Breast Conditions Flashcards
what are risk factors for breast cancer
Age Previous breast cancer FHx BRCA1 and BRCA2 Early menarche and late menopause Late or no pregnancy HRT Alcohol Weight Radiotherapy Tx for cancer
presentation of breast cancer
lump mastalgia (persistent unilateral pain) nipple discharge (blood-stained) nipple changes (Paget’s disease, retraction) change in breast contour lymphaeodema (swelling of the arm) dimpling of the breast skin
what is the triple assessment seen in the breast clinic
- CLINICAL:
History and Examination - RADIOLOGICAL:
Bilateral mammograms / USS - CYTO-PATHOLOGICAL:
FNA- cells only (cytology)
Core Biopsy- tissue (histo-pathol.)
what is the most sensitive breast imaging technique
mammogram
why is sensitivity of a mammogram reduced in young women
presence of increased glandular tissue (<40yrs)
when is breast ultrasound useful
in the assessment of breast lumps
- can differentiate between solid and cystic lesions
what are the invasive breast cancers
Ductal carcinomas 80%
Lobular carcinomas 10%
Others 10%
what are the “others” of the invasive breast cancers
Mucinous 5%
Papillary <5%
Medullary <5%
what are the non invasive breast cancers
Ductal Carcinoma In Situ [DCIS]
Lobular Carcinoma In Situ [LCIS]
where are common mets for breast cancer
local
- chest wall, skin, nipple
distant
- contra-lateral breast, lung, liver, bone, brain,
what are Tx options for breast cancer
Surgery
+/- radiotherapy
+/- chemotherapy
+/- hormonal therapy
what are surgical options for breast cancer
mastectomy
wide local excision
what patient always receive radiotherapy as part of their treatment
All patients after WLE as adjuvant treatment
what is the principle of Tx of hormone therapy in breast cancer
oestrogen deprivation
- only in ER positive tumours
what does ER positive mean
the tumour contains oestrogen receptors
what are the available chemical HT
tamoxifen
aromatase inhibitors
what are the available surgical HT
oophorectomy
Tx for fibroadenoma
if proven on US and FNA cytology = do not have to excise
Excision- if unable to obtain pathological diagnosis, increasing in size, deforming
Tx of duct papilloma
Excision by Microdochectomy (Single Duct Excision) or Total Duct Excision
what is mastalgia
breast pain
who gets cyclical breast pain
premenopausal women
average age 34
how does cyclical mastalgia feel
Heightened awareness, discomfort, fullness, heaviness
Classically – outer half of each breast
Can be unilateral
who gets non-cyclic mastalgia
older women
average age 43
how does non-cyclical mastalgia feel
Pain can arise from chest wall, breast or outside breast
Continuous/Random
Burning/Drawing
Tx of mastalgia
reassurance well fitting bra topical NSAIDs drug treatment can stop OCP
what are the drug treatment options for mastalgia
Danazol - more useful in cyclical.
Gamolenic acid
Bromocriptine
when Ix nipple discharge what can be done if suspicious
Duct Excision
what should be Ix if there is bilateral milky discharge
galactorrhoea
- Ix = Drug history, prolactin levels
what drugs cause Gynaecomastia
digoxin
spironolactone
androgens
anti-oestrogens
Tx options for Gynaecomastia
reassure
Tx underlying cause
surgery = rarely
danazol or tamoxifen - symptomatic improvement
2 main aetiologies for acute mastitis/abscess
duct ectsaisa
lactation
Sx of acute mastitis/abscess
pain, swelling, tenderness of the breast breast warmth + erythema mastitis decreased milk outflow flu-like Sx, malaise + myalgia fever
Ix of acute mastitis/abscess
USS + FNA
Tx of acute mastitis/abscess
Flucloxacillin +/- aspiration
or
Co-amoxicillin
