Breast Malignancy Flashcards
When assessing a breast lump what are the key features to assess and describe?
Location, size, shape, consistency, tenderness, mobile/fixed, margins (smooth/irregular)
What makes up the triple assessment to exclude or diagnose breast cancer?
Clinical assessment (history and examination)
Imaging (mammogram or ultrasound)
Histology (fine needle aspiration or core biopsy)
What are clinical features which may suggest cancer as a cause of a breast lump?
Hard, irregular, painless, fixed, nipple retraction, skin dimpling or oedema, lumps tethered to skin or chest wall
Why does skin dimpling occur with breast cancer?
Coopers ligaments, which create and support normal breast morphology, retract in response to tumour infiltration which pulls the skin of the breast inwards
Why does nipple inversion or retraction occur with breast cancer?
Tumour invasion of the lactiferous ducts behind the nipple shortens them, pulling the nipple into the areola
Why can nipple discharge occur wit breast cancer?
Tumour invasion of the lactiferous ducts can enhance ductal secretions
What features of nipple discharge may indicate breast cancer as the cause?
If its unilateral, uni-ductal and spontaneous
Why can diffuse breast erythema occur with breast cancer?
Tumour cells in dermal layer produce cytokines causing local vasodilation of blood vessels under the skin
Why can we get the clinical sign of peau d’orange with breast cancer?
Tumour cells infiltrate and block lymphatic ducts preventing drainage of interstitial fluid
Which patients would be put through a 2 week wait referral for breast cancer?
> 30 with an unexplained breast lump, >50 with unilateral nipple changes, >30 with unexplained lump in axilla, skin changes suggestive of breast cancer
What are fibroadenomas?
Common benign tumours of the stroma/epithelial breast duct tissue
In what ages are fibroadenomas most common?
20-40
What are fibroadenomas like on examination?
Painless, firm, smooth, well circumscribed, mobile and up to around 3 cm in diameter
When are fibrocystic breast changes mos likely to occur around menstruation?
Within 10 days before menstruation then resolve once menstruation begins
What are fibrocystic breast changes?
When the connective tissue of the breast becomes fibrous and cystic in response to oestrogen and progesterone
hat are symptoms of fibrocystic breast changes?
Lumpiness of the breast(s), breast pain or tenderness, fluctuation of breast size
How can fibrocystic breast change symptoms be managed?
Wearing a supportive bra, NSAIDs, avoiding caffeine, applying heat to the area. Hormonal treatments can be started under specialist guidance (e.g danazol and tamoxifen)
What are breast cysts?
benign, fluid filled lumps in the breast. They can be painful and may fluctuate in size over the menstrual cycle
When are breast cysts most common?
Between the ages of 20 and 50, more so in the perimenopausal period
What are breast cysts like on examination?
Smooth, mobile, well circumscribed and possibly fluctuant
What investigations and management is required for breast cysts?
Imaging with potential fine needle aspiration or excision to rule out cancer. Aspiration may resolve symptoms
Do fibroadenomas, fat necrosis or breast cysts increase the risk of breast cancer?
Fibroadenomas= no
Fat necrosis= no
Cysts= may slightly increase the risk
What causes fat necrosis?
Localised degeneration and scarring of fat tissue of the breast often triggered by an inflammatory reaction because of localised trauma, radiotherapy or surgery
How may fat necrosis appear on examination?
Painless, firm, irregular, can be fixed in local structures,there may be skin dimpling or nipple inversion
