Breast lump (oxford clin cases) Flashcards
What are the 4 common diagnoses when someone presents with a breast lump
Fibroadenoma
Abcess
Benign cystic change
Carcinoma
What is a breast lump likely to be if someone is under 30 years old?
Benign cystic change
Galactocele/other breast feeding issue if they are breast feeding
What is a breast lump likely to be in someone over 60?
Carcinoma
In what age group is a fibroadenoma the most common diagnosis for breast lump?
Under 30s
In what age group is carcinoma the most common diagnosis for breast lump?
Over 60s
What diagnoses will you only see in breastfeeding women for breast lump?
Galactocele or mastitis
What are the 2 biggest risk factors for developing breast cancer?
Being female
Increasing age
What are some risk factors for developing breast cancer?
Female sex Increasing age Family history Pmx of breast, endometrial, bowel, ovarian cancer Prolonged oestrogen exposure Previous radiation to the chest
When would you be concerned about breast cancer in the family history?
When there are 3 blood relatives who have had it
When there are 2 blood relatives under 60
When theres 1 blood relative under 40
When any blood relative has had it bilaterally
When any male blood relative has had it
What are some reasons someone may have had prolonged oestrogen exposure?
Early menstruation Late menopause HRT (especially if oestrogen and progesterone) First child after 30 Not breastfeeding Use of OCP Obesity
If a breast lump has being growing slowly what diagnoses is more likely?
Carcinoma
If a breast lump has being grown very fast what diagnoses is more likely?
Cyst
If a breast lump changes with the menstrual cycle or cyclically in general what diagnosis is more likely and what is less likely?
Benign cyst is more likely
It is unlikely to be a carcinoma
How fast will a benign breast cyst grow?
Very fast, can appear almost overnight
What complications does breast trauma increase the risk of?
Infection
Fat necrosis
If a breast lump is painful what is the diagnosis more or less likely to be?
More likely to be mastitis or cyst
Less likely to be carcinoma
What does erythematous or warm skin on a breast lump indicate?
Infection eg mastitis or abcess
What does peau d’orange indicate when theres a breast lump?
Carcinoma until proven otherwise
What is peau d’orange?
Puckering of the skin that overlays the breast or overlays a lump
What does recent distortion of the nipple suggest?
Carcinoma
What is milky discharge from a nipple likely to be?
Galactocele
What is green/brown/yellow discharge from a nipple likely to be?
Mastitis/infection
What is bloody discharge from a nipple likely to be?
Carcinoma
What symptoms besides from breast lump will a carcinoma present with?
Usually none- systemic symptoms like fever, weight loss, night sweats are unlikely
There may be some symptoms of mets eg back pain due to spinal mets
What symptoms might accompany a breast lump?
Usually none, they often present by themselves
What are some questions you might ask about the lump in a history when someone present with breast lump?
When did the lump appear?
Has the lump grown in size? If so how fast is it growing
Do they notice it changing with their menstrual cycle?
Is it painful?
Is there any discharge from the nipple? If yes what colour is it
Are they having any other symptoms?
Have they noticed any changes to the skin of the breast?
Have they noticed any changes to the nipple?
What should you look for when you inspect the breast?
Contours- any disruptions in the natural curvature?
Asymmetry- this is natural but look for new asymmetry
Discharge
Changes to the nipples- inversion is natural but check if its new or if their nipples have always been inverted
Dimpling or peau d’orange
Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a solitary cyst on the breast
Surface= smooth Border= well defined Consistency= firm to lax Mobility= no Fixity= no Lymphadenopathy= no
Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a fibroadenoma on the breast
Surface= smooth Border= well defined Consistency= rubbery Mobility= yes Fixity= no Lymphadenopathy= no
Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a carcinoma on the breast
Surface= irregular Border= not well defines Consistency= hard Mobility= no Fixity= maybe Lymphadenopathy= maybe
What type of breast lump will have mobility?
Fibroadenoma
What will a cyst on the breast feel like- explain why
They will be either firm or lax, depending on the pressure of fluid inside them
Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a benign cystic change on the breast
Surface= irregular Border= not well defined Consistency= mixed Mobility= no Fixity= no Lymphadenopathy= no
What is a fibroadenoma?
Aberrations of normal breast tissues containing stromal or epithelial cells
How are fibroadenomas managed?
Usually they resolve by themselves
If they are increasing in size, are painful/uncomfortable or the patient really wants them gone they can be removed via excisional biopsy
How are lumps investigated in the breast clinic?
Triple assessment
What does triple assessment at a breast clinic involve?
Clinical examination
Radiography
FNA
What radiography is done for those under 35? Why?
Ultrasound because their breast tissue is too dense to view via mammography
What radiography is done for those over 35? Why?
Mammography because their breast tissue is not too dense and will be visible
On a mammogram what will indicate a cancer?
Regions of increased density, spiculations (look like shards of glass), irregular margins
What is the difference between fine needle aspiration and core biopsy when investigating a breast lump?
FNA= only tells you info on the types of cells and whether they are dysplastic or not
Core biopsy= gives you info on the local architecture of the tissue too
