Breast Lump Flashcards
A lady presents with a breast lump- what sequence of history would you perform?
AGE
ICE
Presenting Complaint (breast lump) Constitutional Symptoms Past breast medical history Past Family History Medical & gynecological History General Features of pc
A lady presents with a breast lump- what would you ask in her PC?
AGE
ICE
Presenting Complaint (breast lump)
• Location, single/multiple • Duration • Any change in size • Consistency? Soft/squishy or firm • Mobility • Constant or fluctuating? (hormonal) • Associated Symptoms: - Pain - Discharge or nipple changes - Skin dimpling or eczema/orange peel - Asymmetry
Constitutional Symtoms:
spine aches/pains
What would you ask her next?
PAST HISTORY
What questions would you ask about the history
- Mammogram
- Previous benign lumps (do they self check?)
- Previous breast cancer
- Trauma or radiation exposure to the breast
What would you ask after Past Medical History?
FAMILY HISTORY
• Breast Cancer – gene testing (BRCA1/2)
• Details of relative with breast cancer
• Related cancers – uterus, ovary, bowel
After family history what could you ask about?
Menstural, Gynecological and Obstetric history
What would you ask about her Menstrual, Gyny and Obstetric hx
- Age menarche
- Age of menopause (late menopause)
- Use of OCP
- HRT
- Nulliparous? Number of children? Where they breast fed? (difficulty with breast feeding)
- Age when had first child (? >30)
Next Q?
General features she has noticed
General Features -?
General Features • Appetite loss, Weight loss • Aches/pain – bone pain! • Respiratory System – cough, dyspnoea (metastasis) • Liver - jaundice
What are some differential diagnosis’ for breast pain?
- Cyclical (associated with menstruation)
- Pregnancy
- Infection – mastitis, abcess
- Neoplasia (breast pain is an uncommon presenting complaint of breast cancer)
What is the managment for breast pain?
Pain alone does not require investigation. Most is self limiting & essentially hormonal (role of HRT). Treatment -
What are some main differentials you would be thinking in a breast lump ?
- Carcinoma until proven otherwise - In situ cancer rarely palpable
- Thickening of normal breast tissue -
- Fibrocystic disease
- Fibroadenoma
- Fat necrosis
- Pyllodes tumour (rare)
- Abscess
- Less commonly: duct ectasia, duct papilloma, Paget’s disease, sarcoma, lipoma
What would be the management for breast lump? AGE IMPORTANT
If 35 mammogram/USS (+/- core biopsy)
Treatment – if any suspicion, excise
What would you expect if your suspicion was Fibroadenoma?
most common benign neoplasm in <25 yo.
More frequent and occurs at younger age in black women. Multiple tumors in 10-15% pts.
Typically round, RUBBERY, discrete, movable, non-tender 1-5cm, discovered accidentallty-
What would you expect if your suspicion was fibrocystic cause
painful,
often multiple,
usually bilateral masses in the breast. Rapid Fluctuation in the size is common.
Frequently, pain occurs or worsens and size increases during PREMENSES
Most common age is 30-50.
Increased risk of breast cancer if they have a variant with epithelial proliferation
