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Oxford Clinical Cases > Breast Lump > Flashcards

Breast Lump Flashcards

1
Q

List the four most common causes of breast lump.

A

Benign cystic change
Fibroadenoma
Breast cyst
Carcinoma

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2
Q

List some other causes of breast lump.

A 
Fat necrosis 
Abscess 
Mastitis 
Galactocoele 
Sarcoma 
Duct papilloma
Non-breast lumps (e.g. lipoma, sebaceous cysts)
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3
Q 
Which causes of breast lump are most likely in:
< 30 yrs
30-40yrs
45-60yrs
> 60yrs
A 
- < 30 yrs
Fibroadenoma
Physiological lumpy breast 
Benign cystic change
- 30-40 yrs
Benign cystic change 
Breast cyst 
Abscess 
Carcinoma 
- 45-60 yrs
Breast cyst 
Abscess 
Carcinoma 
- 60 yrs
Carcinoma
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4
Q

List two causes of breast lump that are exclusive to breast-feeding women.

A 
) Galactocoele
Occurs shortly after cessation of lactation 
Caused by blockage of lactiferous ducts 
May get infects 
2) Mastitis
More common in breast-feeding women
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5
Q

Which organisms are usually responsible for mastitis?

A

Staphylococcus aureus

Staphylococcus epidermidis

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6
Q

List the major risk factors for breast cancer.

A 
Previous breast cancer
Family history of breast cancer 
Chest wall irradiation
Previous cancer (in particular: ovarian, endometrial, bowel)
Increased exposure to oestrogen
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7
Q

List some examples of increased exposure to oestrogen that can be elicited from a history.

A 
Early menarche
Late menopause 
Nulliparity (= woman who has never given birth)
Late first child (> 30 yrs)
HRT 
COCP
Not breast-feeding
Obesity
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8
Q

List some important questions that should be asked regarding the history of presenting complaint.

A

How long has the lump been there for?
Has there been any trauma to the breast?
Is the lump painful?
Has it changed in size? Is the change in size related to your menstrual cycle?
Have you noticed any changes in the skin on the breast?
Have you noticed any discharge?
Are you otherwise fit and well?

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9
Q

Which causes of breast lump appear quite rapidly?

A

Cysts

Abscesses

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10
Q

Which causes of breast lump appear more gradually?

A

Fibroadenoma

Carcinoma

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11
Q

Why is it important to ask about breast trauma?

A

Increases the risk of fat necrosis and infective causes of breast lump (e.g. abscess, mastitis)

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12
Q

Why is it important to ask about the relationship between the changing size of the breast lump and the patient’s menstrual cycle?

A

The lumps in benign cystic change undergo cyclical changes in size and character

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13
Q

Which causes of breast lump are classically associated with being painful?

A

Benign cystic change
Abscess
Mastitis

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14
Q

What would warm, erythematous skin overlying the lump suggest?

A

Infective/inflammatory cause (e.g. mastitis, abscess)

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15
Q

What does tethering of the skin over the lump suggest?

A

Carcinoma until proven otherwise

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16
Q 
Describe the character of the discharge in:
Breast Carcinoma
Intraductal Papilloma
Periductal Mastitis
Galactocoele
A 
- Breast Carcinoma
Bloody
- Intraductal Papilloma
Serous or seranguinous 
- Periductal Mastitis
Yellow, green, brown
- Galactocoele
Milky
17
Q

Define duct ectasia.

A

A condition in which the lactiferous ducts become blocked or clogged

18
Q

Why is it important to check whether the patient is otherwise fit and well?

A

Most patients with breast lumps don’t have an other symptoms
Patients with infective/inflammatory causes of breast lump (e.g. mastitis, abscess) may experience fever
NOTE: breast cancer rarely leads to systemic signs of malignancy

19
Q

List some key features of inspection of the breasts.

A

Asymmetry
Contours
Skin changes
Nipple discharge

20
Q

List some skin changes of the breast that you should look out for.

A 
Erythema 
Ulceration
Peau d’orange 
Tethering
Radiotherapy tattoos
21
Q 
Describe what the following lumps feel like on palpation:
Solitary Cyst 
Benign Cystic Change
Fibroadenoma
Carcinoma
A

Solitary Cyst
Smooth surface + distinct border + firm to lax
NOTE: feels similar to fibroadenoma
Benign Cystic Change
Irregular surface + indistinct borders + mixed consistency
Fibroadenoma
Smooth surface + distinct borders + rubbery + mobile
Carcinoma
Irregular surface + indistinct borders + hard
Tethering?
Lymphadenopathy?

22
Q

What are the components of triple assessment?

A

Clinical examination
Radiological examination
FNA and core biopsy

23
Q

Which types of radiological assessment of the breast lump are offered to patients?

A

< 35 years = ultrasound
35+ years = two-view mammogram
NOTE: younger women do not get mammograms because their breast tissue is more dense and it is difficult to identify masses

24
Q

What is the difference between an FNA and a core biopsy?

A

FNA – samples cells for cytology

Core biopsy – samples tissue for histology

25
Q

Describe the management of fibroadenomas.

A

Benign condition that will resolve over several years

Can be removed by excisional biopsy

26
Q

What are the four most common sites of metastasis of breast cancer?

A

Liver
Bone
Lungs
Brain

27
Q

Describe the treatment options for breast cancer.

A

Local Treatments: Radiotherapy + Surgery

Systemic Treatments: Chemotherapy + Hormonal Therapy + Monoclonal Antibodies

28
Q

Describe the typical presentation of a patient with a breast abscess.

A

Sudden appearance of a painful lump
Usually in middle-aged smokers
Fever, skin erythema and tethering may also be found

29
Q

What important risk factor is strongly associated with breast abscess and non-lactational mastitis?

A

Smoking

30
Q

How are breast abscesses treated?

A

Incision and drainage

Antibiotics

31
Q

Describe the typical presentation of breast cysts.

A

Well-circumcribed lump with a smooth surface and firm texture (may be painful)

32
Q

How can cysts and fibroadenomas be distinguished?

A

Ultrasound
Cysts will be hypoechoic
Fibroadenomas will be hyperechoic
NOTE: when cysts are drained, the fluid will be green, brown or yellow

33
Q

What is gynaecomastia?

A

Enlargement of the breasts in males, either due to hormone imbalance or drug therapy

34
Q

List some pathological causes of gynaecomastia.

A

Liver disease
Drugs (e.g. spironolactone, cimetidine, finasteride)
Primary testicular failure (e.g. bilateral cryptorchidism)
Acquired testicular failure
Secondary testicular failure (e.g. panhypopituitarism)
Endocrine tumours (e.g. testicular, adrenal, pituitary)

Oxford Clinical Cases (28 decks)

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