Breast lumps, moles and lymph nodes Flashcards
What are 10 differentials for a breast lump, other than malignancy?
- Fibroadenoma
- Fibroadenosis / fibrocystic disease / benign mammary dysplasia
- Breast cancer
- Mammary duct ectasia
- Duct papilloma
- Fat necrosis
- Breast abscess
- Breast cyst
- Scerlosing adenosis
- Epithelial hyperplasia
What are breast fibroadenomas?
lumps which develop from a whole lobule of the breast
What is the character of breast fibroadenomas?
mobile, firm breast lumps - known as a ‘breast mouse’
What proportion of all breast lumps are breast fibroadenomas?
12%
What proportion of breast fibroadenomas will get smaller over a 2 year period?
30%
Is there increased risk of malignancy with breast fibroadenomas?
no
What is the management of breast fibroadenomas and what does this depend on?
if >3cm, surgical excision is usual
What is a Phyllodes tumour and what is the management?
rare cause of breast lump; resembles fibroadenoma but tends to occur in older women and grow continuously whereas fibroadenomas tend to stop
should be widely excised, mastectomy if lesion large
How does a breast cyst usually present?
usually presents as a smooth discrete lump (may be fluctuant)
Is there an increased risk of breast cancer with breast cysts?
yes, small increased risk (especially if younger)
What is the management of breast cysts?
should be aspirated, those which are blood stained or persistently refill should be biopsied or excised
What does sclerosing adenosis of the breast involve?
radial scars and complex sclerosing lesions
What are 2 aspects of the presentation of sclerosing adenosis?
- Usuallt presents as breast lump or breast pain
- Causes mammographic changes which may mimic carcinoma
What happens to the breast tissue in sclerosing adenosis?
Cause disortion of distal lobular unit without hyperplasia (complex lesions will show hyperplasia)
considered a disorder of involution
Does the risk of malignancy increase with sclerosing adenosis?
no
What is the management of sclerosing adenosis of the breast?
lesions should be biopsied, excision is not mandatory
What is the presentation of epithelial hyperplasia?
variable clinical presentation ranging from generalised lumpiness through to discrete lump
What happens within the breast in epithelial hyperplasia?
increased cellularity of terminal lobular unit, atypical features may be present
What are 2 things which confer much greater increased risk of malignancy with epithelial hyperplasia?
- Atypical features
- Family history of breast cancer
What is the management of epithelial hyperplasia of the breast?
if no atypical features then conservative; those with atypical features require either close monitoring or surgical resection
What is the aetiology of fat necrosis of the breast in up to 40% of cases?
traumatic aetiology
What do the physical features of fat necrosis of the breast usually mimic?
carcinoma
What is may be the course of fat necrosis with time?
mass may increase in size initially
What is the management of fat necrosis of the breast?
imaging and core biopsy
How do duct papillomas present?
usually with nipple discharge, usually originates from single duct
if large may present with a mass
Is there an increased risk of malignanc with duct papillomas?
no
What is the management of duct papillomas?
microdochectomy
In what age group are fibroadenomas common?
<30 years
In what age group does fibroadenosis of the breast often present?
most common in middle-aged women
How does fibroadenosis of the breast present?
lumpy breasts which may be painful
symptoms may worsen prior to menstruation
What is the typical presentation of breast cancer?
hard, irregular lump. may be associated nipple inversion or skin tethering
What is Paget’s disease of the breast?
intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/ areola
What is mammary duct ectasia?
diltation of the large breast ducts
When does mammary duct ectasia most commonly occur?
most common around the menopause
How may mammary duct ectasia present?
- May present with a tender lump around the areola +/- a green nipple discharge
- If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
In which women is a breast abscess more common?
lactating women
How does a breast abscess present?
red, hot, tender swelling
When does NICE say you should refer people using the 2 week wait referral for breast cancer? 2 situations
- Aged 30 and over and have unexplained breast lump with or without pain, or
- Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
What are 2 situations when NICE suggests you should consider a suspected cancer pathway referral for breast cancer within 2 weeks?
- Skin changes that suggest breast cancer
- Aged 30 and over with an unexplained lump in the axilla
When you should consider non-urgent referral for breast changes?
aged under 30 with unexplained breast lump with or without pain
What is the method for determining whether to refer a skin lesion via 2ww pathway to secondary care?
7-point checklist; 2ww if score 3 or more
What is the method of diagnosis of melanoma?
excision biopsy, performed in secondary care
What is the checklist for diagnosing skin cancer in primary care?
major features of lesions, scoring 2 points each:
- change in size
- irregular shape
- irregular colour
minor features, scoring 1 point each:
- largest diameter 7mm or more
- inflammation
- oozing
- change in sensation
What is the referral made if a squamous cell carcinoma is seen on the skin?
2 week wait referral
How is confirmation of a diagnosis of squamous cell carcinoma made in primary care?
excision biopsy
What are 3 features of basal cell carcinomas?
- Ulcer with raised rolled edge
- Prominent fine blood vessels around a lesion
- Nodule on the skin (particularly pearly or waxy nodules)
How is a diagnosis of basal cell carcinoma made?
excision biopsy
What type of referral is made for a basal cell carcinoma?
routine referral
