Breast Pain and Lumps Flashcards
1
Q
What is another name of breast pain
A
mastalgia
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
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
4
Q
what do you have to consider causing breast pain
A
- Bra
- Posture
- Weight
- Exercise (may exacerbate)
- Life event stressors
5
Q
What is the triple assessment (investigation)
A
- Mammography
- Ultrasound
- Cytology/histology (results take 3 days)
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
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
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
9
Q
What is a mammography
A
- Breast x ray images in 2D
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
11
Q
What is suspicious of malignancy in mammography
A
- An opacity with ill-defined edges
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
13
Q
What is the triple assessment of breast lumps
A
- Clinical assessment – Hx and Ex
- Radiology
<35yrs USS
>35yrs Mammography + USS - Cytology & Histology – Fine Needle Aspirate (FNA) or Core Biopsy (CB)
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
15
Q
Who does a fibroadenoma present in
A
- Present in young women in early 20s
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
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
18
Q
What tumour can be confused with a fibroadenoma
A
Phyllodes tumour
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
20
Q
When are breast cysts common
A
- common in under 35 wars especially around peri menopause
21
Q
What is a breast cyst
A
- benign fluid filled lump (microcyst or macrocyst)
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
What is the management of a breast cyst
- reassure or aspirate if symptomatic
| - occasionally operate but very rarely
26
How do sclerotic or fibrotic lesions present
- symptomatic lump or incidental finding on screening
- often asymptomatic but appears on investigations = radial scar (<1cm) or complex sclerotic lesion (>1cm)
-
27
describe how sclerosing adenosis presents
- palpable mass with pain and worse on mensturation
| - stromal sclerosis, proliferative adenosis, microclacification and myoepithelial proliferation
28
How do you differentiate sclerotic and fibrotic lesions from malignancy
- have to do a core biopsy as it is difficult to differentiate from malignancy
29
What is the management of sclerotic/fibrotic lesions
- excision due to malignant potential
30
when does duct ectasia occur
- typically around menopause
31
What happens with duct ectasia
- with age the ducts shorter and dilate and become blocked and secretions stagnate
32
How does duct ectasia present
- presents with green/brown/bloody discharge and nipple retraction and lump
33
What are the non ANDI causes of breast lumps
- breast infection
- lipomas
- fat necrosis
- Montgomery's gland
- Mondor's disease
- gynaecomastia
- intraductal papilloma
- periductal mastitis
- tuberculosis
34
what are the two types of breast infection
- Lactational – likely when breast feeding
| - Non lactational
35
what is a breast infection
(eg infective mastitis/breast abscesses) – infections of the mammary duct often associated with lactation (eg Staph aureus)
36
How does a breast infection present
- abscess presents as a hot painful swelling of the breast
37
What is the treatment of breast infection
- antibiotics
| - open incision or percutaneous drainage
38
What is a lipoma
- benign fat tumour
39
What is fat necrosis
- fibrosis and calcification following breast tissue injury
| - scarring can lead to a firm lump
40
How do you manage fat necrosis
= refer for triple assessment
| = if it is confirmed as fat necrosis no treatment is needed
41
What are Montgomery's gland
- small periareolar glands around nipple which may develop a cyst
42
What is Mondor's disease
- Thrombophlebitis of superficial veins of the breast
43
What is intraductal papilloma
- blood stained discharge without palpable mass
| - US shows dense breast tissue but no mass lesion
44
Who is intraductal papilloma seen in
- seen in young women
45
What is periductal mastitis
- present at younger age that ductal ectasia
- present with features of inflammation, abscess or mammary duct fistula
- strongly associated with smoking
46
What is the treatment of periductal mastitis
- antibiotics and drainage of abscess
47
How does tuberculosis affect the breast
- 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
What are the causes of nipple discharge
- physiological - during breast feeding
- galactorrhea
- hyperprolactineamia
- mammaryduct ectasia
- carcinoma
- intraductal papilloma
49
what causes galactorrhea
- most common cause may be in response to emotional events
| - drugs such as histamine receptor antagonists may also be implicated
50
What causes hyperprolactinaemia
- 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
What is the discharge from the nipples like in mammary duct ectasia
discharge is thicken and green in colour
| - common in smokers
52
What is the discharge like in carcinomas
- often blood stained
| - may be underlying mass or axillary lymphadenopathy
53
what is discharge like in intraductal papilloma
= may cause blood stained discharge
| - usually no palpable lump
54
Name the ANDI (abberations of normal breast development and involution) causes of breast lumps
- fibroadenomas
- Cysts
- sclerotic/fibrotic lesions
- duct ectasia
