Breast Conditions - Fibroadenoma, Fibroadenosis, Breast abscess, Fat necrosis, Duct papilloma, Duct ectasia, Breast cancer, Paget's disease of the nipple, Inflammatory breast cancer Flashcards
Fibroadenoma
-what is it
-presentation
-management
ABBERATION OF NORMAL DEVELOPMENT
Painless, unilateral, solid, smooth lump
NOT CANCEROUS, no increased risk of malignancy
Found in U30S
Shrink after menopause
3cm+ => surgical excision
Fibrocystic/fibroadenosis breasts
-what are they
-presentation
-management
Nodular, irregular, ropelike lumps
Commonly found in upper lateral quadrant
Symptoms follow menstrual cycle
Found in women of childbearing age
GENERALLY IN OLDER WOMEN
Shrink after menopause
No treatment if asymptomatic
Pain => paracetamol, NSAIDs
Breast abscess
-what is it
-presentation
-causative organism
-diagnosis
-management
Complication of infectious mastitis but can occur in non lactating women and men
Severely painful, unilateral breast lump
Red, edematous
Flu-like
Fever
Can have tender axillary LN, nipple discharge
Saureus
Bloods - FBC, U&E, CRP, blood cultures if septic
Imaging - US to localise abscess
Aspiration with culture
Abscess U5cm => LA + US guided needle aspiration
-repeated daily for 5-7 days
Abscess 5cm+ => surgical incision, drainage, washout
First 12-24hrs - continue breast feeding
If still causing issues => ABx
-fluclox
-pen allergic => doxy
If breastfeeding => express milk to relieve pain
Fat necrosis
-what is it
-presentation
-diagnosis
-management
Trauma/surgery to breast => stony hard masses, adherent to skin, can be bruised, red
Presentation can mimic breast cancer, so MUST RULE THIS OUT FIRST WITH INVESTIGATIONS
Diagnosis of exclusion
Self limiting
If painful => paracetamol, NSAIDs
Duct papilloma
-what is it
-presentation
-investigations
-management
Benign tumour in milk ducts
-bloodstained discharge, generally from a SINGLE duct
-mass if papilloma large
NO INCREASED RISK OF MALIGNANCY
Presentation can mimic breast cancer, so MUST RULE THIS OUT FIRST WITH INVESTIGATIONS
Surgical removal of papilloma
Mammary duct ectasia
-what is it
-presentation
-investigations
-management
Dilation and shortening of multiple terminal breast ducts within 3cm of nipple => nipple retraction and green-brown discharge
-can be painful
Presentation can mimic breast cancer, so MUST RULE THIS OUT FIRST WITH INVESTIGATIONS
-mammography - identify dilated ducts, malignancy
-US - assess lumps found on mammography
Nipple discharge - cytology
If asymptomatic => reassurance
Pain => paracetamol, NSAIDs
If discharge, pain severe => surgical excision
Breast cyst
-what is it
-presentation
-diagnosis
-management
Fluid-filled sac in breast
Smooth, fluctuant
Can have nipple discharge, pain/tenderness
Size and tenderness changes with cycle
Presentation can mimic breast cancer, so MUST RULE THIS OUT FIRST WITH INVESTIGATIONS
-halo appearance on mammography
-fluid confirmed with US
Pain relief
-supportive bra, warm compress
-paracetamol, NSAID
Breast cancer
-types
-2ww criteria
-risk factors
-investigations
Invasive ductal carcinoma - MOST COMMON
Invasive lobar
DCIS, LCIS
2ww if
-30+ breast lump with/without pain
-50+ unilateral discharge/retraction/other changes of concern
Consider 2ww if
-breast cancer skin changes
-30+ axillary lump
BRCA1,2 - 40% lifetime risk of breast/ovarian cancer (tumour suppressor)
Li-Fraumeni - p53 gene mutation (tumour suppressor)
1st deg premenopausal relative
Nulliparous, 1st pregnancy 30+
Early menarche, late menopause
COCP, CombHRT
PHx breast cancer
Not breastfeeding
Obesity
Triple assessment
-Hx and examination
-Imaging - Mammography, US if U35
-Histology - core biopsy to grade and stage
Also assess O, P, HER2 receptors
Suspicion of malignancy is graded at each stage
Paget’s disease of the nipple
-what is it
-presentation
-investigations
-management
Eczema-like change of nipple with UNDERLYING BREAST MALIGNANCY
-starts from nipple, spreads to areola
Red, scaly, thickened skin
Itch, burning pain
Nipple inversion, retraction
Nipple discharge
Ulcerated
Punch biopsy, mammography, US => presence of Paget cells and underlying malignancy
Surgery
-breast conserving/mastectomy
RT
Hormonal/chemo
Breast cancer
-screening
50-70 - every 3 years
mammogram
Screening at younger age if
-1 1deg female relative BC U40
-1 1deg male relative BC
-1 1deg relative with BL, 1st primary diagnosed U50
-2 1deg relative/1 1st deg and 1 2nd deg BC
-1 1st deg/2nd deg with BC + 1 1st deg/2nd deg with OC
-3 1st/2nd deg BC
Breast cancer
-management
Axillary LN
None => preop axillary US
-if negative => sentinal node biopsy to assess nodal burden
-if positive => axillary clearance
Palpable LN => axillary clearance
Can lead to arm lymphedema and functional arm impariments
Surgical
-Mastectomy or wide local excision with reconstruction
RT - especially after WLE
Hormonal
-tamoxifen (SERM) - premenopausal, blocks estrogen
-anatrozole (aromatase inh) - post menopausal, blocks T => O
Biologics - trastuzumab (Herceptin)
-CI if PHx of heart disorders - cardiotoxic
Chemo - downstage primary lesion
SE of tamoxifen
Increased risk of endometrial cancer
VTE
Menopausal symptoms
Breast cancer met locations
Bones => high Ca and ALP
Adrenals
Lungs
Liver
Brain
Inflammatory breast cancer
-presentation
Progressive redness, edema
Absence of signs of infection
-no elevated ESR, CRP)
High CA15-3
Neoadjuvant chemo
Mastectomy
RT
Chemotherapy for breast cancer
