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Conditions > Breast conditions > Flashcards

Breast conditions Flashcards

1
Q

What is Benign Ductal disease?

A

Duct ectasia is when ducts become blocked and secretions stagnate, causing nipple discharge +/- nipple retraction +/- lump

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2
Q

What are the causes of benign ductal disease?

A

In duct ectasia, central ducts become dilated with ductal secretion due to a blockage of the lactiferous ducts
Both occur near menopause age

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3
Q

What are the symptoms of benign ductal disease?

A

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

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4
Q

What are the signs of benign ductal disease?

A

Focal or diffuse nodularity of breast
Discharge
Features of malignancy absent e.g. Dimpling, peau d’orange, enlarged axillary lymph nodes

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5
Q

What investigations are done for benign ductal disease?

A

Triple assessment

  • Clinical examination
  • Imaging
    • Mammography
    • Ultrasoun
  • Cytology/histology
    • FNA
    • Excision biopsy for histological analysis
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6
Q

What is Breast cancer?

A

Most common cancer in women and second most common cause of death from cancer in the UK

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7
Q

How are breast cancers defined?

A

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

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8
Q

What causes breast cancer?

A

Unknown!
Genetic factors 5-10%
BRCA1/BRCA2
Hormonal factors (increased oestrogen)

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9
Q

What risk factors cause breast cancer?

A 
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
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10
Q

What are the signs and symptoms of breast cancer?

A 
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)
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11
Q

What are the investigations for breast cancer?

A 
Mammogram
Breast ultrasound
Breast MRI
Biopsy
Hormone receptor testing
HER2 receptor testing
Gene experession assays
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12
Q

What are breast cysts?

A

Benign fluid-filled sacs

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13
Q

What causes breast cysts?

A

Usually disapear after menopause -related to hormone changes

Exact cause unknown

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14
Q

What are the symptoms of breast cysts?

A

Small breast lump - smooth, distinct border, firm to lax consistency, immobile, not fixed

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15
Q

What are the signs of breast cysts?

A

Fluid-filled, rounded lump

Not fixed to surroundings, easily movable, smooth

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16
Q

What are the investigations for breast cysts?

A 
Clinical examination
Imaging
- Mammography
- Ultrasound <35
Cytology / Histology
- FNA (cytological analysis)
- Excision biopsy (histological analysis)
17
Q

What are breast fibroadenomas?

A

Benign overgrowth of collagenous mesenchyme of one breast lobule

18
Q

What causes fibroadenomas?

A

Formed of a mixture of stromal and epithelial tissue
1/3 regress
1/3 stay the same
1/3 get bigger

19
Q

What are the symptoms of fibroadenomas?

A

Firm, smooth, rubbery, mobile lumo
Painless
May be multiple

20
Q

What are the signs of fibroadenomas?

A

Firm, smooth, mobile lumps

21
Q

What are the investigations for fibroadenomas?

A

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

22
Q

What is the management of fibroadenoma?

A

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

23
Q

What are the complications of fibroadenoma?

A

None or rare to have any

24
Q

What is Mastitis?

A

Infection of mammary duct associated with lactation - usually S. Aureus or epidermidis

25
Q

What is a breast abscess?

A

Come in 2 forms: Lactational and non-lactational

26
Q

What causes mastitis/breast abscesses?

A

May occur with or without infection
Infectious mastitis and breast abscesses usually caused by bacteria colonising the skin
Most commonly S. Aureus

27
Q

What are the risk factors for mastitis/breast abscess?

A 
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
28
Q

What are risk factors for specifically breast abscesses?

A

Prolonged mastitis
Prior breast abscess
Vaginal manipulation

29
Q

What are the symptoms of mastitis/breast abscesses?

A

Abscess presents as painful hot swelling of breast segment
Local pain, especially while breast feeding
Redness + Swelling
Fever
Malaise

30
Q

What are the signs of mastitis/breast abscesses?

A

Red, swollen, tender breast
Cracked nipple
Non-lactational abscess: Scars or tissue distortion from previous episodes; signs of duct ectasia
Systemic: Pyrexia, tachycardia

31
Q

What are the investigations mastitis/breast abscesses?

A

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)

32
Q

What is the management for mastitis/breast abscesses?

A

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

33
Q

What are the complications of mastitis / breast abscesses?

A 
Cessation of breast feeding
Abscess
Sepsis
Scarring
Functional mastectomy
Breast hyperplasia
Necrotising fasciitis
Extra-mammary skin infection
Fistula

Conditions (18 decks)

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