L07: Breast Disease Signs And Symptoms Flashcards
What are the symptoms of breast disease
Lump Change in size Nipple change Nipple discharfe Infection Pain (mastalgia) Skin changes
What questions should be asked in the history
Menstrual cycle- menarche, menopause, preganncy, gynaecological procedures
Drug history: oral contraceptive pills or HRT (risk of breast cancer)
Family history: of breast cancer and ovarian cancer
What are the 3 categories of benign breast conditions
Benign lump
Hormonal breast condition
Inflammatory breast condition
What are the benign lumps that can occur
Fibroadenoma
Cyst
Traumatic fat necrosis
Phyllodes tumour
What is a fibroadenoma
Abberation of normal development where there is proliferation process in single terminal ductal unit in the breast
What is the diagnosis of fibroadenoma
Tripple assessment
What does a tripple assessment involve
Physical examination
Radiological imaging
Biopsy
What is the treatment of fibroadenoma
Monitor the breast as it can grow
What are cysts
Fluid filled lobules
When are cysts common
Around menopause
When are breast cysts uncommon
Post menopause
What is the presentation of cysts
Pain
Tenderness
Mulitple or single lump
What is the diagnosis of cysts
Tripple assessment
Ultrasound- diagnostic
What is the treatment for a cyst
Reassurance and advice
Aspiration if the patient is symptomatic
What is a traumatic fat necrosis
Lump due to iatrogenic e.g surgical or blunt trauma e.g seat belt injury or elbow injury which causes fat necrosis or breakdown of adipose tissue
What is the presentaiton of traumatic fat necrosis
Skin changes with or without bruising
Presents like breast carcinoma
What is the assessment of traumatic fat necrosis
Biopsy- to distunguish between breast carcinoma
What is pyhloddes tumour
A arare tumout that occurs aronnd menopausal age that can be benign or malignant
What is the presentation of phyloddes tumour
Firm
Mobile
Wel circumscribed
Non tender breast mass
What is the diagnosis of phyllodes tumour
Triple assessment
What is the management of phyloddes tumour
Wide excision
What hormonal breast condition can occur
Gynaecomastia
What is gynaecomastia
Hormonal proliferation of breast tissue in males due to increased oestrogen and androgen
Which condition can cause gynaecomastia
Liver cirrhosis
Testicular tumour
Hypogonadism
Idiopathic
What is the treatment for gynaecomastia
Reassurance
Liposuction/excision/cosmetic surgery
What are the types of breast and inflammatory breast condition that can occur
Periductal mastitits
Acute bacterial mastitis and abscess
What is periductal mastitis
Inflammatory process around the dilated milk ducts which can be secondary to duct entasia (dilation of major ducts in the subareolar region)
What is the presentation of periductal mastitis
Pain
Nipple discharge
Cellullitis
Suberaolar mass
What is the assessment of periductal mastitis by
Ultrasound
What is the treatment of periductal mastitis
antibiotics
Surgery
What is acute bacterial mastitis and asbcess
Usually associated with lactation in breastfeeding mothers
In non lactating women can be associated with women immunocompromised
What are the presentation of bacterial mastitis and abscess
Signs of breast inflammation
Localised to a breast area
Systemic signs of infection
What is the assessment of aucte bacterial mastitis
Ultrasound
What is the treatment of acute bacterial mastitis
Antibiotics
Continue breastfeeding
Aspiration of asbcess
What are the types of breast cancer
Ductal: can be separated to intraductal and invasive ductal carcinoma Lobular Tubular Medullary Mucinous
How can breast cancer spread
Direct extension
Lymphatic system: to axillay and internal thoracic nodes
Haematolgical: via blood to lungs, liver, bone and brain
What are the risk factors for developing breast cancer
Gener- female Drugs: ocp and hrt (oestrogen exposure) Family history of BRCA gene mutation Early periods Late menopause Radiation Alcohol and overweight
What are the features of breast cancer
Nipple discharge
Lump
Nipple retraction or inversion
Skin changes such as tethering
How do we diagnose breast cancer, what are the investigations
Triple assessment: clinicla examiantion, imaging and biopsy
Further: bloods, lfts, ue, chest xray, bone scans, liver ultrasound scan
What are the treatment options for breast cancer
Wide local excsision
Mastectomy
Surgery to the axilla: by sentinel lymph nodes biopsy, axillary node sampling, axillary node clearance
What is the difference between wide local excision and mastectomy
Wide local excision: removal of the lump and marging of healthy tissue
Mastectomy: removal of the whole lump
What is sentinel lymph node biopsy
Taking a biopsy from the first axillay lymph node
What is axillay lymph node sampling
When several lymph nodes are removed for histological examination
What is axillay lymph node clearance
Removing lymph nodes that were found to be positive
What are adjuvant therapies
When you give therapy after surgery to prevent reoccurance such as chemotherapy and radiotherapy
When do we give hormonal therapy
To reduce ostreogen levels in an ER positive tumour only
What are the types of hormonal therapy
Selective oestrogen receptor modulators: prevent oestrogen from binding to its receptors
Aromatase inhibitor: inhibit aromatas that produce oestrogen in fatty tissue
Ovarian ablation: chemotherapy, radiotherapy and lh analogue e.g goserelin
Who is aramatase inhibitors given to
post menopausal women that have the oestreogen produced by the fatty tissue instead of the ovaries
If there is a HER2 positive breast cancer what can be given
herceptin
What is herceptin
A monoclonal antibody that binds to HER2 receptors
