Breast Lump Flashcards
What are the four most common diagnoses for a breast lump
Benign cystic change/fibroadenosis
Fibroadenoma
Cyst
Carcinoma
What are the most common diagnoses of a breast lump in patients <30
Physiologically normal, lumpy Benign cystic change Fibroadenoma Abscess (if breastfeeding) Galactocele (If breastfeeding)
What are the most common diagnoses of a breast lump in patients 30-45
Benign cystic change
Abscess (esp. smokers)
Carcinoma
What are the most common diagnoses of a breast lump in patients 45-60
Cyst
Abscess (esp. smokers)
Carcinoma
What are the most common diagnoses of a breast lump in patients >60
Carcinoma
What are galactoceles and how do they present
Caused by obstruction of a lactiferous duct -> become sdistended with milk + epithelial cells
Present as a firm mass (often subareolar) during or shortly after cessation of breastfeeding. Very similar to a cyst on exam.
May become infected -> abscess formation
What are the common causes of mastitis
Skin commensals e.g. S. aureus or staph. epidermis in lactating women
Anaerobic in older women (periductal)
What are the important risk factors for breast cancer
Being female and increasing age Previous breast cancer Family history of breast cancer Previous ovarian, endometrial or bowel cancer Irradiation to the chest wall Increased exposure to oestrogens
What may cause increased exposure to oestrogens
Early menopause (<13) or Late (>51) Nulliparity Having a first child after 30 Not breast-feeding HRT COCP use Obesity
What questions should be asked about a breast lump
How long has the lump been there, when was it noticed Breast trauma? Changes in size, any relating to menses Painful lump Any skin changes Any discharge or nipple changes Risk factors and general health
What can the length of time a lump has been there tell you
Very quick - abscess or cyst
Longer period - fibroadenoma or carcinoma
What is the association between breast trauma and any lumps
Trauma, accidental or iatrogenic, can predispose to fat necrosis and infective sequelae e.g. abscess
What does the changes in size to a breast lump tell you
Abscesses and cysts can change size very rapidly
What can pain tell you about a breast lump
Benign cystic change, acute mastitis and abscesses classically cause pain and tenderness
What do skin changes on the breast tell you
Warm erythematous skin - mastitis or abscess or inflamed carcinoma
Peau d’orange (puckering) suggests carcinoma
What do changes to the nipples ± discharge (blood, milk, coloured, serous) tell you
Recent nipple change - carcinoma
Blood - carcinoma
Milk - galactocele
green/brown/yellow - periductal mastitis from duct ectasia
Serous/seroanguinous - intraductal papilloma
What does back pain with a breast lump suggest
Sign of metastases to the spine
What should be looked for on breast exam
Asymmetry Contours Skin changes (erythema, ulceration, dimpling, radiotherapy tattoo) Nipple changes or discharge
What would a solitary cyst feel like on palpation
Smooth, distinct borders, firm-lax, not mobile or fixed
No lymphadenopathy
What would a fibroadenoma feel like on palpation
Smooth, distinct borders, rubbery, mobile, not fixed
No lymphadenopathy
What would a benign cystic change feel like on palpation
Irregular, indistinct borders, mixed consistency, NOT mobile or fixed
No lymphadenopathy
What would a carcinoma feel like on palpation
Irregular, indistinct borders, hard consistency, NOT mobile, may be fixed and may have lymphadenopathy
What is a fibroadenoma
Aberrations of normal breast development that contains stromal and epithelial elements
7-30% of young women will have one at some stage
How are all solid lumps investigated in a breast clinic
Clinical examination
Radiological examination (USS <35yrs, mammography otherwise)
Fine needle aspiration or core biopsy
What are the treatment options for a fibroadenoma
Either leave it to resolve or excision biopsy
Where do breast carcinomas often metastasise to and which are investigated
Lungs
Liver
Bone
Brain
Liver and bone is always investigated, lung and brain only if they are clinically suspected
How are the following investigated for metastases from the breast: Lungs Liver Bone Brain
Liver: CT/MRI abdomen
Bone: axial skeleton bone scintigraphy or CT/MRI AND imaging of long bones via scintigraphy or radiograph. Blood tests (Ca2+, ALP, phos)
Lungs: CT
Brain: CT
In general, what treatments are available for a breast carcinoma
Surgery or radiotherapy
Chemo, hormonal therapy, monoclonal Abs e.g. herceptin
What is the management for a breast abscess
Antibiotics
Refer to surgeons for drainage
Smoking cessation
What are some causes of gynaecomastia
Liver disease
Drugs e.g. cimetidine, spironolactone, phenothiazines, finasteride, steroids
Primary/acquired/secondary testicular failure
Endocrine tumours e.g. pit, testicular, adrenal
Non-endocrine tumour e.g. bronchial
What are the advantages and disadvantages of fine needle aspiration
Quick, minimally invasive
Low risk of bruising or local complications
Adequate to assess hormone receptor status
May have poor sensitivity. In situ and invasive disease cannot be differentiated
What are the advantages and disadvantages of core biopsy
In situ and invasive disease can be differentiated
Higher risk of local complications and bruising
Results are not immediate
Requires more local anaesthesia, more invasive and time-consuming
What methods exist for axillary staging of breast cancer
Axillary clearance (remove local lymph nodes) Axillary sampling (minimal dissection of the axilla, at least 4 nodes removed) Sentinel lymph node biopsy (injeciton of blue dye and/or radio-isotope into the periareolar tissue)
