breast lumps

Question 1

how do you assess lumps?

Answer 1

She Cuts The Fish PERfectly
S: Site, Size, Surface (overlying skin)
C: Colour, Contour (regular/ irregular borders), Consistency
T: Tenderness, Temperature, Transilluminable
F: Flutuance (fluid filled cysts), Fixity, Fields (regional lymph nodes)
P: Pulsitilty (aneurysms)
E: expansibility
R: reducibility

Question 2

what needs a 2WW within breast lumps?

Answer 2

• Woman aged 30< with unexplained breast lump – with/ without pain
• Woman aged 50< with one or more within one nipple: discharge, retraction, anyb other cause for concern
• Women aged 30+ with unexplained axillary lump
• Skin changes suggestive of breast cancer
• Someone of any age with suggestive symptoms and strong FHx of early breast/ ovarian cancer  BRCA gene

Question 3

what is a triple assessment?

Answer 3

should be done for all breast lumps  refer to breast clinic
- Examination
- Fine needle aspiration / cytology
- Imaging – mammography >50, US – everyone else

Question 4

what is a quadruple assessment?

Answer 4

same as triple + mammography and US
- Depends on breast clinic

Question 5

why is US done on younger as 1st line generally?

Answer 5

• US is done first line on younger  good in denser tissue (younger more likely ot have denser tissue)

Question 6

how is triple assessment graded?

Answer 6

E5,C5, M/U4
1. Examination
- E1: normal – no lump
- E2: benign lump
- E3: lump
- E4: suspicious lump
- E5: probable cancer
2. Cytology
- C1: bad sample
- C2: benign
- C3: atypical features, still likely benign
- C4: atypical features, probably malignant
- C5: malignant
- 3. Imaging
- M1/U1: normal
- M2/U2: benign
- M3/U3: probably benign
- M4/U4: probably malignant

Question 7

what is a fibroadenoma?

Answer 7

: common benign tumours of stromal/ epithelial breast duct tissue
- Typically small and mobile within breast

Question 8

why are fibroadenomas known as breast mice?

Answer 8

move around within breast tissue

Question 9

when are fibroadenomas most common?

Answer 9

common on younger woman (20-40)
- Respond to female hormones (oestrogen/ progesterone)
- Hence less incidence after menopause

Question 10

how do fibroadenomas present on examination?

Answer 10

Presentation: on exam
- Painless
- Smooth
- Round
- Well circumscribed – well defined borders
- Firm
- Mobile_ move under the skin and above chest wall
- Usually up to 3cm in diameter

Question 11

is there a link of btreast cancer and fibroadenomas?

Answer 11

Prognosis: not cancerous and not usually associated with increased risk of developing breast cancer
- Complex fibroadenomas + positive FHx of breast cacner  higher risk

Question 12

what are fibrocystic changes?

Answer 12

Can be normal – as is generalised lumpiness

Question 13

what is the pathophysiology of fibrocystic breast changes?

Answer 13

Pathophys: connective tissues (stroma), ducts and lobules of the breast respond to female sex hormones (oestrogen and progesterone) becoming fibrous (irregular and Hard) cyctic (fluid-filled)
- Can fluctuate throughout cycle

Question 14

when are fibrocystic changes most likely?

Answer 14

• Common in women of menstruation age
• Often occur within 10days prior to menstruating and resolve once come on period
• Symptoms improve/ resolve following menopause

Question 15

what are symptoms of fibrocystic changes?

Answer 15

• Lumpiness
• Breast pain/ tenderness
• Fluctuation of breast size

Question 16

what is mastalgia?

Answer 16

breast pain/ tenderness

Question 17

what management methods can help mastalgia?

Answer 17

• Wearing supportive bra
• NSAIDs
• Avoid caffeine
• Applying heat to area
• Hormonal treatment – danazol/ tamoxifen under specialist

Question 18

what are breast cysts?

Answer 18

Benign, individual, fluid filled lumps

Question 19

when are breast cysts most common?

Answer 19

Incidence: most common cause of breast lumps
- Common between 30 -50
- More common within perimenopausal period (around time of menopause)

Question 20

how do you manage breast cysts?

Answer 20

Management: require further assessment to exclude exam
- Triple assessment: exam, imaging, aspiration – cutology
- Aspiration can resolve symptoms in those with pain

Question 21

are breast cysts linked to breast cancer?

Answer 21

Breast Cancer risk: breast cyst can increase risk

Question 22

what is fat necrosis?

Answer 22

benign lump formed by localised degeneration and scarring of fat tissue in the breast
- May be associated with oil cyst containing liquid fat

Question 23

what can trigger fat necrosis?

Answer 23

localised trauma, radiotherapy, surgery  inflame reaction causing fibrosis/ necrosis

Question 24

is fat necrosis linked to breast cancer?

Answer 24

no

Question 25

how would fat necrosis present on examination?

Answer 25

painless, firm, irregular fixed to local structures skin dimpling/ nipple inversion

Question 26

what diagnostic tests can be used for fat necrosis?

Answer 26

• US/ mammogram can show similar appearance to BC
• Histology from fine needle biopsy: can confirm and exclude BC

Question 27

what are lipomas?

Answer 27

: benign tumours of adipose (fat) tissue
- Can occur anywhere on body

Question 28

how would lipomas present on examination?

Answer 28

Exam: soft, painless, mobile, do not cause skin changes

Question 29

what are the management options of lipomas?

Answer 29

Management: reassurance
- Can be surgically removed if necessary

Question 30

what are phyllodes tumour?

Answer 30

rare tumour of connective tissue (stroma)

Question 31

what age group is phyllodes tumour most common?

Answer 31

mainly occur in those 40-50

Question 32

how does phyllodes tumour present?

Answer 32

large and fast growing

Question 33

are phyllodes tumour malignant?

Answer 33

• Can be benign -50%
• Borderline -25%
• Malignant – 25%
• Malignant phyllodes tumours can metastasise

Question 34

how do you manage phyllodes tumours?

Answer 34

treatment surgical removal of tumour and surrounding tissue  wide excision
- Can reappear following excision
- Chemo: malignant/ metastatic tumours