Breast Lumps and Pain

Question 1

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

Answer 1

adipose, areola, ducts, lobules

Question 2

What is the tripple assessment of breast cancer?

Answer 2

1. Clinical assessment (history and examination)
2. Imaging (USS or mammography)
3. Histology (fine needle aspiration or core biopsy)

Question 3

List 4 clinical features which may suggest breast cancer

Answer 3

1. Hard, irregular, painless or fixed lumps
2. Lumps may be tethered to the skin or the chest wall
3. Nipple retraction
4. Skin dimpling or oedema (peau d’orange)

Question 4

Two week wait referral for suspected breast cancer?

Answer 4

• ≥ 30 with unexplained breast lump
• ≥ 50 with unilateral nipple changes (discharge, retraction or other changes)

Question 5

What is a fibroadenoma?

Answer 5

Benign tumours of stromal/epithelial breast duct tissue

Question 6

Describe the typical presentation of a fibroadenoma

Answer 6

Small and mobile within the breast tissue - sometimes called a “breast mouse”

Question 7

In what age group are fibroadenomas most common?

Answer 7

Between 20 and 40 years

Respond to oestrogen and progesterone, hence why they are more common in younger women and often regress after menopause

Question 8

List 4 clinical features of a fibroadenoma

Answer 8

• 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

Question 9

What are Fibrocystic Breast Changes?

Answer 9

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

Question 10

List 3 key symptoms of fibrocystic breast changes

Answer 10

1. Lumpiness
2. Breast pain or tenderness (mastalgia)
3. Fluctuation of breast size

Question 11

What must be excluded In a patient presenting with lumpiness, mastalgia and or fluctuation of breast size?

Answer 11

Breast cancer

Question 12

What are breast cysts?

Answer 12

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

Question 13

Examination findings of breast cysts

Answer 13

• Smooth
• Well-circumscribed
• Mobile
• Possibly fluctuant

Question 14

How may pain associated with breast cysts be treated?

Answer 14

Aspiration

Question 15

What is Fat necrosis?

Answer 15

Benign lump formed by localised degeneration and scarring of fat tissue in the breast

Commonly triggered by localised trauma, radiotherapy or surgery

Question 16

Examination findings of fat necrosis

Answer 16

1. Painless
2. Firm
3. Irregular
4. Fixed in local structures
5. May be skin dimpling or nipple inversion

Question 17

Fat necrosis may mimic what condition?

Answer 17

Breast cancer

Histology (core biopsy) may be required to confirm the diagnosis and exclude cancer

Question 18

What are lipomas?

Answer 18

Benign tumours of fat (adipose) tissue

Can occur almost anywhere on the body where there is adipose tissue

Question 19

Examination findings of lipomas

Answer 19

1. Soft
2. Painless
3. Mobile
4. Do not cause skin changes

Question 20

What is a Galactocele?

Answer 20

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

Question 21

How does a Galactocele present?

Answer 21

Firm, mobile, painless lump, usually beneath the areola.

Question 22

What is a Phyllodes tumour?

Answer 22

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%)

Question 23

Treatment of Phyllodes tumours?

Answer 23

Surgical removal (“wide excision”) +/- chemotherapy in malignant or metastatic tumours

Question 24

How can breast pain (mastalgia) be classified?

Answer 24

1. Cyclical – occurring at specific times of the menstrual cycle
2. Non-cyclical – unrelated to the menstrual cycle

Question 25

Typical features of cyclical breast pain?

Answer 25

1. Bilateral and generalised
2. Heaviness
3. Aching

Question 26

How may cyclical breast pain be diagnosed?

Answer 26

A breast pain diary

Question 27

Management of cyclical breast pain (mastalgia)

Answer 27

• Wearing a supportive bra
• NSAIDs
• Avoiding caffeine
• Applying heat to the area
• Hormonal treatments (eg. danazol and tamoxifen)

Question 28

List 4 causes of non-cyclical breast pain?

Answer 28

1. Idiopathic
2. Medications (eg. contraception)
3. Mastitis
4. Pregnancy

Question 29

List 3 key things to exclude in anyone presenting with breast pain?

Answer 29

1. Cancer
2. Infection (mastitis)
3. Pregnancy

Question 30

Where may non-cyclical breast pain be felt?

Answer 30

1. Breast
2. chest wall (eg. costochondritis)
3. Skin (eg. shingles or post-herpetic neuralgia)