L24: Benign And Malignant Breast Disease Flashcards
What are the common symptoms of breast disease
Lump Change in skin Nipple change Nipple discharge Pain Infection
In the drug history what should you specifically ask for
HRT
OCP
In the family history what should you ask for
Ovarian and breast cancer
What is a triple assessment
Physical examination
Radiological imaging
Biopsy
What are the benign lumps in the breast
Fibroadenoma
Cyst
Traumatic fat necrosis
Phyllodes tumour
What hormonal changes can occur in the breast
Gynaecomastia
What infection can occur in the breast
Periductal mastitis
Acute bacterial mastitis
Abscess
What is a fibroadenoma
Commonest breast lump in women
What are the features of fibroadenoma
Rubbery Firm Painless Oval and smooth defined border Mobile i.e not attached to the skin
What is the diagnosis of fibroadenoma by
Tripple assessment
What is the treatment of fibroadenoma
Reassurance
Monitor
Excision
What are cysts
Fluid filled lobules
In which group of females are cyst common in
Perimenopausal
What is the diagnosis of cysts by
Triple assessment
What is the presentation of cysts
Single of multiple smooth lumps
Short history
Pain and tenderness
Can become big or painful before menstruation
What is the treatment of cysts
Reassurance
Aspiration
What is traumatic fat necrosis
Traumatic necrosis
What is traumatic fat necrosis due to
seat belt injury
Elbow injury
What happens in traumatic fat necrosis
Adipose tissue (fat) breaks downs
What are the presentation of traumatic fat necrosis
Painless, irregular and firm lump
Skin changes
With or without bruising
What is the assessment of traumatic fat necrosis
Triple assessment
Why is the biopsy in traumatic fat necrosis important
Because it can rememble cancer
What is the management of traumatic fat necrosis
Should resolve on its own
What is phyllodes tumour
A rare tumour that occurs in women around menopause
Which cells does phyllodes tumour arise from
Stromal cells
What is the presentation of phyllodes tumour
Firm Mobile Well circumscribed Non tender Similar to fibroadenoma
What is the diagnosis of phyllodes tumour by
Triple assessment
What is the management of phyllodes tumour
Triple assessment
What is the management of phyllodes tumour
Wide excision
Follow up with imaging
What is gynacomastia and who does it occur in
Proliferation of breast tissue in males
What are the causes of gynacomastia
Liver cirrhosis Testicular tumour Hypogonadism Idiopathic Drugs; osteogen and androgen
What is the treatment of gynaecomastia
Reassurance
Manage the cause
Liposuction or cosmetic surgery
What is periductal mastitis
Inflammation around the dilated milk ducts
What is the presentation of periductal mastitis
Pain
Nipple discharge
Cellulitis
Subareolar mass
What is the diagnosis of periductal mastitis by
Ultrasound
What is the treatment of periductal mastitis
Antibiotics
Surgery- if recurrent
What is acute bacterial mastitis usually associated with
Breast feeding
Which organism is likely to cause acute bacterial mastitis
Staphylococcus Auerus
What is the presentation of acute bacterial mastitis
Breast inflammation: redness, swelling, tenderness and warmth
Localised to small area
Fluctuant mass
Systemic signs of inflammation
What is the diagnosis of acute bacterial mastitis by
Ultrasound
What is the treatment of acute bacterial mastitis
Antibiotics
Continue breastfeeding
Aspirate the abscess
What are the types of breast carcinoma dependent on
The location
What are the types of breast carcinoma
Ductal Lobular Tubular Medulla Mucinous
What are the subtypes of ductal breast carcinoma
Ductal carcinoma in situ
Invasive ductal carcinoma
Where can spread of breast carcinoma to
Local: skin, muscle and chest wall
Lymphatic: axillary and internal thoracic nodes
Haematological: lungs, liver, bone and brain
What are the risk factors for breast cancer
Age Family history BRCA gene mutations Oestrogen exposure: early menarache, late menopause, OCP, HRT Chest radiation Alcohol Overweight
What are the protective factors against breast cancer
Breastfeeding
Having children
Physical activity
What are the features of breast cancer
Lumps: firm and irregular Nipple retraction and inversion Blood stained nipple discharge Skin tethering Peau de orange appearance Change in breast shape Palpable axillary lymph nodes
What is the diagnosis of breast cancer by
Triple assessment: examination, imaging and biopsy
What are the treatment options in breast cancer
Surgery:
- wide local excision: removal of the lump and some healthy margin
- mastectomy: removal of the whole breast
- surgery to the axilla: also used as prognosis
Adjuvant therapy
Hormonal therapy
Biological therapy
What is adjuvant therapy
Therapy given before or after the surgery
Name examples of adjuvant therapy
Chemotherapy
Radiotherapy
When is hormonal therapy used
If the tumour is postive for oestrogen receptors (ER)
What can hormonal therapy be
Selective oestrogen receptor modulator e.g tamoxifen
Aromatase inhibitors e.g anastrozole
Ovarian ablation
Who uses Aromatase inhibitors
Post menopausal women who make oestrogen from fatty tissue and do not have oestrogen production from the ovary
Who has ovarian ablation
Pre-menopausal women
If there is a HER2 over expressing tumour what biological therapy can be used
Herceptin
What is herceptin
Monoclonal antibody for HER2 receptor
