Breast Lumps Flashcards
What are the other differentials for a breast lump?
Fat necrosis Periductal mastitis Abscess Galactocele Phyllodes tumour Sarcoma Duct papilloma 'Non breast' lumps eg lipoma, sebaceous cyst
What is the most common diagnosis for a breast lump in women
Physiologically normal lumpy breasts Benign cystic change Fibroadenoma Abscess (if breast feeding) Galactocele
What is the most common diagnosis for a breast lump in women aged 30-45?
Benign cystic change
Cyst
Abscess (smokers)
Carcinoma
What is the most common diagnosis for a breast lump in women aged 45-60?
Cyst
Abscess (smokers)
Carcinoma
What is the most common diagnosis for a breast lump in women aged >60?
Carcinoma
What breast lump diagnoses would you only come across in breast feeding women?
Galactoceles
Lactating women are also more prone to mastitis
What is are galactoceles and what is there cause?
Firm mass (often subareolar) and are caused by the obstruction of a laciferous duct
What are the main risk factors for breast cancer?
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
What are the relevant pieces of information you want to obtain from a woman with a breast lump?
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?
Why would you ask about breast trauma in a patient with a breast lump?
Predispose to fat necrosis and infective sequel we such as an abscess
Why do you ask about change in breast lump size when taking a history from a patient with a breast lump?
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
What kind of breast lumps are painful?
Benign cystic change, acute mastitis and abscesses classically cause breast pain and tenderness
Carcinoma can be painful but are more often non-tender
What are the most common causes of a breast lump?
Benign cystic change (AKA fibrocystic change)
Fibroadenoma
Cyst
Carcinoma
Why do you ask about changes to the skin of the breast when taking a breast lump history?
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
Why do you ask about changes to the nipple when taking a history form a patient with a breast lump?
Recent distortion of the nipple hint at carcinoma
What kinds of nipple discharge might a patient with a breast mass experience and what are their likely causes?
Bloody discharge - Carcinoma
Serous or serosanguinous discharge - Intraductal papilloma
Green, brown or yellow discharge - Periductal mastitis arising from duct ectasia
Milky discharge - Galactocele
Why do you ask about the patients general wellbeing when taking a history about a breast lump?
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
What do you look for on examination of the breasts?
Asymmetry
Contours
Skin changes
Nipple changes
What will a solitary breast cyst feel like on examination?
Smooth
Distinct borders
Firm to lax consistency
Non mobile
No fixity
No lymphadenopathy
What will a fibroadenoma feel like on examination?
Smooth
Distinct edges
Rubbery consistency
Mobile
No fixity
No lymphadenopathy
What will benign cystic change feel like on examination?
Irregular surface
Indistinct border
Mixed consistency
No fixity
No mobility
No lymphadenopathy
What will breast carcinoma feel like on examination?
Irregular
Indistinct edges
Hard consistency
No mobility
May have fixity
May have lymphadenopathy
How are all solid lumps investigated at the breast clinic?
Clinical examination
Radiological examination
Fine needle aspiration or core biopsy
What are the two treatment options for fibroadenoma?
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
