Breast Lumps

Question 1

What symptoms would patients with a breast lump present with?

Answer 1

• Lump
• Breast pain
• Skin or nipple changes
• Met symptoms:
  
  • bone pain or fractures,
  • lung- dyspnoea,
  • liver- abdo pain,
  • brain- headache, seizures

Question 2

What are the risk factors for breast cancer?

Answer 2

“BOOBYS”

• Bleeding: Early menarche (<13), late menopause (>55)
• Oestrogen: OCP, HRT
• Other breast disease: Previous ca, DCIS, atypia
• Breast feeding: Protective
• Young ‘un: First child >35 yo –> increased risk
• Sister: FH of breast ca

Question 3

What imaging would you carry out on a patient <35 yo with a breast lump?

Answer 3

USS

Question 4

What imaging would you carry out on a patient >35 with a breast lump?

Answer 4

USS and mammography (oblique and craniocaudal)

Question 5

When would you MRI a patient with a breast lump?

Answer 5

• Cosmetic implants
• Multifocal disease

Question 6

How would you investigate a cystic breast lump?

Answer 6

Fine needle aspirate (FNA) and cytology

• Clear fluid –> reassure
• Bloody –> send cytology
• Core biopsy if:
  
  • Residual mass
  • Positive cytology

Question 7

How would you investigate a solid breast lump?

Answer 7

Tru-Cut biopsy

Question 8

What investigations are indicated in all patients with a breast lump?

Answer 8

• Bloods:
  
  • FBC
  • LFTs
  • ESR
  • Bone profile
• Imaging: After investigative imaging, helps stage
  
  • CXR
  • Liver USS
  • CT
  • Breast MRI
  • Bone scan and PET-CT

Question 9

What are the types of malignant breast disease?

Answer 9

• Ductal carcinoma NOS: 70%
• Lobular carcinoma: 20%
• Other: Mucinous, papillary, medullary
• Phylloides tumours

Question 10

What are some congenital causes of benign breast lumps?

Answer 10

Supernumerary nipples

Hypoplasia

Question 11

What are the most common causes of a single breast lump?

Answer 11

• Fibroadenoma
• Cyst
• Fat necrosis
• Cancer

Question 12

What features of a lump would raise a suspicion of malignancy?

Answer 12

• Irregular surface
• Poorly defined edge
• Hard consistency
• Painless
• Fixation to skin or chest wall
• Nipple involvement

Question 13

What are some inflammatory causes of a benign breast lump?

Answer 13

• Mastitis (recently post partum)
• Abscess
• Fat necrosis
• Duct ectasia and periductal mastitis