Clinical Presenting Features

Question 1

What are the clinical presenting features of breast disease?

Answer 1

Physiological swelling and tenderness
Nodularity
Breast pain (not usually malignant)
Palpable breast lumps
Nipple discharge inc. galactorrhoea
Infection and inflammation (usually associated with lactation)

Question 2

What are the three histological groups of patient and their potential future cancer risk?

Answer 2

Non-proliferative disorders (no ↑ risk)
Proliferative disorders without atypia (mild-moderate ↑ risk)
Atypical hyperplasias (substantial ↑ risk)

Question 3

What is the most common benign breast disorder?

Answer 3

Fibrocystic change
Women age 20-50
Hormonal aetiology
Presents with pain and nodularity

Question 4

What is the clinical presentation of nodularity?

Answer 4

Symptoms greatest one week before menstruation, decrease when it starts.
Area of nodularity/thickening, poorly differentiated from surrounding tissue, often upper outer quadrant of breast.
If bilaterally symmetrical, rarely pathological. If asymmetry, review patient after 1 or 2 menstrual cycles, seeing her midcycle.

Question 5

What is the treatment for nodularity?

Answer 5

Analgesia and a good, well-fitting bra.

Question 6

What is cyclical mastalgia?

Answer 6

Tenderness and nodularity in premenstrual stage.

Common and rapidly resolving as menstruation starts.

Question 7

What are the most common kinds of benign palpable breast lumps?

Answer 7

Cysts
Fibroadenomas
(Usually three dimensional, mobile, smooth, regular borders. Solid/cystic in consistency)

Question 8

When are cysts most common?

Answer 8

35-50

Question 9

What are cysts?

Answer 9

Fluid filled masses.

Palpable as discrete lumps; may be recurrent.

Question 10

Can cysts be distinguished from solid tumours on clinical examination?

Answer 10

No, not reliably.

Question 11

What are fibroadenomas?

Answer 11

Benign tumours common in young women (peak incidence 20-24)

Most common type of breast lesion

Question 12

How do fibroadenomas present?

Answer 12

Arise in breast lobules
Composed of fibrous and epithelial tissue
Firm, non tender, highly mobile palpable lumps

Question 13

What is the aetiology of fibroadenomas?

Answer 13

Hormones involved - HRT increases incidence.

Question 14

What is an intraductal papilloma?

Answer 14

A benign growth within a milk duct

Presents with spontaneous unilateral nipple discharge

Question 15

What is mammary duct ectasia?

Answer 15

Dilatation of major ducts

Filled with creamy secretion with periductal inflammation

Question 16

How does mammary duct ectasia present?

Answer 16

May be asymptomatic
Nipple discharge (bloody/serous/creamy white/yellow)
Retracted nipple
Acute inflammation
Recurrent chronic inflammation with abscess formation

Question 17

How is mammary duct ectasia treated?

Answer 17

Surgical excision of the major duct

Correction of nipple retraction

Question 18

What is mastitis?

Answer 18

Generalised cellulitis of the breast

Question 19

How is mastitis treated?

Answer 19

Antibiotics

Question 20

What are the main causes of breast abscesses?

Answer 20

Infective - usually staph. or strep.

Question 21

How do breast abscesses present?

Answer 21

Point tenderness, erythema, fever

Generally related to lactation - non-lactational more frequent in smokers

Question 22

How are breast abscesses treated?

Answer 22

Staph - incision and drainage

Strep - (more diffuse and superficial) local wound care and antibiotics

Question 23

When should people be referred to suspected cancer pathway?

Answer 23

≥30 with unexplained breast lump without pain

≥50 with unilateral discharge/retraction/other concerning changes

Question 24

When should cancer pathway referral be at least considered?

Answer 24

Skin changes suggesting breast cancer
≥30 with unexplained lump in axilla
Non urgent referral considered <30 with unexplained breast lump with/without pain