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Year 3 - Met3b > Breast Pain and Lumps > Flashcards

Breast Pain and Lumps Flashcards

1
Q

What is another name of breast pain

A

mastalgia

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2
Q

What can be the case of breast pain

A
  • True or referred
  • Relationship with menstruation
  • Associated swelling/nodularity
  • Perimenopausal
  • Exogenous hormone intake SE
  • Unknown cause – most common
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3
Q

How do you start the assessment of breast pain

A
  • history and examination + mammography + USS
  • Pain charts (mapping over a month can be related to dietary intake)
  • it is rare for pain to be associated with cancer
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4
Q

what do you have to consider causing breast pain

A
  • Bra
  • Posture
  • Weight
  • Exercise (may exacerbate)
  • Life event stressors
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5
Q

What is the triple assessment (investigation)

A
  • Mammography
  • Ultrasound
  • Cytology/histology (results take 3 days)
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6
Q

What is one stop clinic setting

A
  • this is where patients are discharged or seen within one setting - all investigations done in one setting
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7
Q

What is the management of breast pain

A
  • reassurance
  • lifestyle changes – e.g. reduce fat intake
  • soya milk
  • evening primrose oil

Medications

  • tamoxifen
  • danazol
  • zoladex
  • bromocriptine
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8
Q

Describe the assessment of breast lump

A
  • Hx, Ex, and Ix – mammography, USS, cytology, histology
  • One Stop Clinics (Triple Assessment) – clinical assessment, imaging and cytology in one visit 🡪 result of lump status by the end of the clinic and discharge or plan
  • Triple Assessment reporting
    1. Normal (cytology insufficient)
    2. Benign
    3. Intermediate, probably benign
    4. Suspicious of cancer
    5. Cancer
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9
Q

What is a mammography

A
  • Breast x ray images in 2D
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10
Q

What are the two views in mammography

A

Two views: cranio-caudal (CC) & medial-lateral-oblique (MLO) – allowing for discrimination of abnormality position

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11
Q

What is suspicious of malignancy in mammography

A
  • An opacity with ill-defined edges
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12
Q

How is a mammography used in screening programmes

A
  • used in screening programme in UK for women between ages of 50-70
  • every 3 years - has a reduction in breast cancer deaths by 30% in women >50 years
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13
Q

What is the triple assessment of breast lumps

A
  1. Clinical assessment – Hx and Ex
  2. Radiology
    <35yrs USS
    >35yrs Mammography + USS
  3. Cytology & Histology – Fine Needle Aspirate (FNA) or Core Biopsy (CB)
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14
Q

What is aberrations of normal breast development and involution (ANDI)

A

Most common cause of benign lumps are benign changes that occur through development, cyclical change and involution

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15
Q

Who does a fibroadenoma present in

A
  • Present in young women in early 20s
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16
Q

describe what a fibroadenoma is like

A
  • Extremely mobile, discrete and rubbery mass
  • Arise from the stromal tissue and proliferatory epithelium
  • Arise from the lobular unit
  • In the over 40s must differentiate from cancer
  • Management depends on age, size of fibroadenoma and triple assessment
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17
Q

What is a phyllodes tumour

A
  • Can be confused with fibroadenoma
  • Women are usually older
  • Rare – less than 1% of breast lumps
  • Fibroepithelial tumour, needs wide local excision
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18
Q

What tumour can be confused with a fibroadenoma

A

Phyllodes tumour

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19
Q

What is the management of a phyllodes tumour

A
  • observation and reassurance but if in doubt refer for triple assessment (if >4cm to exclude phyllodes tumour)
  • USS is usually conclusive
  • surgical excision if large
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20
Q

When are breast cysts common

A
  • common in under 35 wars especially around peri menopause
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21
Q

What is a breast cyst

A
  • benign fluid filled lump (microcyst or macrocyst)
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22
Q

What is a breast cyst caused by

A
  • benign fluid filled lump (microcyst or macrocyst) caused by distended and involuted lobules
23
Q

