Breasts

Question 1

Abscess

Answer 1

Swollen area containing pus. Usually a complication of mastitis.

Question 2

How common are Abscesses

Answer 2

Rare. 0.4-0.5% of breastfeeding mothers

Question 3

Risk factors for Abscess

Answer 3

Maternal Age >30
Gestational Age >41 weeks
Incomplete emptying of the breast
Past History of mastitis

Question 4

Symptoms of Abscess

Answer 4

Tender, hard breast mass, fluctuant, overlying erythema

Question 5

Investigations for Abscess

Answer 5

Ultrasound

Question 6

Management for Abscess

Answer 6

Assessment of breast feeding technique
Manual expression of milk after feeding 
Antibiotics: Flucloxacillin or erythromycin
Surgical Incision and Drainage
Needle aspiration every other day

Question 7

Complication of Abscess

Answer 7

Sepsis

Question 8

Fibrocystic Disease

Answer 8

Noncancerous breast lumps affecting over 50% of women of childbearing age.

Question 9

Symptoms of Fibrocystic Disease

Answer 9

Lumpy cobblestone texture in the breast, free moving, breast aching, tenderness, swelling, itchy

Question 10

Investigations for Fibrocystic Disease

Answer 10

Mammography, ultrasound, MRI, nipple fluid or fine needle aspiration

Question 11

Treatment of Fibrocystic Disease

Answer 11

No treatment normally.

Progesterone ointments if necessary

Question 12

Prognosis of Fibrocystic Disease

Answer 12

Usually subsides after menopause

Question 13

Intraductal Papilloma

Answer 13

Benign proliferative breast lesions occurring anywhere in the ductal system which can be solitary or proliferative.

Question 14

Risk factors for Intraductal Papilloma

Answer 14

Middle aged women
2-3% incidence
Common cause of bloody nipple discharge in women aged 20-40

Question 15

Symptoms for Intraductal Papilloma

Answer 15

Breast enlargement, breast pain, bloody nipple discharge

Question 16

Investigations for Intraductal papilloma

Answer 16

Galactogram, fine needle aspiration, nipple discharge examination

Question 17

Management of Intraductal Papilloma

Answer 17

Surgical excision followed by biopsy to confirm that it is not cancer

Question 18

Prognosis of Intraductal Papilloma

Answer 18

Excellent if solitary and central

Peripheral and multiple associated with higher risk of breast cancer

Question 19

Breast Carcinoma

Answer 19

Malignancy of the breast tissue. Can be ductal or lobular and invasive or in situ.

Question 20

Paget’s Disease

Answer 20

Infiltrating carcinoma of the nipple epithelium. Represents 1% of all breast cancers

Question 21

How common is Breast Carcinoma

Answer 21

1 in 8

Question 22

Risk Factors for Breast Carcinoma

Answer 22

Female, old age, smoking, family history, BRCA1, BRCA2 and TP53 mutations, no children, never breastfed, early menarche and late menopause, continuous combined HRT, radiation to chest, high alcohol intake, men with Klinefelter’s syndrome, gynaecomastia

Question 23

Symptoms of Breast Carcinoma

Answer 23

Lump 80% and painful in 20%, hard, irregular, fixed, painless, skin dimpling, nipple discharge, skin contour changed, bloody nipple discharge

Question 24

Differential diagnosis for Breast Carcinoma

Answer 24

Fibrocystic breast disease, Cyst

Question 25

Investigations for Breast Carcinoma

Answer 25

Mammography, fine needle aspiration, core biopsy, Staged using TNM

Question 26

Management for Breast Carcinoma

Answer 26

Wide local excision or masectomy with radiotherapy followed by breast reconstruction
Adjuvant hormone therapy if the tumour is positive for hormonal receptors: tamoxifen
Herceptin can be used in those expressing HER2 gene
Adjuvant chemotherapy required for patients with endocrine unresponsive tumours