History & Examination Flashcards
How common is breast cancer?
Most common cancer in UK population
& Most common amongst women globally
What is triple assessment?
Gold standard practice of assessment of breast symtoms
Clinical assessment + Radiology + Histopathology
Why is triple assessment used?
Enables rapid detection of breast cancer
What constitutes the clinical assessment
- History
- Examination of breast & lymph nodes
What is included in the radiological assessment?
Mammography
+/- USS
What is included in the pathological assessment?
- Core biopsy = Use needle to take contents of lesion
- Fine-needle aspirate cytology (FNAC)
- VAC-biopsy (similar to FNAC)
Difference between core biopsy & FNAC?
Core biopsy
- Looks at tissue so gives tissue diagnosis
- Can tell difference between CIS & invasive disease
FNAC
- Can detect presence of malignant cells (cellular diagnosis)
What abbreviated terminology can be used to describe breast lesions?
1 = Normal breast tissue
2 = Benign
3 = Possible malignant
4 = Likely malignant
5 = Malignant
Why are mammograms harder to interpret in younger patients?
More fatty tissue in breast of younger patient so can lead to false shadowing on imagine - MORE FALSE POSITIVES
What is a con of using USS?
You have to be present to know where an image was taken anatomically.
What key features should you elicit from a history?
- History of PCC & onset
- Lump
- Pain
- Discharge
- Nipple retraction
- Bleeding
- Skin changes
- Swelling / inflammation
- Recent trauma
- Age of menarche / menopause
- Any children? Age when having first child?
- Systemic symptoms
- Loss of appetite
- Weight loss
- Lethargy
- FHx
- Genetics (e.g. BRCA 1/2)
What would you describe a lump
- Site
- Upper/Lower
- Outer/Inner
- Central
- Midline
- Axial
- Size
- Shape - Round / Oval / Irregular
- Margins - Sharp / ill-defined
Give some different nipple changes
- Retraction
- Eczema vs Paget’s
- Paget’s can be sign of underlying malignancy
- Cracked nipple
- Can occur in breastfeeding
- Discharge - Clear, blood-stained, black/green, milk
What are different types of nipple retraction?
- Slit-like retraction
- Can be sign of duct ectalasia
- Circumferential retraction (More concerning)
Important to know if it’s new or longstanding.
Whare different skin changes?
- Skin dimpling
- Peau d’orange
- Skin lymph expands due to direct invasion into lymphatics or indirect lymphatic compromisation
- Puckering
- Rash / redness
How do you inspect the breast?
- Inspect
- Scars, visibles masses, skin changes, nipple changes, etc
- Ask patients to put hands on hips
- Does mass move with contraction of pectoralis?
- Ask patient to put hands behind head
How do you palpate the breast?
- Patient lying down, hands behind head
- Use pads of fingers to press breast against chest wall
- Clock face method
- Spiral method
- Make sure to complete exam before examining specific lumps
How do you palpate the axillary lymph nodes?
- Ask patient to rest their arm on yours
- Palpate axilla with other hand
- Repeat on other side
What are the differential diagnoses for patients with breast lump?
- Fibroadenoma
- Breast cyst
- Sebaceous cyst
- Abscess
- Phyllodes tumour
- Fat necrosis
- Fibrocystic change
- Cancer
What are the features of fibroadenoma?
- Benign, may recur
- Mobile
- Smooth
- More prevalent in young population
- Resection doesn’t necessarily relieve pain
What are the typical features of a breast cyst?
- Benign
- Disteended, involuted lobules
- Oval/round, smooth, fluid filled
- Can be painful or visible
What do you do if you drain a breast cyst yet the lump still remains?
Give triple assessment
What are the features of sebaceous cysts?
- Confined to skin and subcut tissue
- Can become infected / painful
- Can visualise punctum (small hole in middle)
