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Phase 3a Jemima > Breast disease - women's health > Flashcards

Breast disease - women's health Flashcards

(104 cards)

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1
Q

what is Peau d’orange

A

it is an irregular patch of skin which may be associated with inflammatory breast cancer

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2
Q

what causes Peau d’orange

A

blocked lymphatic drainage from the affected skin area causes superficial oedema which makes the skin thickened. The sweat ducts cause small dimples within the oedematous skin leading to a thickened and dimpled appearance

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3
Q

what is pagets disease of the nipple

A

it is an erythematous scaly rash of the nipple region which resembles eczema, it can be itchy inflamed or ulcerated
- may indicate an underlying breast cancer

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4
Q

what is the basic anatomy of the breast

A

the breast sits in front of the chest wall. Most of the breast is adipose tissue, the areola surrounds the nipple. Behind the nipple are the ducts which lead into lobules where breast milk is produced. Milk is secreted through the ducts and out of openings in the nipple

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5
Q

what does triple assessment involve when screening for cancer

A

clinical assessment - history and exam
imaging - ultrasound or mammogram
histology - fine needle aspiration or core biopsy

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6
Q

what clinical features may suggest breast cancer

A

lumps that are hard, irregular, painless or fixed
lumps tethered to either the skin or the chest wall
nipple retraction
skin dimpling or oedema

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7
Q

when do you refer someone on two week wait for suspected breast cancer

A
  1. unexplained breast lump in patients aged 30 or above
  2. unilateral nipple changes in patients 50 or above
  3. consider referral if there is an unexplained lump in the axilla or if there are skin changes suggestive of cancer
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8
Q

what is a fibroadenoma

A

it is a common benign tumour of the stromal or epithelial duct tissue

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9
Q

when are fibroadenomas most common

A

in younger women between the ages of 20 and 40

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10
Q

on examination what are fibroadenomas like

A

painless
smooth
round
well circumscribed
firm
mobile
usually up to 3cm in diameter

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11
Q

what is fibrocystic breast changes

A

it is considered a variation of normal
it is a benign condition causing lumpiness and pain of the breast

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12
Q

what causes fibrocystic breast changes

A

the connective tissue (stroma), ducts and lobules of the breast respond to oestrogen and progesterone, and become fibrous and cystic. this can fluctuate with the menstrual cycle

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13
Q

when do the symptoms of fibrocystic breast changes present

A

it normally presents around 10 days prior to menstruation and will resolve once menstruation begins

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14
Q

what are the symptoms of fibrocystic breast changes

A

lumpiness
pain or tenderness (mastalgia)
fluctuation in breast size

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15
Q

what is the management for fibrocystic breast changes

A

wearing a supportive bra
non steroidal anti-inflammatories
avoid caffeine
apply heat to the area
hormonal treatments (danazol and tamoxifen)

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16
Q

what are breast cysts

A

these are benign, individual, fluid filled lumps

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17
Q

on examination what can breast cysts feel like

A

smooth
well circumscribed
mobile
possibly fluctuant
can be painful

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18
Q

what is the management of breast cysts

A

require further assessment to rule out cancer
aspiration is the patient is in pain

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19
Q

what happens if you get fat necrosis of the breast

A

you have a benign lump

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20
Q

what happens when there is fat necrosis of the breast

A

there is localised degeneration and scarring of the fat tissue due to inflammation and fibrosis, which may be associated with an oil cyst, causing a lump

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21
Q

what are common causes of fat necrosis in the breast

A

trauma
radiotherapy
surgery

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22
Q

on examination what is fat necrosis of the breast like

A

painless
firm
irregular
fixed in local structures
there may be dimpling of the skin or nipple inversion

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23
Q

what is the management of fat necrosis of the breast

A

need to have imaging and histology to rule out cancer
it is treated conservatively normally as it will go away over time
can have surgical excision if the symptoms are bad