What does a breast cyst feel like

A
  • not fixed to surrounding tissue, is soft and fluctuant
24
Q

What do you refer a breast cyst to and what would it look like on an mammography

A
  • refer to triple assessment - FNA is conclusive

- on mammography it will show a halo appearance

25
Q

What is the management of a breast cyst

A
  • reassure or aspirate if symptomatic

- occasionally operate but very rarely

26
Q

How do sclerotic or fibrotic lesions present

A
  • symptomatic lump or incidental finding on screening
  • ## often asymptomatic but appears on investigations = radial scar (<1cm) or complex sclerotic lesion (>1cm)
27
Q

describe how sclerosing adenosis presents

A
  • palpable mass with pain and worse on mensturation

- stromal sclerosis, proliferative adenosis, microclacification and myoepithelial proliferation

28
Q

How do you differentiate sclerotic and fibrotic lesions from malignancy

A
  • have to do a core biopsy as it is difficult to differentiate from malignancy
29
Q

What is the management of sclerotic/fibrotic lesions

A
  • excision due to malignant potential
30
Q

when does duct ectasia occur

A
  • typically around menopause
31
Q

What happens with duct ectasia

A
  • with age the ducts shorter and dilate and become blocked and secretions stagnate
32
Q

How does duct ectasia present

A
  • presents with green/brown/bloody discharge and nipple retraction and lump
33
Q

What are the non ANDI causes of breast lumps

A
  • breast infection
  • lipomas
  • fat necrosis
  • Montgomery’s gland
  • Mondor’s disease
  • gynaecomastia
  • intraductal papilloma
  • periductal mastitis
  • tuberculosis
34
Q

what are the two types of breast infection

A
  • Lactational – likely when breast feeding

- Non lactational

35
Q

what is a breast infection

A

(eg infective mastitis/breast abscesses) – infections of the mammary duct often associated with lactation (eg Staph aureus)

36
Q

How does a breast infection present

A
  • abscess presents as a hot painful swelling of the breast
37
Q

What is the treatment of breast infection

A
  • antibiotics

- open incision or percutaneous drainage

38
Q

What is a lipoma

A
  • benign fat tumour
39
Q

What is fat necrosis

A
  • fibrosis and calcification following breast tissue injury

- scarring can lead to a firm lump

40
Q

How do you manage fat necrosis

A

= refer for triple assessment

= if it is confirmed as fat necrosis no treatment is needed

41
Q

What are Montgomery’s gland

A
  • small periareolar glands around nipple which may develop a cyst
42
Q

What is Mondor’s disease

A
  • Thrombophlebitis of superficial veins of the breast
43
Q

What is intraductal papilloma

A
  • blood stained discharge without palpable mass

- US shows dense breast tissue but no mass lesion

44
Q

Who is intraductal papilloma seen in

A
  • seen in young women
45
Q

What is periductal mastitis

A
  • present at younger age that ductal ectasia
  • present with features of inflammation, abscess or mammary duct fistula
  • strongly associated with smoking
46
Q

What is the treatment of periductal mastitis

A
  • antibiotics and drainage of abscess
47
Q

How does tuberculosis affect the breast

A
  • usually secondary TB
  • affects women later in child-bearing period
  • chronic breast or axillary sinus is present in up to 50% of cases
  • deleted by biopsy culture and histology
48
Q

What are the causes of nipple discharge

A
  • physiological - during breast feeding
  • galactorrhea
  • hyperprolactineamia
  • mammaryduct ectasia
  • carcinoma
  • intraductal papilloma
49
Q

what causes galactorrhea

A
  • most common cause may be in response to emotional events

- drugs such as histamine receptor antagonists may also be implicated

50
Q

What causes hyperprolactinaemia

A
  • most common type of pituitary tumour
  • micro adenomas <1cm in diameter
  • Macroadenomas >1cm in diameter
  • pressure of the optic chiasma may cause bitemporal hemianopais
51
Q

What is the discharge from the nipples like in mammary duct ectasia

A

discharge is thicken and green in colour

- common in smokers

52
Q

What is the discharge like in carcinomas

A
  • often blood stained

- may be underlying mass or axillary lymphadenopathy

53
Q

what is discharge like in intraductal papilloma

A

= may cause blood stained discharge

- usually no palpable lump

54
Q

Name the ANDI (abberations of normal breast development and involution) causes of breast lumps

A
  • fibroadenomas
  • Cysts
  • sclerotic/fibrotic lesions
  • duct ectasia

Year 3 - Met3b (26 decks)

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