Breast Lumps and Pain Flashcards
Most of the breast is ______ tissue. The ______ surrounds the nipple.
Behind the nipple are the ______, which lead into the ______, where breast milk is produced.
Milk is secreted through the ducts and out of openings on the nipple
adipose, areola, ducts, lobules
What is the tripple assessment of breast cancer?
- Clinical assessment (history and examination)
- Imaging (USS or mammography)
- Histology (fine needle aspiration or core biopsy)
List 4 clinical features which may suggest breast cancer
- Hard, irregular, painless or fixed lumps
- Lumps may be tethered to the skin or the chest wall
- Nipple retraction
- Skin dimpling or oedema (peau d’orange)
Two week wait referral for suspected breast cancer?
- ≥ 30 with unexplained breast lump
- ≥ 50 with unilateral nipple changes (discharge, retraction or other changes)
What is a fibroadenoma?
Benign tumours of stromal/epithelial breast duct tissue
Describe the typical presentation of a fibroadenoma
Small and mobile within the breast tissue - sometimes called a “breast mouse”
In what age group are fibroadenomas most common?
Between 20 and 40 years
Respond to oestrogen and progesterone, hence why they are more common in younger women and often regress after menopause
List 4 clinical features of a fibroadenoma
- Painless
- Smooth
- Round
- Well circumscribed (well-defined borders)
- Firm
- Mobile (moves freely under the skin and above the chest wall)
- Usually up to 3cm diameter
What are Fibrocystic Breast Changes?
Benign condition causing fibrous and cystic changes to the breast
Responds to O&P hence symptoms occur prior to menstruating and resolve once menstruation begins. Usually resolves after menopause
List 3 key symptoms of fibrocystic breast changes
- Lumpiness
- Breast pain or tenderness (mastalgia)
- Fluctuation of breast size
What must be excluded In a patient presenting with lumpiness, mastalgia and or fluctuation of breast size?
Breast cancer
What are breast cysts?
Benign, individual, fluid-filled lumps which can be painful and may fluctuate in size over the menstrual cycle
Occur between ages 30-50, esp in perimenopausal period
Examination findings of breast cysts
- Smooth
- Well-circumscribed
- Mobile
- Possibly fluctuant
How may pain associated with breast cysts be treated?
Aspiration
What is Fat necrosis?
Benign lump formed by localised degeneration and scarring of fat tissue in the breast
Commonly triggered by localised trauma, radiotherapy or surgery
Examination findings of fat necrosis
- Painless
- Firm
- Irregular
- Fixed in local structures
- May be skin dimpling or nipple inversion
Fat necrosis may mimic what condition?
Breast cancer
Histology (core biopsy) may be required to confirm the diagnosis and exclude cancer
What are lipomas?
Benign tumours of fat (adipose) tissue
Can occur almost anywhere on the body where there is adipose tissue
Examination findings of lipomas
- Soft
- Painless
- Mobile
- Do not cause skin changes
What is a Galactocele?
Occur in women that are lactating, often after stopping breastfeeding
They are breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk
How does a Galactocele present?
Firm, mobile, painless lump, usually beneath the areola.
What is a Phyllodes tumour?
Rare tumours of the CT (stroma) of the breast. They are large and fast-growing.
Occur between 40 - 50 and may be benign (50%), borderline (25%) or malignant (25%)
Treatment of Phyllodes tumours?
Surgical removal (“wide excision”) +/- chemotherapy in malignant or metastatic tumours
How can breast pain (mastalgia) be classified?
- Cyclical – occurring at specific times of the menstrual cycle
- Non-cyclical – unrelated to the menstrual cycle
Typical features of cyclical breast pain?
- Bilateral and generalised
- Heaviness
- Aching
How may cyclical breast pain be diagnosed?
A breast pain diary
Management of cyclical breast pain (mastalgia)
- Wearing a supportive bra
- NSAIDs
- Avoiding caffeine
- Applying heat to the area
- Hormonal treatments (eg. danazol and tamoxifen)
List 4 causes of non-cyclical breast pain?
- Idiopathic
- Medications (eg. contraception)
- Mastitis
- Pregnancy
List 3 key things to exclude in anyone presenting with breast pain?
- Cancer
- Infection (mastitis)
- Pregnancy
Where may non-cyclical breast pain be felt?
- Breast
- chest wall (eg. costochondritis)
- Skin (eg. shingles or post-herpetic neuralgia)
