Breast Lumps Flashcards
Breast lump assessment
Triple assessment:
1) Clinical examination
2) Radiology
3) Histology / Cytology
Radiological assessment for breast lumps
< 35 yrs USS
> 35 yrs USS + mammogram
Modes of cytology for breast lump assessment
Core biopsy or Fine needle aspiration
+/- Sentinel node biopsy
Role of sentinel node biopsy
Reduces unnecessary axillary lymph node clearance
Breast cyst definition
Benign
Fluid filled
Mobile
Breast cyst epidemiology
Common > 35 yrs
esp Peri-menopausal
Mastitis / Breast abscess definition
Infection of mammary duct
Associated with lactation
Most common cause of mastitis
Staph aureus
Sx of breast abscess
Painful, hot swelling of breast segment
Mx of breast abscess
Abx / drainage
Mx of mastitis
Abx if:
Milk culture positive
Open infected nipple fissure
Failure to improve with 24hrs effective milk removal
Abx for mastitis
Flucloxacillin
Duct ectasia definition
Around menopause
Ducts become blocked
Secretions stagnate
Sx of duct ectasia
Nipple discharge
Green/brown/bloody
+/- nipple retraction or lump
Mx of duct ectasia
Usually none required
Fat necrosis definition
Lump following breast tissue injury
Fibrosis + calcification post injury
No Rx needed
Fibroademona definition
Benign overgrowth of collagenous mesenchyme of one breast lobule
Fibroadenoma age of presentation
Usually < 30 yrs
Sx of fibroadenoma
Firm
Smooth
Mobile
Painless
Mx of fibroadenoma
Observation and reassurance
Surgical excision if large
Biochemical cause of gynaecomastia
Raised oestrogen/androgen ratio
Causes of gynaecomastia
Hypogonadism Liver cirrhosis Hyperthyroidism Tumours Drugs
Drug causes of gynaecomastia
Oestrogen
Spironolactone
Digoxin
Paget’s disease of the breast
Intra-epidermal spread of an intraduct cancer
Sx of Paget’s disease of breast
Any red scaly lesion of nipple - must biopsy
Looks like eczema
Mx of Paget’s disease of breast
Breast conserving surgery
+ Radiotherapy
+ Sentinel node biopsy
Tamoxifen
ER antagonist
Hormonal therapy for ER positive tumours
Anastrozole
Aromatase inhibitor
Post-menopausal hormonal therapy for ER positive tumours
Targets peripheral E2 synthesis
Generic name for Herceptin
Traztuzumab
Traztuzumab
For HER2 positive tumours
Goserelin
GnRH analogue
If premenopausal + ER positive
Shrink tumour prior to surgery
