Breast medicine Flashcards by Aureliah K

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

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FIBROADENOMA

Describe fibroadenomas on examianiton

Unilateral

Painless

Smooth

Round

Well circumcised

Firm

Mobile

<5cm diameter

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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

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FIBROCYSTIC BREAST

Describe the pattern of symtpoms

Occur prior to menstruation - within 10 days

resolve once menstruation begins

resolve after menopause

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FIBROCYSTIC BREAST

How does fibrocystic breast changes present

lumpiness - upper outer quadrant

breast pain and tenderness

fluctuation of breast size

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FIBROCYSTIC BREAST

What is the management

triple assessment - exclude cancer

manage cyclical breast pain:

wear a supportive bra

NSAIDs

Apply heat to the area

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BREAST CYST

Describe a breast cyst

Benign unilateral fluid-filled lumps
Painful
Flucuate in size

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BREAST CYST

Describe a breast cyst on examination

Smooth
well circumcised
mobile
fluctuant

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BREAST CYST

What is the management of a breast cyst

Triple assessment to exclude cancer

aspiration or excision

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BREAST CYST

Does having a breast cyst increase cancer risk

Yes - slightly

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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

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FAT NECROSIS

Describe the presentation of fat necrosis

Painless
Firm
Irregular
Fixed to local structures
Skin dimpling or nipple inversion

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FAT NECROSIS

What investigations are required in fat necrosis

Triple assesment
- USS shows similar appreance to cancer
- Histology required

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FAT NECROSIS

What is the manageemnt

Conservative

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LIPOMA

What is a lipoma

Benging tumour of adipose tissue

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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