Breast disease Flashcards
What are the clinical features of breast fibroadenomas?
- benign tumours that are common in young women (peak 20-24)
- most common type of breast lesion
- arise in the breast lobules (composed of fibrous + epithelial tissue)
- present as firm, non-tender, high mobile palpable lumps
What are the clinical features of breast cysts?
- most common between ages 35-50 y/o
- palpable and discrete lumps
- cannot reliably distinguish from solid tumours on examination
What are the clinical features of cyclical mastalgia?
- main presentation is breast pain/discomfort
- generally involves both breasts and occurs during the pre-menstrual phase
- rapidly resolves as menstruation begins
What are the differential diagnoses for breast lumps?
- Breast cancer
- Fibroadenoma
- Breast cyst
- Duct ectasia/periductal mastitis
- Haematoma or fat necrosis
- Phyllodes tumours
- Intraductal papilloma
- Lipoma or sebaceous cyst
What is the general management of a breast lump?
- no lump → reassure; educate about breast awareness; consider reviewing in 6 weeks
- discrete lump → refer
- asymmetrical nodularity:
- <30 with FH of breast cancer or ≥30 → non-urgent referral
- <30 with no FH → review in 6 weeks; if the nodularity has gone then reassure, otherwise refer
What are the differential diagnoses for nipple discharge?
- physiological (e.g. pregnancy)
- duct ectasia
- breast cancer
- intraductal papilloma
What features indicate that nipple discharge is likely to be physiological?
- bilateral
- multiple ducts
- on expression only
- green, milky
- stains only
What features indicate that nipple discharge is likely to be pathological?
- unilateral
- single duct
- spontaneous
- red (bloody), brown or black
- profuse and watery
What is the management for nipple discharge?
- refer urgently if unilateral, spontaneous bloody discharge
- refer if >50y or features suggesting pathological cause
What are the differential diagnoses for breast pain?
- physiological
- duct ectasia/periductal mastitis
- breast cancer
- sclerosis adenosine
- mastitis
- breast abscess
- referred pain (e.g. cervical root pressure)
How should mild/moderate cyclical breast pain be managed?
- Diet → reducing saturated fats and caffeine may be helpful
- Support → wear a soft support bra at night
- OTC medication → paracetamol, NSAIDs, evening primrose oil
- Changing/stopping hormonal contraceptives or HRT
How should severe cyclical breast pain be managed?
Defined as pain for >7d/mo for >6mo which interferes with lifestyle
- try measures for management of mild/moderate cyclical pain first
- specialist treatment includes: danazol, bromocriptine, tamoxifen, LHRH
What are the potential causes of non-cyclical breast pain?
- well-localised:
- ill-fitting bras
- breast cyst
- breast abscess
- mastitis
- breast cancer (rare)
- chest wall causes - generalised:
- usually referred pain (nerve root pain, post herpetic neuralgia or lung disease)
What do scores 1-5 mean in regards to scoring breast examination, mamograms, USS, cytology and histology?
1 = normal (cytology insufficient) 2 = benign 3 = intermediate, probably benign 4 = suspicious of cancer 5 = cancer