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24
Q

what is a lipoma

A

benign tumours of fat tissue

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25
what is a lipoma like on examination
soft painless mobile does not cause any skin changes
26
how is lipoma treated
they are typically treated conservatively with reassurance they can be surgically removed
27
what is a galactocele
it can occur in women that are lactating they are breast milk filled cysts that occur when the lactiferous duct is blocked
28
how does a galactocele present
firm mobile painless usually beneath the areola
29
how do you treat galactocele
benign and usually resolve without treatment can be drained rarely become infected and require antibiotics
30
what is phyllodes tumour
rare tumour of the stroma (connective tissue) which are large and very fast growing - can be benign, borderline and malignant
31
what age are phyllodes tumours most common in
ages 40-50
32
how do you treat phyllodes tumour
surgical removal and surrounding tissue chemotherapy if malignant
33
what are they two types of breast pain
cyclical non cyclical
34
what is cyclical pain
it is breast pain that is related to hormonal fluctuations in the menstrual cycle
35
when does cyclical breast pain typically present
normally presents two weeks before menstruation and settles during the menstrual period
36
what are the other symptoms of premenstrual syndrome other that breast pain
low mood bloating fatigues headaches
37
what are symptoms of cyclical breast pain
bilateral and generalised breast pain heaviness aching
38
when is non cyclical breast pain common
more common in women aged 40-50
39
what can be causes of non cyclical breast pain
medications - hormonal contraceptives infection pregnancy chest wall pain - costochondritis skin issues - shingles, post herpetic neuralgia
40
how do you diagnose breast pain
breast pain diary - cyclical breast pain history and exam to rule out cancer perform pregnancy test to rule out pregnancy need to rule out infection
41
how do you manage breast pain
wearing a supportive bra NSAIDS - oral or topical avoiding caffeine applying heat to the area hormonal treatments - danazol and tamoxifen
42
what is gynaecomastia
it is the enlargement of glandular breast tissue in males
43
what causes gynaecomastia
it is caused by a hormonal imbalance between oestrogen and androgens (testosterone), with it being caused by higher oestrogen levels high levels of prolactin can also stimulate glandular breast tissue development
44
what are causes of gynaecomastia
idiopathic dopamine antagonists - increased prolactin physiological in adolescence due to increased oestrogen in puberty obesity - increased oestrogen testicular cancers liver cirrhosis and liver failure hyperthyroidism hGC secreting tumour - small cell lung cancer testosterone deficiency of old age hypothalamus/pituitary changes klinefelters syndrome orchitis testicular damage
45
what are some medications that can cause gynaecomastia
anabolic steroids antipsychotics digoxin - stimulates oestrogen receptors spironolactone - inhibits testosterone production GnRH agonists opiates marijuana alcohol
46
how do you tell the difference between gunaecomastia and breast enlargement due to obesity
on palpation there will be firm tissue behind the areolas in gynaecomastia due to growth of the gland and duct tissue
47
what points should be covered in a gynaecomastia examination
if its true gynaecomastia or weight gain unilateral or bilateral and palpable lumps, skin changes or lymphadenopathy BMI testicular examination signs of testosterone deficiency signs of liver disease signs of hyperthyroidism
48
what investigations would you want to do for gynaecomastia
Bloods: U+E, LFT, TFT, testosterone, sex hormone binding globulin, oestrogen, prolactin, LH and FSH, alpha fetoprotein and beta-hCG, genetic karyotyping imaging: breast ultrasound, mammogram, biopsy, testicular ultrasound, chest X-ray
49
how is gynaecomastia managed
- stop causative drug - tamoxifen to reduce effect of oestrogen - surgery - refer to specialist if cancer suspected
50
what is galactorrhoea
it is breast milk production not associated with pregnancy or breastfeeding
51
where is prolactin produced
anterior pituitary gland
52
what inhibits the secretion of prolactin in pregnancy
oestrogen and progesterone
53
what stimulated milk excretion
oxytocin
54
what are key causes of hyperprolactinaemia
