Breast Lump Flashcards
What are the 4 most common diagnoses for breast lump?
- Benign cystic change
- Fibroadenoma
- Cyst
- Carcinoma
Age is v important when looking at ddx for breast lump. What are the ddx for different age groups?
<30: normal lumpy breast, benign cystic change, abscess/galactocele (both if breast feeding)
30-45: benign cystic change, abscess (if smoker), carcinoma
45-60: cyst, abscess (smoker), carcinoma
60+: carcinoma
MUST EXCLUDE BREAST CANCER AS A DDX. Or you could get a malpractice claim.
Which diagnoses would you only encounter in breastfeeding women?
Galactocele - can occur during/just after lactation
Lactating women also predisposed to mastitis
What are the main RFs for breast cancer
- Previous breast cancer
- FHx of breast cancer
- Previous ovarian / endometrial / bowel cancer
- Irradiation to chest wall
- Increased exposure to oestrogens
What aspects of the HPC are important
- How long has lump been there? Abscess/cyst appears rapidly. Tumours grow slowly.
- Any breast trauma? Predisposes to e.g. abscess
- Lump bigger/smaller/same size? - Abscess and cyst can rapidly increase in size.
Lumps that undergo cyclical changes in size/character (e.g. becoming more tender) are likely to be?
Benign cystic breast disease
What information about the breast or lump should be ascertained
- Is lump painful? - pain = benign cystic breast, acute mastitis, abscesses. Carcinomas usually non-tender lumps.
- Skin changes on breasts? - white erythematous skin = infective/inflammatory cause. Puckering of overlying skin = carcinoma until otherwise proven. Nipple distortion suggests carcinoma.
- Nipple discharge? - bloody = carcinoma. Serous/seosanguinous = intraductal papilloma. Green/brown/yellow discharge = periductal mastitis. Milky discharge = galactocele
- Is the patient fit and well? - febrile = mastitis/abscess. Back pain may indicate metastasis to spinal cord
What are the key features to look for in a breast exam
Asymmetry - new changes are significant
Contours
Skin changes - erythema/ulceration/dimpling/puckering/radiotherapy tattoos
Nipple changes/discharge
What kind of surface does a solitary cyst/fibroadenoma have?
What about benign cystic change / carcinoma?
Solitary cyst/fibroadenoma = smooth surface
Benign cystic change / carcinoma = irregular surface
What kind of border does a solitary cyst / fibroadenoma have?
What about benign cystic change / carcinoma?
Solitary cyst /fibroadenoma = distinct borders
Benign cystic change/fibroadenoma = indistinct borders
What consistency does a carcinoma have?
Hard
What type of lump is typically quite mobile
Fibroadenoma
What kind of consistency does a fibroadenoma have?
Rubbery
Where do breast carcinomas metastasise to?
Lung
Liver
Bone
Brain
Out of fibroadenomas and cysts, which are painful
Cysts are painful