Breast conditions Flashcards
What is Benign Ductal disease?
Duct ectasia is when ducts become blocked and secretions stagnate, causing nipple discharge +/- nipple retraction +/- lump
What are the causes of benign ductal disease?
In duct ectasia, central ducts become dilated with ductal secretion due to a blockage of the lactiferous ducts
Both occur near menopause age
What are the symptoms of benign ductal disease?
Duct ectasia
Green/Brown/bloody nipple discharge
Swelling or lump
History of breast discomfort/pain
Intraductal papilloma: Small lump or near nipple, discharge
Multiple papillomas are smaller and occur further away from nipple
What are the signs of benign ductal disease?
Focal or diffuse nodularity of breast
Discharge
Features of malignancy absent e.g. Dimpling, peau d’orange, enlarged axillary lymph nodes
What investigations are done for benign ductal disease?
Triple assessment
- Clinical examination
- Imaging
- Mammography
- Ultrasoun
- Cytology/histology
- FNA
- Excision biopsy for histological analysis
What is Breast cancer?
Most common cancer in women and second most common cause of death from cancer in the UK
How are breast cancers defined?
Epithelial lining of ducts is called ductal
Epithelium of terminal ducts of the lobules are called lobular
Carcinomas can be invasive or in situ
Paget’s disease of the breast (Infiltrating carcinoma of the nipple)
Inflammatory carcinoma is a small minority with a rapidly growin sometimes painful mass enlarging the breast
What causes breast cancer?
Unknown!
Genetic factors 5-10%
BRCA1/BRCA2
Hormonal factors (increased oestrogen)
What risk factors cause breast cancer?
Previous history Risk increases with age Genetic factors Never having had a child Not having breast fed Early menarche or late menopause Radiation to chest Western-style diet HRT COCP Smoking Reduced physical inactivity
What are the signs and symptoms of breast cancer?
Breast mass Nipple discharge Axillary lymphadenopathy Skin thickening or discolouration Retraction or scaling of nipple Breast pain/mastalgia Mets symptoms (bone pain, lung, liver or brain issues)
What are the investigations for breast cancer?
Mammogram Breast ultrasound Breast MRI Biopsy Hormone receptor testing HER2 receptor testing Gene experession assays
What are breast cysts?
Benign fluid-filled sacs
What causes breast cysts?
Usually disapear after menopause -related to hormone changes
Exact cause unknown
What are the symptoms of breast cysts?
Small breast lump - smooth, distinct border, firm to lax consistency, immobile, not fixed
What are the signs of breast cysts?
Fluid-filled, rounded lump
Not fixed to surroundings, easily movable, smooth
What are the investigations for breast cysts?
Clinical examination Imaging - Mammography - Ultrasound <35 Cytology / Histology - FNA (cytological analysis) - Excision biopsy (histological analysis)
What are breast fibroadenomas?
Benign overgrowth of collagenous mesenchyme of one breast lobule
What causes fibroadenomas?
Formed of a mixture of stromal and epithelial tissue
1/3 regress
1/3 stay the same
1/3 get bigger
What are the symptoms of fibroadenomas?
Firm, smooth, rubbery, mobile lumo
Painless
May be multiple
What are the signs of fibroadenomas?
Firm, smooth, mobile lumps
What are the investigations for fibroadenomas?
Clinical exam
Imaging
- Mammography (oval/round, circumscribed lump potential coarse calcifications)
- Ultrasound if <35
Cytology/Histology
- FNA (cytological analysis)
- Excision biopsy ( histological analysis)
Imaging show oval or round, circumscribed lumps, may have coarse calcificaitons
Biopsy will show epithelial and stromal elements
What is the management of fibroadenoma?
Observation and reassurance
If in doubt refer to USS +/- FNA
If large or growing quick/causing discomfort/preferred by patient, surgical excision done by excisional biopsy
What are the complications of fibroadenoma?
None or rare to have any
What is Mastitis?
Infection of mammary duct associated with lactation - usually S. Aureus or epidermidis
What is a breast abscess?
Come in 2 forms: Lactational and non-lactational
What causes mastitis/breast abscesses?
May occur with or without infection
Infectious mastitis and breast abscesses usually caused by bacteria colonising the skin
Most commonly S. Aureus
What are the risk factors for mastitis/breast abscess?
Female sex >30 Poor breastfeeding technique Lactation Milk stasis Nipple injury Previous history Shaving or plucking areola hair Nipple piercing Foreign body Primiparity Tight clothing Cigarette smoking Poor nutrition Antiretroviral therapy Fibrocystic breast disease Antifungal nipple cream
What are risk factors for specifically breast abscesses?
Prolonged mastitis
Prior breast abscess
Vaginal manipulation
What are the symptoms of mastitis/breast abscesses?
Abscess presents as painful hot swelling of breast segment
Local pain, especially while breast feeding
Redness + Swelling
Fever
Malaise
What are the signs of mastitis/breast abscesses?
Red, swollen, tender breast
Cracked nipple
Non-lactational abscess: Scars or tissue distortion from previous episodes; signs of duct ectasia
Systemic: Pyrexia, tachycardia
What are the investigations mastitis/breast abscesses?
Diagnosis on presentations
Breast examinations
Ultrasound detects a potential abscess (differentiate if a mass is a tumour or abscess)
Culture may be needed to determine type of organisms (MC+S of pus samples)
What is the management for mastitis/breast abscesses?
Paracetamol/Ibuprofen
Warm compression to relieve pain and help milk flow
Advise to continue breast feeding to allow milk removal
Avoid bras
Oral Abx (1st: Flucloaxicillin, 2nd: Erythromycin/clarithromycin)
Or: If non-lactational - ABx covering anaerobes too
Reassure
Admit if signs of sepsis
For breast abscesses suspicion - refer to surgeons for incision or drainage
Any remaining mass need triple assessment
What are the complications of mastitis / breast abscesses?
Cessation of breast feeding Abscess Sepsis Scarring Functional mastectomy Breast hyperplasia Necrotising fasciitis Extra-mammary skin infection Fistula