idiopathic prolactinomas - hormone secreting tumours endocrine disorders - hypothyroidism and PCOS medications - dopamine antagonists
55
how can hyperprolactinaemia present
menstrual irregularities - amenorrhoea reduced libido erectile dysfunction in men gynaecomastia in men
56
what is a prolactinoma
it is a tumour of the pituitary which causes excessive secretion of prolactin - may be associated with multiple endocrine neoplasia (MEN) type 1
57
what are the two classes of prolactinomas
microprolactinomas - smaller than 10cm macroprolactinomas - larger than 10cm
58
what adverse effects can macroprolactinomas lead to
headaches bitemporal hemianopia
59
what breast diseases can cause nipple discharge that is not breast milk
mammary duct ectasia duct papilloma pus from a breast abscess
60
what investigations should be done if someone who is having galactorrhoea
serum prolactin renal profile (U+E) liver function tests thyroid function tests pregnancy test should be done in women of childbearing age MRI scan
61
what is the investigation of choice for diagnosing a pituitary tumour
MRI scan
62
what is the management for galactorrhoea
dopamine agonists (bromocriptine/cabergoline) used to treat the symptoms of hyperprolactinaemia trans sphenoidal surgical removal or the pituitary tumour
63
what is mammary duct ectasia
it is a benign condition where there is dilation of the large ducts in the breasts
64
how can mammary duct ectasia present
nipple discharge - due to inflammation in ducts, may be white, green or grey tenderness or pain nipple retraction or inversion - slit like retraction a breast lump (pressure on lump may produce discharge)
65
how is mammary duct ectasia diagnosed
Need to exclude breast cancer ! clinical assessment - history and exam imaging - ultrasound, mammography, MRI histology - core biopsy or fine needle aspiration
66
what key finding is seen in mammary duct ectasia mammogram
microcalcifications (although not specific)
67
what other investigations may be performed in mammary duct ectasia
ductography - contrast injected into an abnormal duct and mammograms used to visualise the duct nipple discharge cytology ductoscopy - inserting tiny endoscope into the duct
68
how is mammary duct ectasia managed
can resolve without any treatment reassurance after excluding cancer symptomatic management of mastalgia antibiotics if infection is present/suspected surgical excision of the affected duct in problematic cases
69
what is an intraductal papilloma
it is a warty lesion that grows within a duct of a breast due to the proliferation of epithelial cells - it is a benign tumour of the breast
70
what is the typical presentation of intraductal papilloma
can present asymptomatically and picked up incidentally clear or blood stained nipple discharge tenderness or pain palpable lump
71
at what age are intraductal papillomas most common
35-55
72
how are intraductal papillomas diagnosed
clinical assessment - history and exam imaging - ultrasound, mammogram, MRI histology- core biopsy, vacuum assisted biopsy ductography may also be used to visualise the duct
73
how are intraductal papillomas managed
complete surgical excision after removal the tissue is examined for atypical hyperplasia or cancer
74
what is mastitis
it is inflammation of the breast tissue can occur with or without infection
75
what are causes of mastitis
blockage - obstruction and accumulation of milk flow infection - bacteria can enter at the nipple and back tract into ducts
76
what is the most common cause of infective mastitis
staphylococcus aureus
77
how does mastitis present
breast pain and tenderness (unilateral) erythema in a focal area of the breast tissue local warmth and inflammation nipple discharge fever
78
how is mastitis managed
conservative - continue breastfeeding and breast massage, heat packs, warm showers, simple analgesia medication - flucloxacillin (first line), erythromycin if allergic to penicillin, fluconazole for candidiasis
79
what is a rare complication of mastitis
breast abscess
80
how is a breast abscess managed
surgical incision and drainage
81
how does candida infection of the nipple present
recurrent mastitis sore nipples bilaterally particularly after feeding nipple tenderness and itching cracked flaky or shiny areola symptoms in the baby such as white patched in the mouth, on the tongue or candidal nappy rash
82
what is the treatment for candida of the nipple
topical miconazole 2%, put on nipple after each breastfeed treatment for baby - oral miconazole gel or nystatin
