breast revision

Question 1

triple assessment

Answer 1

2ww pathway with breast lump

clinical-hx and exam-P score
radio-radio/uss-m/U score
pathology-needle or core B

1 normal
2 benign
3 uncertain/likely
4-likely
5-certain
1-2-=discharge
uncertain-other look

Question 2

diagnostic principle of breast cancer

Answer 2

50-70-screening programs
>40-mammograph, <40-USS
lump-biopsy

Question 3

breast exam in paces inspection and positions

Answer 3

intro, wash and permission
always ask for pain and discomfort
visible for both breast
2 position-sitting in front on ocuch-raise hand, press on hips
other is 45 degree on couch with hand over head

look–
asymetry, skin changes, nipple changes, AND BACK/AXILLA
scars are subtle- inframammory under breast, peri-areolar, axillar

Question 4

breast exam in paces palpation

Answer 4

examine with pulp of finger
be systemic-go via quandrants, axilla and do nipple
discribe where (clock), size (cm), shape (smooth), surface, fixed
Lymphnodes- clavicular, cervical, axillar

Question 5

Breast pain

Answer 5

90% are benign
common with drugs like cocp, heart, and ssri
fibrocystic disease in young people

mx- topical gels
fitting/supporting bra
evening primrose oil

Question 6

Nipple discharge

Answer 6

lactational or not
can be -preg, gallacotorea, ectasia, cancer

uni/bilat, character, multiduct?

ix- preg test, prolactin/TSH, brain MRI (for prolactin)
Mammogram/USS

mx- reassure, refer, meds
no other cause- can be intraductal papilloma- surgical excision (single or multi duct)

Question 7

Pagets disease of the breast

Answer 7

common in FINALS
assox with cancer- eczema changes around nipple
need biopsy of the site + exam/radio

mx- masectomy OR breast conservative+radio

Question 8

fibroadenoma

Answer 8

young ladies with very mobile lump, painless

can excise if rapid growth
biopsy if large (think phyloides tumour)

Question 9

Breast cysts

Answer 9

sudden enlargments in young ladies taht dissapear quickly
small-ignore
large-aspirate

Question 10

Breast abscesses

Answer 10

lactational vs not
lactational-staph aureus
RF- smokers, breastfeeding, diabetics
Large red hot breast (not while breast), painful
cracked nipples
can have discharge

mx-abx and USS aspiration
v rarely-necrosis of skin

if lactational-continue breast feeding, abx, cold packs

Question 11

Phylloides tumours

Answer 11

rapid growth with venous congestion, fixed to skin
v rare-but usually one large blue breast

Question 12

Breast ulcerative changes

Answer 12

usually mix of new and old ulcer-granulomatous mastitis

ix- biopsy
avoid excision if possible as hard to heal
Steroids/immunosupressants

Question 13

Gynacomastia

Answer 13

abnormal tissue in males-puberty/old
idiopathic, obese
Endocrine
Cancer
drugs (spirlactone, amiodarone, alcohol)
Renal, liver failure

need USS
mx- treat cause, tamoxifen, surgery

Question 14

DCIS

Answer 14

most common DCIS
abnormal cells of milk duct- but not spread out-risk of cancer
Usually via screening pathway

mammogram
biopsy- grade (higher=more chance of cancer)

mx-breast conservation surgeries
rarely masectomy if spread

Question 15

Breast cancer

Answer 15

most common woman cancer
Invasive ductal (80%)>invasive lobular
RF-no child, age, not breastfeeding, early menarche, HRT, obesity
BRCA1/2 (also ovarian)

ix- USS-biopsy-> MRI if proven
>40-mammo, uss and biopsy
scan axilla /nodes
>3 nodes- consider stage with ct and bone scan
stage with TNM
<2cm-t1. t4>5cm
N-nodal-n0, N2 big nodes
M-mets
80% are grade 2- slighty differentated
grade3 is bad

mx
need HER2, ER and __ for mx
always mention MDT
Surgery-mascectomy vs large excision