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GP > Breast lumps, moles and lymph nodes > Flashcards

Breast lumps, moles and lymph nodes Flashcards

1
Q

What are 10 differentials for a breast lump, other than malignancy?

A
  1. Fibroadenoma
  2. Fibroadenosis / fibrocystic disease / benign mammary dysplasia
  3. Breast cancer
  4. Mammary duct ectasia
  5. Duct papilloma
  6. Fat necrosis
  7. Breast abscess
  8. Breast cyst
  9. Scerlosing adenosis
  10. Epithelial hyperplasia
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2
Q

What are breast fibroadenomas?

A

lumps which develop from a whole lobule of the breast

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3
Q

What is the character of breast fibroadenomas?

A

mobile, firm breast lumps - known as a ‘breast mouse’

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4
Q

What proportion of all breast lumps are breast fibroadenomas?

A

12%

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5
Q

What proportion of breast fibroadenomas will get smaller over a 2 year period?

A

30%

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6
Q

Is there increased risk of malignancy with breast fibroadenomas?

A

no

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7
Q

What is the management of breast fibroadenomas and what does this depend on?

A

if >3cm, surgical excision is usual

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8
Q

What is a Phyllodes tumour and what is the management?

A

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

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9
Q

How does a breast cyst usually present?

A

usually presents as a smooth discrete lump (may be fluctuant)

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10
Q

Is there an increased risk of breast cancer with breast cysts?

A

yes, small increased risk (especially if younger)

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11
Q

What is the management of breast cysts?

A

should be aspirated, those which are blood stained or persistently refill should be biopsied or excised

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12
Q

What does sclerosing adenosis of the breast involve?

A

radial scars and complex sclerosing lesions

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13
Q

What are 2 aspects of the presentation of sclerosing adenosis?

A
  1. Usuallt presents as breast lump or breast pain
  2. Causes mammographic changes which may mimic carcinoma
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14
Q

What happens to the breast tissue in sclerosing adenosis?

A

Cause disortion of distal lobular unit without hyperplasia (complex lesions will show hyperplasia)

considered a disorder of involution

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15
Q

Does the risk of malignancy increase with sclerosing adenosis?

A

no

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16
Q

What is the management of sclerosing adenosis of the breast?

A

lesions should be biopsied, excision is not mandatory

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17
Q

What is the presentation of epithelial hyperplasia?

A

variable clinical presentation ranging from generalised lumpiness through to discrete lump

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18
Q

What happens within the breast in epithelial hyperplasia?

A

increased cellularity of terminal lobular unit, atypical features may be present

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19
Q

What are 2 things which confer much greater increased risk of malignancy with epithelial hyperplasia?

A
  1. Atypical features
  2. Family history of breast cancer
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20
Q

What is the management of epithelial hyperplasia of the breast?

A

if no atypical features then conservative; those with atypical features require either close monitoring or surgical resection

21
Q

What is the aetiology of fat necrosis of the breast in up to 40% of cases?

A

traumatic aetiology

22
Q

What do the physical features of fat necrosis of the breast usually mimic?

A

carcinoma

23
Q

What is may be the course of fat necrosis with time?

A

mass may increase in size initially

24
Q

What is the management of fat necrosis of the breast?

A

imaging and core biopsy

25
Q

How do duct papillomas present?

A

usually with nipple discharge, usually originates from single duct

if large may present with a mass

26
Q

Is there an increased risk of malignanc with duct papillomas?

A

no

27
Q

What is the management of duct papillomas?

A

microdochectomy

28
Q

In what age group are fibroadenomas common?

A

<30 years

29
Q

In what age group does fibroadenosis of the breast often present?

A

most common in middle-aged women

30
Q

How does fibroadenosis of the breast present?

A

lumpy breasts which may be painful

symptoms may worsen prior to menstruation

31
Q

What is the typical presentation of breast cancer?

A

hard, irregular lump. may be associated nipple inversion or skin tethering

32
Q

What is Paget’s disease of the breast?

A

intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/ areola

33
Q

What is mammary duct ectasia?

A

diltation of the large breast ducts

34
Q

When does mammary duct ectasia most commonly occur?

A

most common around the menopause

35
Q

How may mammary duct ectasia present?

A
  • 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’
36
Q

In which women is a breast abscess more common?

A

lactating women

37
Q

How does a breast abscess present?

A

red, hot, tender swelling

38
Q

When does NICE say you should refer people using the 2 week wait referral for breast cancer? 2 situations

A
  1. Aged 30 and over and have unexplained breast lump with or without pain, or
  2. Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
39
Q

What are 2 situations when NICE suggests you should consider a suspected cancer pathway referral for breast cancer within 2 weeks?

A
  1. Skin changes that suggest breast cancer
  2. Aged 30 and over with an unexplained lump in the axilla
40
Q

When you should consider non-urgent referral for breast changes?

A

aged under 30 with unexplained breast lump with or without pain

41
Q

What is the method for determining whether to refer a skin lesion via 2ww pathway to secondary care?

A

7-point checklist; 2ww if score 3 or more

42
Q

What is the method of diagnosis of melanoma?

A

excision biopsy, performed in secondary care

43
Q

What is the checklist for diagnosing skin cancer in primary care?

A

major features of lesions, scoring 2 points each:

  1. change in size
  2. irregular shape
  3. irregular colour

minor features, scoring 1 point each:

  1. largest diameter 7mm or more
  2. inflammation
  3. oozing
  4. change in sensation
44
Q

What is the referral made if a squamous cell carcinoma is seen on the skin?

A

2 week wait referral

45
Q

How is confirmation of a diagnosis of squamous cell carcinoma made in primary care?

A

excision biopsy

46
Q

What are 3 features of basal cell carcinomas?

A
  1. Ulcer with raised rolled edge
  2. Prominent fine blood vessels around a lesion
  3. Nodule on the skin (particularly pearly or waxy nodules)
47
Q

How is a diagnosis of basal cell carcinoma made?

A

excision biopsy

48
Q

What type of referral is made for a basal cell carcinoma?

A

routine referral

GP (43 decks)

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