Breast Core Conditions Flashcards
Who gets mastitis?
Primarily occurs in breast feeding women (up to 1 in 3)
Typically in the first few weeks
What causes mastitis?
Bacterial infection (often Staph aureus) typically through a tear in the skin or piercing
Infection invades the fatty tissue causing swelling and blockage of milk ducts
Abscesses form if severe/untreated
Risk factors for mastitis?
Inconsistent feeding schedule Skipping feeds Weaning too soon Bras too tight Stress Exhaustion Obesity Being of childbearing age Smoking Hx of breast abscesses
Differentials for mastitis?
Blocked duct Galactolcele Infection of mammary duct Dermatitis HSV of the nipple BCa Cyst
Symptoms of mastitis?
Breast tenderness
Red/warm skin in wedge shape
Malaise/fever
Pain on breast feeding
Investigations for mastitis?
General exam (look for skin infections) Breast exam US (biopsy for unusual cases)
Treatment for mastitis?
Mild should resolve itself
Broad spectrum Abx (ceph, erythromycin, penicillins)
Drainage for abscesses
Who is most likely to have fibrocystic disease?
Younger women of childbearing age
Causes of breast lumps?
Physiological fibrocystic change with menses Fibroadenoma Breast cysts Infection Fat necrosis following trauma Lipoma BCa
Risk factors for fibrocystic disease?
30-50
Young women (for fibroadenomas)
HRT
Symptoms of fibrocystic disease?
Breast swelling/thickening/lumps Tenderness Itching Aching Nipple discharge Typically worst before menses and then symptoms ease
Differentials for fibrocystic disease?
BCa Fibroadenoma Costochondritis Chest pain causes Cyst
Investigations for FCD?
Breast exam
US and mammogram
Fine needle aspiration
Core biopsy
Treatment for FCD?
Pain relief
NSAID gel
Heat/ice
Better fitting bra
At what age do women present with ductal papilloma?
35-55
What causes ductal papilloma?
Unknown
Risk factors for ductal papilloma?
None known
Symptoms of ductal papilloma?
Clear or bloody discharge from a nipple
Breast lump near or behind the nipple
Breast enlargement/pain
Differentials for ductal papilloma?
Ductal carcinoma in situ Invasive ductal carcinoma with an in situ component Papillary carcinoma of the breast Fat necrosis Complex breast abscess with debris
Investigations for ductal papilloma?
Breast exam
Mammography
Galactography
US
Treatment for ductal papilloma?
Mastectomy
Surgical removal of papilloma and affected ducts (microdochectomy)
Where does BCa rank in common cancers?
2nd most common cancer in women
Who gets BCa?
Women >50
Rarely in younger women
Causes of BCa?
FHx/genetics (1 in 20 due to BRCA)
High breast density
Higher oestrogen exposure (nullparity, late menopause)
HRT and OCP
Risk factors for BCa?
Age Obesity Excess alcohol Menopause >55 Being tall FHx Not breast feeding Chest radiation exposure
Symptoms of BCa?
Painless, growing mass Nipple discharge/changes Skin changes Ulcerations Lump in armpit
Differentials for BCa?
Fat necrosis Abscess Cyst Atypical ductal hyperplasia Fibrocystic disease
Investigations for BCa?
Breast exam (inc armpit) US + mammogram MRI Fine needle aspiration and cytology Biopsy
Treatment for BCa?
Surgical resection
