Breast lumps (zero to finals) Flashcards
What tissue type is most common in the breast?
Fat (adipose) tissue
How is milk produced by the breasts?
The areola surrounds the nipple. Behind the nipple are the ducts, which lead into the lobules, where breast milk is produced.
Milk is secreted through the ducts and out of openings on the nipple.
What tests are used to exclude breast cancer as a differential?
Triple assessment, consists of:
- Clinical assessment (history and examination)
- Imaging (ultrasound or mammography)
- Histology (fine needle aspiration or core biopsy)
What clinical features can indicate the presence of breast cancer?
Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction (inverted nipples are nipples that point inward or lie flat, rather than pointing out. It’s also called retracted nipples).
Skin dimpling or oedema (peau d’orange)
What factors would warrant a 2 week referral for suspected breast cancer?
An unexplained breast lump in patients aged 30 or above
Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
An unexplained lump in the axilla in patients aged 30 or above
Skin changes suggestive of breast cancer
What are fibroadenomas?
Common benign tumours of stromal/epithelial breast duct tissue.
What is an unofficial name often given to fibroadenomas?
“Breast mouse”
Typically small and mobile within the breast tissue.
They are sometimes called a “breast mouse”, as they move around within the breast tissue.
Most common ages for fibroadenoma and why?
More common in younger women, aged between 20 and 40 years.
They respond to the female hormones (oestrogen and progesterone), which is why they are more common in younger women and often regress after menopause.
Features of fibroadenoma on examination?
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 is fibrocystic breast changes (fibrocystic breast disease)?
The connective tissues (stroma), ducts and lobules of the breast respond to the female sex hormones (oestrogen and progesterone), becoming fibrous (irregular and hard) and cystic (fluid-filled).
These changes fluctuate with the menstrual cycle.
Typical symptoms of fibrocystic breast disease?
Lumpiness
Breast pain or tenderness (mastalgia)
Fluctuation of breast size
Management of fibrocystic breast changes?
Wearing a supportive bra
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
Avoiding caffeine is commonly
recommended
Applying heat to the area
Hormonal treatments (e.g., danazol
and tamoxifen) under specialist guidance
What are breast cysts?
Breast cysts are benign, individual, fluid-filled lumps.
What is the most common cause of breast lumps and what ages do they commonly occur in?
Breast cysts which occur most often between ages 30 and 50, more so in the perimenopausal period.
Features of breast cysts on examination?
Smooth
Well-circumscribed
Mobile
Possibly fluctuant
Having a breast cyst may slightly increase risk of breast cancer. True/false?
True
What can fat necrosis do to fat tissue in the breast?
Fat necrosis causes a benign lump formed by localised degeneration and scarring of fat tissue in the breast.
What are the typical triggers for fat necrosis of the breast?
Commonly triggered by localised trauma, radiotherapy or surgery, with an inflammatory reaction resulting in fibrosis and necrosis (death) of the fat tissue.
Fat necrosis increases risk of breast cancer. True/false?
False
Does not increase risk
Features of fat necrosis
Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion
Can ultrasound/mammogram differentiate fat necrosis from breast cancer?
No, ultrasound or mammogram can show a similar appearance to breast cancer.
Histology (by fine needle aspiration or core biopsy) may be required to confirm the diagnosis and exclude breast cancer.
Fat necrosis is usually managed medically. True/false?
False
Fat necrosis is usually treated conservatively. It may resolve spontaneously with time. Surgical excision may be used if required for symptoms.
What are lipomas?
Benign tumours of fat (adipose) tissue. They can occur almost anywhere on the body where there is adipose tissue, including the breasts.
Features of breast lipoma on examination?
Soft
Painless
Mobile
Do not cause skin changes
How are lipomas treated?
They are typically treated conservatively with reassurance. Alternatively, they can be surgically removed.
What are galactoceles?
They are breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk.
What women are galactoceles most common in?
Occur in women that are lactating (producing breast milk), often after stopping breastfeeding.
What are the typical features of a galactocele and how does it present?
They present with a firm, mobile, painless lump, usually beneath the areola.
They are benign and usually resolve without any treatment.
It is possible to drain them with a needle. Rarely, they can become infected and require antibiotics.
What are phyllodes tumours?
Rare tumours of the connective tissue (stroma) of the breast, occurring most often between ages 40 and 50.
Are phyllodes tumours benign or malignant?
Can be both benign or malignant
They are large and fast-growing.
They can be benign (~50%), borderline (~25%) or malignant (~25%). Malignant phyllodes tumours can metastasise.
Treatment of phyllodes tumours?
Treatment involves surgical removal of the tumour and the surrounding tissue (“wide excision”). They can reoccur after removal.
Chemotherapy can be used in malignant or metastatic tumours.
