Breast disease Flashcards
What r some presenting feautures of breast disease?
How is breast disease divided? & explain their future risk of cancer?
- Non-proliferative disorders - no increased risk.
- Proliferative disorders without atypia - mild to moderate increase in risk.
- Atypical hyperplasias - substantial increase in risk (relative risk in the order of 4.1-5.3).
Causes for physiological swelling and tenderness
Puberty
• Breast enlargement, sometimes initially unilateral, is the first obvious sign of puberty in girls. Breast buds may initially be unilateral. Pubertal breast development is known as thelarche.
What is the most common benign breast disorder
how does it present?
when r the symptoms at its greatest? When do the decrease?
examination?
treatment?
Fibrocystic change
• This usually affects women aged 20-50 and appears to be hormonal in aetiology.
Most often presents with pain and nodularity.
The symptoms are greatest about one week BEFORE menstruation and decrease when it starts.
Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper outer quadrant of the breast.
If the changes are bilaterally or unilateral symmetrical, they are rarely pathological.
Choose one
Bikateral
Cyclical mastalgia
The breasts are active organs that change throughout the menstrual cycle and some degree of tenderness and nodularity in the premenstrual phase is so common that it may be considered as normal, affecting up to two thirds of all menstruating women. It rapidly resolves as menstruation starts.
Most benign lumps will be either _____or_______
cysts or fibroadenomas
Describe how a benign mass feels?
Smooth, hard,mobile, regualr borders, solid or cystic in consistency
Breasts cysts
commin in ages?
treatment
common ages of 35 & 50.
milk glands can fill up with fluid
palpable lumps and may be recurrent. (sometimes painful)
They cannot be reliably distinguished from solid tumours on clinical examination
aspirate it and the patient says its gone
Name 2 stromal tumors
type of patient, presentation, treatment
stromal (are connective tissue cells of any organ,)
WLE >> wide local excision
Most common breast lesion?
age?
where do they arise from? Composed of?
presentation?
what increases the incident?
Fibroadenomas
- benign tumours that are common in young women, peak at 20-24 years of age.
- They are the most common type of breast lesion.
- Fibroadenomas arise in breast lobules and are composed of fibrous and epithelial tissue.
- They present as firm, non-tender, highly mobile palpable lumps.
- Hormones seem to be involved in aetiology, & (HRT) increases the incidence.
Wsh tha?
Fibroadenoma
In terms of nipple discharge,
is unilateral or bilatera discharge likely to be breast cancer?
Unilateral
What is intraductal papilloma?
how does it cause nipple discharge?
wart-like lump that develops in one or more of the milk ducts in the breast
Benign growth causes imflammation>> reach end of nipple>> discharge
Mammary duct ectasia
near menopuase > major ducts behind nipple DILATE + SHORTEN & fill w/ creamy secretion w/ periductal inflammation.
COMMON IN SMOKERS!
Symptoms
- may be asymptomatic
- nipple dishcarge (bloody, creamy white or yellow, serous)
- retracted nipple (bc duct shortened)
- recurrent chronic inflammation w/ abscess formation
treatment>> surgical excison of the major duct, and correct nipple retraction.
What is this?
treatemnt
presentation
caused by?
Mastitis
Gynaecomastia
Occurs in 30% of boys at puberty
Hormone secreting tumours: e.g. sex-cord testicular
Chronic liver disease: hypogonadism + ↓E2
metabolism, kleinfelters
Drugs: spironolactone, digoxin, cimetidine
Amastia
complete absence of breast and nipple
Accessory nipples
Can occur anywhere along the milk line
Mastalgia
types? age common? releived by? treated?
Cyclical
~35yrs
Pre-menstrual pain
Relieved by menstruation
Commonly in UOQ bilaterally
Non-cyclical
~45yrs
Severe lancing (sharp) breast pain (often left)
May be assoc. ̄c back pain
Rx
check other breast disease
Reassurance + good bra for most
1st line: EPO (eveing primrose oil) (contains gamma-linoleic acid)
OCP
Topical NSAIDs (e.g. ibuprofen)
Bromocriptine ( inhibits prolactin release)
Danazol (an androgen similar to testosterone)
Tamoxifen
Inflammatory breast conditions?
type of patient, presentation, treatment
PAD Fat
fat necorosis> damage to the fatty tissue (following breast surgery, biospy, radiotherapy, trauma)
Benign Epithelial Lesions
type of patient, presentation, treatment
Malignant Conditions
type of patient, presentation, treatment
