diagnosis, management?

A

Localised collection of pus within breast tissue secondary to infection.

Recent mastitis -failed tx, Staph aureus.

Presents same as mastitis.

Diagnosis:
- breast US
- MC&S of nipple discharge

Management:
- surgical incision and drainage or US guided needle aspiration
- abx

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6
Q

Define/causes of fibroadenoma?

A

Benign solid tumours that consist of a mixture of fibrous and epithelial/glandular tissue, typically arising from lobules (milk-producing glands in the breast).

Unclear cause.
Influence by reproductive hormones (e.g. oestrogen therapy), as they often enlarge during pregnancy and shrink after menopause.

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7
Q

Presentation of fibroadenoma?

A

A firm, non-tender mass, highly mobile, rounded with smooth edges.

Rubbery consistency.

<3cm in diameter.

Not painful
May become painful immediately before menstruation.

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8
Q

Diagnosis/IVx of fibroadenoma?

A

Triple assessment:
- clinical examination
- US and/or mammogram
- needle biopsy

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9
Q

Management of fibroadenoma?

A

No tx, will regress naturally after menopause.

Surgical excision -if large >3cm) and symptomatic

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10
Q

Define/causes of fibrocystic disease?

A

Benign condition characterised by the presence of fibrous tissues and cysts in the breasts.

In other words, lumpy breasts associated with pain and tenderness that fluctuate with menstrual cycle.

Affects ages 20-50.

Caused by cumulative effect of cyclical hormones (oestrogen and progesterone).

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11
Q

Presentation of fibrocystic disease?

A

“lumpy” breasts, dull breast pain and cyclical symptoms that typically peak in the week before menstruation.

Found upper outer quadrant of breast.

Bilateral breasts.

+/- nipple discharge.

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12
Q

Diagnosis/IVx of fibrocystic disease?

A

Clinical examination
Mammogram (to identify any abnormalities)
US (distinguish between solid mass and fluid-filled cysts)
Biopsy (exclude malignancy)

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13
Q

Management of fibrocystic disease?

A

Breast pain:
- supportive bra
- limit caffeine, sodium
- analgesia
- evening primrose oil

Symptomatic cysts -aspiration

Nipple discharge -refer to breast surgeon

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14
Q

Define/RFs of breast cancer?

A

A malignant tumor originating from the cells of the breast tissue.

IN Situ = stays in ducts
Invasive = spreads to other breast tissue

RFs:
- early menarche
- late menopause
- nulliparity or late first pregnancy
- oral contraceptive or HRT
- BRCA mutation
- older age
- Caucasian ethnicity
- obesity
- lack of exercise
- alcohol
- smoking
- hx of breast cancer
- previous radiotherapy tx

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15
Q

Presentation of breast cancer?

A

Unexplained breast mass +/- pain

Firm, immobile, clear border, irregular shape mass

Breast asymmetry

Nipple changes -discharge, retraction, rash

Breast skin changes
- Peau d’Orange
- erythema
- ulceration
- dimpling
- nipple scaling

Axillary lymphadenopathy

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16
Q

Diagnosis/IVx of breast cancer?

A

Mammogram
US/MRI
Biopsy
Sentinel lymph node biopsy -staging

17
Q

Management of breast cancer?

A

Hormonal therapies:
Tamoxifen
- oestrogen receptor modulator
- offered if hormone-receptive positive breast cancer and pre-menopausal

Aromatase inhibitor
- blocks conversion of androgens to oestrogen
- offered if hormone-receptive positive breast cancer and post-menopausal

Late stage:
Lumpectomy or mastectomy
Chemotherapy
Radiotherapy

18
Q

Breast cancer screening?

A

Free breast screening for all women registered with a GP.

For women ages 50-70years.
Every 3 years.

Involves:
- mammogram

Aim of breast cancer screening is to find cancer at an early stage when tx is most effective.