Breast Medicine Flashcards
What are the different types of benign breast lumps?
Fibroadenoma
Breast Cyst
Sclersocing adenosis
Epithelial hyperplasia
Fat necrosis
Duct papilloma
What are the features of a fibroadenoma, and what is its management?
Mobile, firm breast lumps
If >3cm surgical excision is usual,
Phyllodes tumours should be widely excised (mastectomy if the lesion is large)
If >3cm surgical excision
What are the features of a breast cyst, and what is its management?
Smooth discrete lump
‘halo appearance’ on mammography.
Small increased risk of breast cancer (especially if younger)
Ultrasound will confirm the fluid-filled nature of the cyst
Cysts should be aspirated, and those which are blood-stained or persistently refilled should be biopsied or excised
What are the features of sclerosing adenosis, and what is its management?
Usually presents as a breast lump or breast pain
Causes mammographic changes which may mimic carcinoma
Distort the distal lobular unit, without hyperplasia (complex lesions will show hyperplasia)
Considered a disorder of involution, there is no increase in malignancy risk
Lesions should be biopsied, excision is not mandatory
What are the features of epithelial hyperplasia, and what is its management?
Ranges from generalised lumpiness through to discrete lump
Increased cellularity of the terminal lobular unit, atypical features may be present
Atypical features and a family history of breast cancer = greatly increased risk of malignancy
If no atypical features then conservative, those with atypical features require either close monitoring or surgical resection
What are the features of breast fat necrosis, and what is its management?
Traumatic aetiology ( falling down stairs, hitting breast on something)
Physical features usually mimic carcinoma
The mass may increase in size initially
Imaging and core biopsy
What are the features of duct papilloma, and what is its management?
Nipple discharge, usually originating from a single duct
Large papillomas may present with a mass
No increased risk of malignancy
Management: Microdochectomy
What are the features of duct ectasia, and what is its management?
Cheese-like nipple discharge and slit-like retraction of the nipple
Thick and green discharge
No specific treatment is require
Troublesome nipple discharge may be treated by microdochectomy (if young) or total duct excision (if older).
What are the features of mastitis and what is its management?
Inflammation of the breast tissue is associated with breastfeeding
Painful, tender, red hot breast
Fever and general malaise may be present
Infective mastitis is Staphylococcus aureus
First-line management
- Continue breastfeeding.
- Analgesia
- Warm compresses
If systemically unwell, nipple fissure, culture indicates infection or symptoms do not improve after 12-24 hours of effective milk removal
First-line
- Oral flucloxacillin for 10-14 day
- Breastfeeding should continue
.
What are the features of a breast abscess and what is its management?
Lump/swelling, pain, warm, red, fever
Management: Incision and drainage + antibiotics based on culture
Overlying skin necrosis is an indication for surgical debridement
What are the features of Paget’s Disease of the Nipple and what is its management?
Eczematoid change of the nipple is associated with an underlying breast malignancy
Intraductal carcinoma associated with a reddening and thickening
Paget’s disease differs from the eczema of the nipple in that it involves the nipple primarily and only laterally spreads to the areolar (the opposite occurs in eczema).
Diagnosis
- Punch biopsy
- Mammography
- Ultrasound of the breast.
Treatment will depend on the underlying lesion.
What are the 4 types of breast cancer?
Invasive ductal carcinoma ‘No Special Type (NST)’. (Most Common)
Invasive lobular carcinoma
Ductal carcinoma-in-situ (DCIS)
Lobular carcinoma-in-situ (LCIS)
Rarer Breast Cancer
Medullary breast cancer
Mucinous (mucoid or colloid) breast cancer
Tubular breast cancer
Adenoid cystic carcinoma of the breast
Metaplastic breast cancer
Lymphoma of the breast
Basal-type breast cancer
Phyllodes or cystosarcoma phyllodes
Papillary breast cancer
What are the referral criteria for Breast Cancer?
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:
- aged 30 and over and have an unexplained breast lump with or without pain or
- aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:
- with skin changes that suggest breast cancer or
- aged 30 and over with an unexplained lump in the axilla
Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain.
What are some Breast Cancer risk factors?
- BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer
- 1st-degree relative premenopausal relative with breast cancer (e.g. mother)
- Nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
- Early menarche, late menopause
- Combined hormone replacement therapy (relative risk increase * 1.023/year of use), combined oral contraceptive use
- Past breast cancer
- Not breastfeeding
- Ionising radiation
- P53 gene mutations
- Obesity
- Previous surgery for benign disease (?more follow-up, scar hides lump)
When is radiotherapy offered for breast cancer?
After a wide-local excision, this may reduce the risk of recurrence by 2/3
Mastectomy radiotherapy is offered for T3-T4 tumours and those with four or more positive axillary nodes
