breast lumps Flashcards
how do you assess lumps?
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
what needs a 2WW within breast lumps?
- 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
what is a triple assessment?
should be done for all breast lumps refer to breast clinic
- Examination
- Fine needle aspiration / cytology
- Imaging – mammography >50, US – everyone else
what is a quadruple assessment?
same as triple + mammography and US
- Depends on breast clinic
why is US done on younger as 1st line generally?
- US is done first line on younger good in denser tissue (younger more likely ot have denser tissue)
how is triple assessment graded?
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
what is a fibroadenoma?
: common benign tumours of stromal/ epithelial breast duct tissue
- Typically small and mobile within breast
why are fibroadenomas known as breast mice?
move around within breast tissue
when are fibroadenomas most common?
common on younger woman (20-40)
- Respond to female hormones (oestrogen/ progesterone)
- Hence less incidence after menopause
how do fibroadenomas present on examination?
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
is there a link of btreast cancer and fibroadenomas?
Prognosis: not cancerous and not usually associated with increased risk of developing breast cancer
- Complex fibroadenomas + positive FHx of breast cacner higher risk
what are fibrocystic changes?
Can be normal – as is generalised lumpiness
what is the pathophysiology of fibrocystic breast changes?
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
when are fibrocystic changes most likely?
- Common in women of menstruation age
- Often occur within 10days prior to menstruating and resolve once come on period
- Symptoms improve/ resolve following menopause
what are symptoms of fibrocystic changes?
- Lumpiness
- Breast pain/ tenderness
- Fluctuation of breast size
what is mastalgia?
breast pain/ tenderness
what management methods can help mastalgia?
- Wearing supportive bra
- NSAIDs
- Avoid caffeine
- Applying heat to area
- Hormonal treatment – danazol/ tamoxifen under specialist
what are breast cysts?
Benign, individual, fluid filled lumps
when are breast cysts most common?
Incidence: most common cause of breast lumps
- Common between 30 -50
- More common within perimenopausal period (around time of menopause)
how do you manage breast cysts?
Management: require further assessment to exclude exam
- Triple assessment: exam, imaging, aspiration – cutology
- Aspiration can resolve symptoms in those with pain
are breast cysts linked to breast cancer?
Breast Cancer risk: breast cyst can increase risk
what is fat necrosis?
benign lump formed by localised degeneration and scarring of fat tissue in the breast
- May be associated with oil cyst containing liquid fat
what can trigger fat necrosis?
localised trauma, radiotherapy, surgery inflame reaction causing fibrosis/ necrosis
is fat necrosis linked to breast cancer?
no
