Breast Lump

Question 1

History Questions

Answer 1

Describe lump
Painful? SOCRATES, uni/bilateral,rule out cardiac CP, Hx of trauma, 
Previous?
Related to period?
Getting bigger/smaller, same
Red
Nipple changes - discharge (amount, colour, consistency), bleeding, tethering
Itch
Colour change
Skin change
Family history
No. of pregnancies
Past mammograms + results
PMH

Question 2

Examination

Answer 2

Inspect - lift arms to side, look under axilla
Palpate - 4 quadrants, axilla, nipple
Palpate spine for tenderness (bony mets) + liver for HM (liver mets)

Question 3

Investigations

Answer 3

Triple assessment:

1. Clinical (history + examination)
2. Pathological: Histology (core biopsy)/cytology (fine needle aspiration -FNAC)
3. Radiological: Mammogram/US

Question 4

Breast Cancer

Answer 4

1. In-situ (pre-invasive) “ductal carcinoma in situ”
2. Invasive:
   Ductal (70%) (tubular, medullary, mucinous, papillary)
   Lobular (10%)
3. Paget’s disease of the nipple

Question 5

Benign breast lump

Answer 5

Fibroadenoma - cyclical mastalgia, hormones cause size to fluctuate, smooth well-demarcated mobile mass
Cyst - cyclical breast pain, symmetrical, resolve after menopause
Fibroadenosis = multiple cysts - multiple, tender lumps
Nodularity-normal to have ‘lumpy’ breast
Duct papillom - blood stained discharge
Duct ectasia - green nipple discharge, tender lumps under areola
Mastitis - painful inflamed breast
Breast abscess -hard, red, painful