BREAST LUMP Flashcards
TWO WEEK WAIT REFERRAL CRITERIA
Descrete lump with FIXATION
Women >30 with PERSISTENT BREST OR AUXILLARY LUMP
Previous breast cancer
SKIN OR NIPPLE CHANGES suggestive of breast cancer
UNILATERAL BLOODY NIPPLE DISCHARGE
Fibroadenoma:
What is it?
Who does it affect?
How does it present?
Benign tumour of stromal/ epithelial breast duct tissue
Most common in <40s
Smooth, well-circumscribed, firm, MOBILE lump (usually <3 cm)
Usually painless, may be tender around menstruation
Fibroadenoma:
management
cancer risk
Hormone-dependent, so will regress after menopause
Surgery –> if large, complex of juvenile fibroadenoma
Slight increased risk of cancer if COMPLEX OR MULTIPLE fibroadenomas
Fibrocystic disease:
what is it?
who does it affect?
when does it resolve?
Benign condition related to hormone changes around menstrual cycle
Affects women of menstruating age
Usually resolves after menopause
Fibrocystic disease - presentation
BILATERAL breast lumpiness & tenderness
Fluctuation of breast size
Symptoms occur WITHIN 10 DAYS BEGORE MENSTRUATION & resolve afterwards
Green/ dark nipple discharge
Fibrocystic disease - management
Supportive Clothing
NSAIDs
Weight Loss
Hormonal contraception may make it worse (consider stopping)
Breast Cyst:
what is it?
who does it affect?
how does it present?
Discrete collection of fluid in the breast - i.e. fluid in the milk glands
Most common age 30-60
smooth, well circumscribed, mobile lump
May be tender/ painful (not always!!)
Breast Cyst - management
conservative (usually self-limiting)
Needle aspiration
Breast Abscess:
what is it?
who does it affect?
Acute (usually bacterial) infection of the breast tissue
Most common in women who are BREAST FEEDING (i.e. if mastitis is untreated)
Breast Abscess - presentation
Painful, red, warm breast
Tender lump
Assc: FEVER, PUS DISCHARGE FROM NIPPLE
Breast Abscess - diagnosis & management
ULTRASOUND
Surgical inscision & drainage - then PO antibiotics
Fat Necrosis:
what is it?
what can cause it?
Lump formed by degeneration/ scarring of fat tissue
INFLAMMATORY REACTION –> results in fibrosis & necrosis
Caused by ANY DAMAGE TO BREAST TISSUE - e.g. local TRAUMA or BREAST SURGERY / RADIOTHERAPY
Fat Necrosis - presentation
A firm, irregular, fixed lump. May cause skin dimpling or nipple inversion
(usually painless but can be painful)
Fat Necrosis - investigation
Mammogram - FAT NECROSIS LOOKS LIKE BREAST CANCER ON XRAY –> NEED TO BIOPSY
Fat Necrosis - management
May resolve spontaneously (usually several months)
Or surgical excision
Lipoma:
what is it?
how does it present?
how is it managed?
Benign collection of FAT
Soft, painless, mobile lump
Conservative/ surgery
Breast cancer: presentation
Hard, irregular, painless, FIXED lesion
May be tethered to skin or chest wall
May cause nipple retraction/ skin dimpling (peu d’orange)
Differentials for a breast lump (8)
Fibroadenoma Fibrocystic Disease Cyst Abscess Fat Necrosis Lipoma Phyllodes Tumour Breast Cancer
Phyllodes Tumour:
what is it?
how does it present?
how is it managed?
Rare tumour from connective tissue. May be benign, borderline or malignant
Difficult to distinguish from fibroadenoma
Surgery! WIDE EXCISION