83
what is a breast abscess
it is a collection of pus within an area of the breast, usually caused by bacterial infection
84
what are the types of breast abscess
lactational - associated with breastfeeding non lactational
85
what is a key risk factor in the development of infective mastitis and breast abscess
smoking
86
what are the most common causative bacteria of breast abscesses
staphylococcus aureus (most common) streptococcus enterococcus anaerobic bacteria - Bacteroides and anaerobic streptococci
87
how does breast abscess present
acute nipple changes purulent nipple discharge localised pain tenderness tenderness warmth erythema hardening of the skin or breast tissue swelling
88
what are key features of a breast abscess
swollen, fluctuant, tender lump within the breast
89
how is non lactational mastitis managed
analgesia antibiotics treatment of the underlying cause - eczema, candida infection (broad spectrum abx)
90
how are breast abscesses managed
referral to on call surgical team antibiotics ultrasound (confirm dx) drainage - needle aspiration or surgical incision and drainage microscopy, culture and sensitivities of drained fluid
91
how many women will develop breast cancer in their life
1 in 8
92
what are risk factors for breast cancer
female increased oestrogen exposure - early period onset and later menopause more dense breast tissue - more glandular tissue obesity smoking family history - first degree relative COCP - small increase HRT - particularly combined HRT
93
what genetic factor predisposes you to developing breast cancer
BRCA gene mutations in either BRCA1 or BRCA2 - BRCA1 is on chromosome 17 (increased risk of breast cancer in faults with this one over BRCA2) - BRCA2 is on chromosome 13 rare genetic abnormalities - TP53, PTEN
94
what are different types of breast cancer
ductal cancer in situ lobular carcinoma in situ invasive ductal carcinoma invasive lobular carcinoma inflammatory breast cancer pagets disease of the nipple medullary breast cancer mucinous breast cancer tubular breast cancer
95
what are the characteristics of ductal carcinoma in situ
it is precancerous or cancerous epithelial cells of the breast ducts localised to a single area often picked up on mammogram screening potential to spread over years potential to become invasive breast cancer good prognosis if excised and adjuvant treatment
96
what are the characteristics of lobular carcinoma in situ
a pre-cancerous condition occurring in pre menopausal women (typically) usually asymptomatic and undetectable on mammogram usually diagnosed incidentally on breast biopsy increased risk of future invasive breast cancer managed with close monitoring
97
what are characteristics of invasive ductal carcinoma - NST (non special/specific type)
originates from the cells in the breast ducts 80% of invasive breast cancers is this can be seen on mammograms
98
what are the characteristics of invasive lobular carcinomas
originate in cells from the breast lobules 10% of invasive cancers not always visible on mammograms
99
what are the characteristics of inflammatory breast cancer
presents similarly to a breast abscess or mastitis swollen, warm, tender breast with pitting skin doesnt respond to Abx 1-3% of breast cancers worse prognosis than other breast cancers
100
what are the characteristics of pagets disease of the nipple
looks like eczema of the nipple/areolar erythematous, scaly rash indicated breast cancer involving the nipple may represent DCIS or invasive cancer
101
what is the breast cancer screening program in the UK
it is a screening program that offers a mammogram every three years to women aged 50-70
102
what is the recommendations for screening patients who are high risk of developing breast cancer
patients may be seen in a secondary care breast clinic or in a specialist genetic clinic patients get genetic counselling and pre test counselling annual mammograms are offered to women who are increased risk chemoprevention may be offered to women who are high risk risk reducing bilateral mastectomy or bilateral oophorectomy may be done in high risk women
103
what criteria indicate a woman is high risk for developing breast cancer
first degree relative with breast cancer under 40 first degree male relative with breast cancer first degree relative with bilateral breast cancer first diagnosed under 50 two first degree relatives with breast cancer
104

Phase 3a Jemima (16 decks)

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