Breast medicine Flashcards
FIBROADENOMA
What is a fibroadenoma and describe it’s epidemiology
benign tumour of epithelial breast lobule tissue
Common in younger women (20-40)
Respond to oestrogen and progesterone
FIBROADENOMA
Describe fibroadenomas on examianiton
Unilateral
Painless
Smooth
Round
Well circumcised
Firm
Mobile
<5cm diameter
FIBROCYSTIC BREAST
Describe fibrocystic breast changes
Bilateral diffuse lumpiness of breasts - connective tissue, ducts and lobules of breasts respond to oestrogne and progesterone becoming fibrous (irregular and hard) and cystic
Changes fluctuate with menstrual cycle
FIBROCYSTIC BREAST
Describe the pattern of symtpoms
Occur prior to menstruation - within 10 days
resolve once menstruation begins
resolve after menopause
FIBROCYSTIC BREAST
How does fibrocystic breast changes present
lumpiness - upper outer quadrant
breast pain and tenderness
fluctuation of breast size
FIBROCYSTIC BREAST
What is the management
triple assessment - exclude cancer
manage cyclical breast pain:
wear a supportive bra
NSAIDs
Apply heat to the area
BREAST CYST
Describe a breast cyst
Benign unilateral fluid-filled lumps
Painful
Flucuate in size
BREAST CYST
Describe a breast cyst on examination
Smooth
well circumcised
mobile
fluctuant
BREAST CYST
What is the management of a breast cyst
Triple assessment to exclude cancer
aspiration or excision
BREAST CYST
Does having a breast cyst increase cancer risk
Yes - slightly
FAT NECROSIS
What is fat necrosis of the breast
Benign lump caused by localised degeneration and scarring of fat tissue in breast - triggered by localised trauma / radiotherapy / surgery
Inflammatory reaction in fibrosis and necrosis of fat tissue
FAT NECROSIS
Describe the presentation of fat necrosis
Painless
Firm
Irregular
Fixed to local structures
Skin dimpling or nipple inversion
FAT NECROSIS
What investigations are required in fat necrosis
Triple assesment
- USS shows similar appreance to cancer
- Histology required
FAT NECROSIS
What is the manageemnt
Conservative
LIPOMA
What is a lipoma
Benging tumour of adipose tissue
LIPOMA
How does a lipoma present on examination
Soft
painless
mobile
no skin changes
GALACTOCELE
What is a galactocele
breast milk filled cyst that occur when lactiferous duct is blocked preventing drainage of milk
GALACTOCELE
How does a galactocele present one examination
Firm
Mobile
Painless lump - beneath areola
Describe a triple assesment
Examination
USS or mammogram
Fine needle aspiration (cytology) or core biopsy (histology)
Fine needle aspiration for benign, core biopsy for malignant
What is the NICE referral criteria for breast lumps
> 30 with unexplained breast lump
> 50y/o with nipple changes
Unexplained lump in axilla
Skin changes suggestive of breast cancer
DUCTAL PAPILLOMA
Describe a ductal papilloma
Benign tissue of breast ductal tissue
Common in women aged 40-50
DUCTAL PAPILLOMA
How does a duct papilloma present
Clear / bloody discharge
Small areolar lump
DUCTAL PAPILLOMA
How is it managed?
Triple assessment and complete excision
DUCT ECTASIA
Describe ductal ectasia
Dilatation of lactiferous ducts
common in peri/post-menopausal women
DUCT ECTASIA
What increases the risk of ductal ectasia and ehat is seen on mammograhy
smoking
microcalcification
DUCT ECTASIA
How does it present
Tender lump - periareolar
nipple inversion
nipple discharge - blood stained / green or brown
Bilateral
DUCT ECTASIA
What is the investigation
Tripple assesment
BREAST CANCER
Name 5 risk factors
FHx
personal hx
increased oestrogen - early menarche and late menopause
obesity
smoking
more dense breast tissue
COCP
HRT
BREAST CANCER
Describe the appearance of Paget’s disease of the nipple
eczeme of nipple
erythematous
crusty rash
itching
burning sensation
bloody nipple discharge
non healing ulcer
breast lump
BREAST CANCER
what is the time frame for screening
Every 3 years for women aged 50 - 70
BREAST CANCER
name 4 negatives to cancer screening
Anxiety and stress
Exposure to radiation, with a very small risk of causing breast cancer
Missing cancer, leading to false reassurance
Unnecessary further tests or treatment where findings would not have otherwise caused harm
BREAST CANCER
Outline the specific referral crietria for higher risk patients
A first-degree relative with breast cancer under 40 years
A first-degree male relative with breast cancer
A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
Two first-degree relatives with breast cancer
BREAST CANCER
How does breast cancer present
irregular lump
painless
fixed in place
tethered to skin wall
skin dimpling / peau d’orange
lymphaednopathy
BREAST CANCER
Outline the 2 week wait referral criteria
An unexplained breast lump in patients aged 30
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
BREAST CANCER
When are USS and mammograms used in triple assessment
USS - Women under 30
- distinguish solid lumps (e.g., fibroadenoma or cancer) from cystic (fluid-filled) lumps
Mammograms - older women
- better at identifying califications
management of lymphoedema
massage techniques
compression bandaging
weight loss
good skin care
outline tamoxifen
SERM
Blocke oestrogen receptors in breast tissue
Stimulates receptors in bones and endometrium
Ouline letrozole
converts androgens to oestrogens
Outline herceptin
Trastuzamab - MAB against human epidermal growth factor 2
