breast disease: signs and symptoms Flashcards
what are the common symptoms of breast disease
lump change in shape or distortion of lump skin changes nipple changes nipple discharge infection pain - mastalgia
what is included in a breast history
HPC
- location
- duration
- change
- relation to mestrual cycle
- age
PMH
- menstural history - menarche, pregnancies, gynaecological procedures
DH
- Oral contraceptive pill
- HRT
FH
- breast and ovarian cancer
SH
what investigations would you do for breast disease
imaging
- ultrasound - used when there is more dense breast tissue in people who are less than 40 or who are pregnanct and lactating
- mamography - in people who are over 35. in screening there are 2 views done and in symptoms there are more views
- MRI for more detail
needle biopsy
- core biospy - sample of breast tissue with preserved architecture which differentiates between invasive and in situ disease which can be used to grade the tumour and determine receptor statis
- fine needle aspiration - isolated cells and cannot distinguish between invasive and in situ disease
this is all done in the tripple assessment
- physical examination
- radiological imaging
- biopsy
you grade breast cancer from 1-5
- normal
- benign
- uncertain
- suspicious
- malignant - 5a in situ and 5b malignant
what are the most common benign breast conditions
benign lumps
- fibroadenoma
- cysts
- traumatic fat necrosis
- phyllodes tumour
hormonal breast conditions
- gynaecomastia
breast infection and acute inflammatory conditions
- periductal mastitis
- acute bacterial mastitis
- abscess
what is fibroadenoma, how is it diagnosed and treated
fibroadenoma is the most common breast lump and is commonly found in young women in the seccond decade of life due to an aberration of normal development
the lump is
- rubbery
- firm
- painless
- oval, smooth, well defined borders
- mobile, detatched
diagnosed through tripple assesment
teated through reassurance and monitoring. it may grow or it may regress and may be necessary for excision
what is a cyst, how is it diagnosed and treated?
a cyst is a distended, fluid filled lobule which is most common in the 4th and 5th decades of life. they can change with the normal hormonal cycle so will increase in size and be painful just before mensturation
presentation
- single or multiple lumps
- smooth
- fluctuant
- recent short history
- associated with pain and tenderness
diagnosed through tripple assessment with an ultrasound being diagnostic
treated through reassurance and advice, aspiration may be needed
what is traumatic fat necrosis, how is it diagnosed and treated?
iatrogenic (surgical) or blunt (seatbelt or elbow injury) trayma causes fat necrosis or breakdown of the adipose tissue which mimics carcinoma
presentation
- lump
- irregular
- firm
- may be skin changes such as thickening or retraction
- may be bruising
imaging may be confusing and be mixed up with carcioma so must be confirmed with biopsy
it should resolve on its own but may leave a fat cyst
what is a phyllodes tumour, how is it diagnosed and treated?
a rare tumour that tends to occur between 40 and 50 and arrises from stromal cells sarcoma, it can be benign, borderline or malignant. It rarely metastasises but can reocur locally
presentation
- firm lump
- mobile
- well circumscribed
- non tender
- similar to fibroadenoma
- grows quickly
diagnosed through tripple assessment
managed through a wide excision and regular mammograms to follow up
what is gynaecomastia, how is it diagnosed and treated?
proliferation of the breast tissue in males due to an altered oestrogen-androgen balance. This may be physiological during puberty or it may be pathological
- drugs
- liver cirrhosis
- testicular tumour
- hypogonadism
- idiopathic
presentation
- varies from small rubbery to firm mass
- can be unilateral or bilateral
diagnosis
- needs to exclude carcinoma
- tripple assessment
management
- reassurance and management of the cause may mean it will resolve
- if it does not resolve then may need liposuction, excision or cosmetic surgery
what is periductal mastitis, how is it diagnosed and treated?
inflamatory process around dilated milk ducts. this may be contributed to by smoking
presentation
- pain
- nipple discharge
- nipple retraction
- cellulitis
- subareolar mass
- mammary duct fistula in periareolar region
diagnosis - thickened or dilated ducts on US
management - antibiotics and possibly a total duct excision
what is acute bacterial mastitis and abcess, how is it diagnosed and how is it treated?
this is useually associated with lactation from saphylococcus aureus infection. It may also be associated with immunocomprimisation.
presentation
- breat inflammation
- localised breast area or spread to entire breast
- fluctuant mass
- systemic signs of infectoon
diagnosed through pus visible on US
treated with antibiotics, continuance of breastfeeding and aspiration of abcess
what are the different types of breast cancer?
named after where they are found
ductal carcinoma - most common
- intraductal DCIS - non invasive
- invasice ductal carcinoma IDC - most common
lobular
tubular
medullary
mucinous
less common types of breast cancer
- inflammatory breast cancer
- pagets disease of the nipple
- malignant phyllodes tumour
how does breast cancer spread?
direct extension to the skin, muscle and chest wall
lymphatic spread - axillary and internal thoracic nodes first
haematological - commonly affects the lungs, liver, bone and brain
what are the risk factors of breast cancer
- female
- age
- family history
- genetics - BRACA gene
- oestrogen exposure - early menarche, late menopause, later age at first pregnancy, hormonal medication exposure (oral contraceptive, HRT)
- chest radiation
- lifestyle factors - alcohol, obesity
protective factors
- breastfeeding
- physical activity
what are the features of breast cancer
lump - firm/hard, irregular
nipple retraction or inversion
blood stained nipple discharge
pagets disease of the nipple - excema like changes
skin tethering - fixing to underlying muscles
peu d’orange appearence
change in breast shape / contour
palpable axillary lymph nodes
