breast lump, breast discharge Flashcards
investigating a new breast symptom - cancer Australia
breast symptoms - features suggesting breast cancer (5)
contour
- thickening or ridge on breast
- breast or nipple asymmetry
surface
- skin changes - dimpling, redness
- nipple changes or discharge
deep
- unilateral breast pain
breast symptoms - ‘significant’ nipple changes (4)
contour
- whole nipple inversion
- ulceration
surface
- color change
- eczematous changes
breast symptoms - ‘significant’ nipple discharge (3)
- 1 sided
- bloody or serous, from 1 duct
- age over 60
breast examination - inspection - 3 positions to examine breasts
- arms by side
- arms raised above head
- arms pressed on hips, leaning forward
breast examination - inspection - characteristics to observe (2)
breast
nipple
breast examination - inspection - breast -abnormalities to consider (6)
silhouette
- erythema
- skin change
- peau d’orange
contour
- dimpling
- puckering
- visible lumps
breast examination - inspection - nipples - abnormalities to consider (6)
- height difference
- inversion
- erythema
- eczema
- nodules
- ulcers
breast symptoms - what situations can investigation be deferred
- no lump
- changes are likely normal hormonal change
- discharge in both breasts
- discharge on expression
breast symptoms - ‘non-significant symptoms’
- management
- stop expressing
- review at 6-8 weeks
- mammogram if due
- arrange imaging if sx. persists
breast symptoms - criteria that warrant further imaging
- unilateral spontaneous discharge
- discharge in age >50
- discharge from a single duct
- bilateral symptoms but abnormal clinical exam
breast symptoms requiring investigation - when is ultrasound + mammogram indicated (2)
- over 35
- nipple discharge warranting investigation
breast symptoms requiring investigation - when to do ultrasound first (3)
- under 35
- pregnant
- breastfeeding
breast symptoms requiring investigation - additional imaging warranted if something suspicious on breast is detected
ipsilateral axillary ultrasound
breast symptoms requiring investigation - difference between core biopsy and FNA in diagnostic ability
core biopsy can differentiate in-situ vs invasive
FNA cannot differentiate insitu vs invasive
breast symptoms - indication for referral to specialist breast investigation clinic
clinical findings
- ‘significant’ nipple or discharge sx
- suspicious clinical exam
imaging findings
- imaging or core biopsy +ve
- can’t completely aspirate cyst
- blood in cyst aspirate
- results confusing
rx response
- inflammatory breast condition that doesn’t respond to 2 weeks antibiotics
