Breast Lumps

Question 1

What are the differential diagnoses of a breast lump?

Answer 1

Menstrual changes
Fibroadenoma
Lipoma
Fat necrosis
Fibrocystic changes
Breast Ca

Question 2

If a breast lump is found how should it be investigated?

Answer 2

Triple screening:

• History and examination
• Imaging (mammogram or US in women less than 40)*
• Biopsy

Mammograms are not used in those less than 40 as they have denser glandular tissue therefore it is difficult to assess.

Question 3

Describe the key characteristics of fibroadenomas?

Answer 3

Benign breast lumps.

Highly mobile.
Painless rubbery lumps.
Well defined and should be less than 2cm.
Tend to be more common in younger women.

There should be no:

• lymphadenopathy
• erythema/skin changes

Question 4

Describe the key characteristics of a lipoma?

Answer 4

Soft fatty smooth lump.
Painless usually.
More common in obese/overweight women.

Question 5

Describe the key characteristics of fibrocystic changes?

Answer 5

Very common benign condition.
More common in younger women.

May get:
Breast swelling or thickening
Lumps within the breast, which may vary in size and texture
Heaviness
Breast pain or tenderness

Tends to change throughout the menstrual cycle in response to hormones.

Question 6

Describe the key characteristics of fat necrosis?

Answer 6

Firm tender lump +/- skin retraction
Irregular 2-3cm.

No erythema or Lympdenopathy and there should be a normal nipple.

Often history of trauma (may be minor)
More likely in middle aged overweight/obese women.

Question 7

Describe the key characteristics of breast cancer lump?

Answer 7

Hard.
Painless.
Fixed.
Rough texture.
Associated skin changes and lympadenopathy.
That has not changed/has increased in size over time.

Note: this is for late presenting disease may only have a hard lump, or may not be clinically present and picked up on screening.

Question 8

How would you treat a fibroadenoma?

Answer 8

Sometimes will disappear on there own.
Usually leave for 6 months to see if any change.
Remove if >4cm or >40y old.

Question 9

How would you treat a fibrocystic breast changes?

Answer 9

Reassurance, anti-inflammatories, topical evening primrose oil, COC

Question 10

Describe the key characteristics of a breast cyst?

Answer 10

These can be associated with fibrocystic changes or occur alone.
Well demarcated, firm + mobile
Perimenopausal women > round symmetrical lumps

Question 11

How should a breast cyst be treated?

Answer 11

Drained via USS guided. If fluid suspicious then sent away for cytology

Question 12

Describe the key characteristics of a phylloides tumour?

Answer 12

Benign tumour. Bulky and distorts breast.
40-50y
Usually remove them

Question 13

Describe the characteristics of a benign breast lump?

Answer 13

Smooth and mobile

No skin changes or lymphadenopathy