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Oxford Cases in Medicine and Surgery > Breast Lumps > Flashcards

Breast Lumps Flashcards

1
Q

What are the other differentials for a breast lump?

A 
Fat necrosis
Periductal mastitis
Abscess
Galactocele
Phyllodes tumour
Sarcoma
Duct papilloma
'Non breast' lumps eg lipoma, sebaceous cyst
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2
Q

What is the most common diagnosis for a breast lump in women

A 
Physiologically normal lumpy breasts
Benign cystic change
Fibroadenoma
Abscess (if breast feeding)
Galactocele
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3
Q

What is the most common diagnosis for a breast lump in women aged 30-45?

A

Benign cystic change
Cyst
Abscess (smokers)
Carcinoma

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4
Q

What is the most common diagnosis for a breast lump in women aged 45-60?

A

Cyst

Abscess (smokers)

Carcinoma

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5
Q

What is the most common diagnosis for a breast lump in women aged >60?

A

Carcinoma

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6
Q

What breast lump diagnoses would you only come across in breast feeding women?

A

Galactoceles

Lactating women are also more prone to mastitis

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7
Q

What is are galactoceles and what is there cause?

A

Firm mass (often subareolar) and are caused by the obstruction of a laciferous duct

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8
Q

What are the main risk factors for breast cancer?

A

Previous breast cancer

Family history of breast cancer

Previous ovarian, endometrial or bowel cancer

Irradiation to the chest wall

Increased exposure to oestrogens

  • Early menarche
  • Late menopause
  • Nulliparity
  • Having first child after 30
  • Non breast feeding
  • HRT
  • COCP
  • Obesity
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9
Q

What are the relevant pieces of information you want to obtain from a woman with a breast lump?

A

How long has the lump been there for? Why was it first noticed?

Breast trauma?

Size changes? Relation to menses?

Is it painful?

Any skin changes to the breast?

Discharge from the nipple?

Otherwise fit and well?

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10
Q

Why would you ask about breast trauma in a patient with a breast lump?

A

Predispose to fat necrosis and infective sequel we such as an abscess

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11
Q

Why do you ask about change in breast lump size when taking a history from a patient with a breast lump?

A

Abscess or cysts can appear overnight and undergo rapid increases in size

Lumps that undergo cyclical change in size/character are more likely to be benign cystic breast disease

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12
Q

What kind of breast lumps are painful?

A

Benign cystic change, acute mastitis and abscesses classically cause breast pain and tenderness

Carcinoma can be painful but are more often non-tender

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13
Q

What are the most common causes of a breast lump?

A

Benign cystic change (AKA fibrocystic change)

Fibroadenoma

Cyst

Carcinoma

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14
Q

Why do you ask about changes to the skin of the breast when taking a breast lump history?

A

Warm erythematous skin should raise your suspicion of an infective or inflammatory process such as mastitis or an abscess

Or perhaps inflammatory breast carcinoma

Puckering of the skin over a lump suggests carcinoma until proven otherwise

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15
Q

Why do you ask about changes to the nipple when taking a history form a patient with a breast lump?

A

Recent distortion of the nipple hint at carcinoma

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16
Q

What kinds of nipple discharge might a patient with a breast mass experience and what are their likely causes?

A

Bloody discharge - Carcinoma

Serous or serosanguinous discharge - Intraductal papilloma

Green, brown or yellow discharge - Periductal mastitis arising from duct ectasia

Milky discharge - Galactocele

17
Q

Why do you ask about the patients general wellbeing when taking a history about a breast lump?

A

Patients with mastitis or an abscess may be febrile

Breast carcinoma rarely causes generalised systemic symptoms - such as weight loss, night sweats and fevers

Also back pain may occur in breast cancers with spinal metastases

18
Q

What do you look for on examination of the breasts?

A

Asymmetry

Contours

Skin changes

Nipple changes

19
Q

What will a solitary breast cyst feel like on examination?

A

Smooth

Distinct borders

Firm to lax consistency

Non mobile

No fixity

No lymphadenopathy

20
Q

What will a fibroadenoma feel like on examination?

A

Smooth

Distinct edges

Rubbery consistency

Mobile

No fixity

No lymphadenopathy

21
Q

What will benign cystic change feel like on examination?

A

Irregular surface

Indistinct border

Mixed consistency

No fixity

No mobility

No lymphadenopathy

22
Q

What will breast carcinoma feel like on examination?

A

Irregular

Indistinct edges

Hard consistency

No mobility

May have fixity

May have lymphadenopathy

23
Q

How are all solid lumps investigated at the breast clinic?

A

Clinical examination

Radiological examination

Fine needle aspiration or core biopsy

24
Q

What are the two treatment options for fibroadenoma?

A

Reassure the patient
- Most will resolve over several years and pose no increased risk of malignancy

Excisional biopsy
- Indication include patient preference, lump of increasing size or a lump that is causing discomfort

25
Q

What are the most likely sites of metastasis for a breast carcinoma and how are the identify?

A

Lungs - CXR

Liver - Abdominal palpation, liver enzymes, liver ultrasound

Bone - Palpation for sites of bony tenderness, serum calcium and phosphate, isotope bone scan

Brain - CT head (only if symptoms such as fitting or early morning headache and nausea)

26
Q

What is peau d’orange and what causes it?

A

Peau d’orange refers to the skin change that may occur with an infiltrating carcinoma of the breast

The skin has a dimpled appearance

27
Q

What it the difference between skin fixity and skin tethering?

A

If a lesion is fixed to the skin, it cannot be moved independently of the overlying skin

If a lesion is tethered to the skin then it can be moved independently of the skin to some extent (as if tethered by a string)

28
Q

What are the advantages of FNA in breast lump sampling?

A

Quick

Minimally invasive

Low risk of bruising or local complications

Adequate for assessing the hormone receptor status of the cancerous cells

29
Q

What are the disadvantages of FNA in breast lump sampling?

A

May have poor sensitivity

In situ and invasive disease cannot be differentiated as local architecture is lost

30
Q

What are the advantages of core biopsy in breast lump sampling?

A

In situ and invasive disease can be differentiated as local architecture is preserved during the biopsy

31
Q

What are the disadvantages of core biopsy in breast lump sampling?

A

Higher risk of complication and bruising than FNA

Results are not immediate

Requires local anaesthesia

More invasive and time consuming than FNA

32
Q

What methods exist for axillary staging of breast cancer?

A

Axillary clearance

Axillary sampling

Sentinel lymph node biopsy

33
Q

Axillary clearance

A

Removal of all local lymph nodes. Three levels of clearance (I, II and III) refer to removal of increasing numbers of lymph nodes lateral, posterior and medial to pectoralis minor

34
Q

Axillary sampling

A

A minimal dissection of axilla is undertaken and a selection of at least four nodes is removed from the low axilla for histological analysis

35
Q

Sentinel lymph node biopsy

A

Aim is to identify the first node which drains the breast

Blue dye and/or radio-isotope is injected into the peri-areolar tissure in the same breast quadrant as the cancerous tissue - taken up by node

Single node can be removed and sent for histology

36
Q

What is the scoring system used to describe breast cancer staging?

A

Eg P4R4C4B5

P = Physical examination
R = Radiological examination
C = Cytology (FNA)
B = Biopsy (core)

1 = normal, 2 = benign, 3 = probably benign, 4 = probably benign, 5 = malignant

37
Q

What is ANDI?

A

Aberrations of Normal Development and Involution

Oxford Cases in Medicine and Surgery (19 decks)

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