L07: Breast Disease Signs And Symptoms

Question 1

What are the symptoms of breast disease

Answer 1

Lump
Change in size
Nipple change
Nipple discharfe 
Infection
Pain (mastalgia)
Skin changes

Question 2

What questions should be asked in the history

Answer 2

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

Question 3

What are the 3 categories of benign breast conditions

Answer 3

Benign lump
Hormonal breast condition
Inflammatory breast condition

Question 4

What are the benign lumps that can occur

Answer 4

Fibroadenoma
Cyst
Traumatic fat necrosis
Phyllodes tumour

Question 5

What is a fibroadenoma

Answer 5

Abberation of normal development where there is proliferation process in single terminal ductal unit in the breast

Question 6

What is the diagnosis of fibroadenoma

Answer 6

Tripple assessment

Question 7

What does a tripple assessment involve

Answer 7

Physical examination
Radiological imaging
Biopsy

Question 8

What is the treatment of fibroadenoma

Answer 8

Monitor the breast as it can grow

Question 9

What are cysts

Answer 9

Fluid filled lobules

Question 10

When are cysts common

Answer 10

Around menopause

Question 11

When are breast cysts uncommon

Answer 11

Post menopause

Question 12

What is the presentation of cysts

Answer 12

Pain
Tenderness
Mulitple or single lump

Question 13

What is the diagnosis of cysts

Answer 13

Tripple assessment

Ultrasound- diagnostic

Question 14

What is the treatment for a cyst

Answer 14

Reassurance and advice

Aspiration if the patient is symptomatic

Question 15

What is a traumatic fat necrosis

Answer 15

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

Question 16

What is the presentaiton of traumatic fat necrosis

Answer 16

Skin changes with or without bruising

Presents like breast carcinoma

Question 17

What is the assessment of traumatic fat necrosis

Answer 17

Biopsy- to distunguish between breast carcinoma

Question 18

What is pyhloddes tumour

Answer 18

A arare tumout that occurs aronnd menopausal age that can be benign or malignant

Question 19

What is the presentation of phyloddes tumour

Answer 19

Firm
Mobile
Wel circumscribed
Non tender breast mass

Question 20

What is the diagnosis of phyllodes tumour

Answer 20

Triple assessment

Question 21

What is the management of phyloddes tumour

Answer 21

Wide excision

Question 22

What hormonal breast condition can occur

Answer 22

Gynaecomastia

Question 23

What is gynaecomastia

Answer 23

Hormonal proliferation of breast tissue in males due to increased oestrogen and androgen

Question 24

Which condition can cause gynaecomastia

Answer 24

Liver cirrhosis
Testicular tumour
Hypogonadism
Idiopathic

Question 25

What is the treatment for gynaecomastia

Answer 25

Reassurance | Liposuction/excision/cosmetic surgery

Question 26

What are the types of breast and inflammatory breast condition that can occur

Answer 26

Periductal mastitits | Acute bacterial mastitis and abscess

Question 27

What is periductal mastitis

Answer 27

Inflammatory process around the dilated milk ducts which can be secondary to duct entasia (dilation of major ducts in the subareolar region)

Question 28

What is the presentation of periductal mastitis

Answer 28

Pain Nipple discharge Cellullitis Suberaolar mass

Question 29

What is the assessment of periductal mastitis by

Answer 29

Ultrasound

Question 30

What is the treatment of periductal mastitis

Answer 30

antibiotics | Surgery

Question 31

What is acute bacterial mastitis and asbcess

Answer 31

Usually associated with lactation in breastfeeding mothers | In non lactating women can be associated with women immunocompromised

Question 32

What are the presentation of bacterial mastitis and abscess

Answer 32

Signs of breast inflammation Localised to a breast area Systemic signs of infection

Question 33

What is the assessment of aucte bacterial mastitis

Answer 33

Ultrasound

Question 34

What is the treatment of acute bacterial mastitis

Answer 34

Antibiotics Continue breastfeeding Aspiration of asbcess

Question 35

What are the types of breast cancer

Answer 35

``` Ductal: can be separated to intraductal and invasive ductal carcinoma Lobular Tubular Medullary Mucinous ```

Question 36

How can breast cancer spread

Answer 36

Direct extension Lymphatic system: to axillay and internal thoracic nodes Haematolgical: via blood to lungs, liver, bone and brain

Question 37

What are the risk factors for developing breast cancer

Answer 37

``` Gener- female Drugs: ocp and hrt (oestrogen exposure) Family history of BRCA gene mutation Early periods Late menopause Radiation Alcohol and overweight ```

Question 38

What are the features of breast cancer

Answer 38

Nipple discharge Lump Nipple retraction or inversion Skin changes such as tethering

Question 39

How do we diagnose breast cancer, what are the investigations

Answer 39

Triple assessment: clinicla examiantion, imaging and biopsy | Further: bloods, lfts, ue, chest xray, bone scans, liver ultrasound scan

Question 40

What are the treatment options for breast cancer

Answer 40

Wide local excsision Mastectomy Surgery to the axilla: by sentinel lymph nodes biopsy, axillary node sampling, axillary node clearance

Question 41

What is the difference between wide local excision and mastectomy

Answer 41

Wide local excision: removal of the lump and marging of healthy tissue Mastectomy: removal of the whole lump

Question 42

What is sentinel lymph node biopsy

Answer 42

Taking a biopsy from the first axillay lymph node

Question 43

What is axillay lymph node sampling

Answer 43

When several lymph nodes are removed for histological examination

Question 44

What is axillay lymph node clearance

Answer 44

Removing lymph nodes that were found to be positive

Question 45

What are adjuvant therapies

Answer 45

When you give therapy after surgery to prevent reoccurance such as chemotherapy and radiotherapy

Question 46

When do we give hormonal therapy

Answer 46

To reduce ostreogen levels in an ER positive tumour only

Question 47

What are the types of hormonal therapy

Answer 47

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

Question 48

Who is aramatase inhibitors given to

Answer 48

post menopausal women that have the oestreogen produced by the fatty tissue instead of the ovaries

Question 49

If there is a HER2 positive breast cancer what can be given

Answer 49

herceptin

Question 50

What is herceptin

Answer 50

A monoclonal antibody that binds to HER2 receptors