Lecture 12- Breast disease Flashcards
breast cancer intro
- Breast cancer is the most common cancer in women in developed world
- 4th most common cause of cancer death in UK
- 76% 10 year survival rate
common features of breast disease
- physiological swelling and tenderness
- nodularity
- breast pain
- palpable breast lumps
- nipple discharge including galactorrhoea
- nreast infection and inflammation- usually asscoiated with lactation
history taking
Physiological swelling and tenderness
- Puberty
- Breast enlargement, sometimes initially unilateral
- Breast buds may initially be unilateral (puberty breast development is known as therlarche)
Nodularity
- Bilateral symptoms often caused by benign breast disease
- The symptoms are greatest about one week before menstruation and decrease when it starts.
- Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper outer quadrant of the breast.
- Women present with lumpiness of the breast and varying degrees of pain and tenderness
Cyclical mastalgia
The breasts are active organs that change throughout the menstrual cycle and some degree of tenderness and nodularity in the premenstrual phase is so common that it may be considered as normal, affecting up to two thirds of all menstruating women. It rapidly resolves as menstruation starts.
Watch out for Non-Cyclical Mastalgia
Ongoing discomfort and pain in the breast
- Hormonal medication, especially hormone replacement therapy (HRT). Also oral contraceptive pills.
- Antidepressants (including sertraline, venlafaxine and mirtazapine).
- Antipsychotics (including haloperidol).
- Cardiovascular drugs (including digoxin and spironolactone).
- Antibiotics (including metronidazole) and antifungals (including ketoconazole).
- Extramammary causes e.g. costochondritis Benign breast disease
- Breast cancer
Breast lumps
A discrete mass should be described in terms of (LMS=TM (Leicester medical school = too much)):
- Location
- Size
- Mobility
- Texture
- Mobility
Most breast lumps (45%) are found in
upper outer quadrant
Peau d’orange- ‘the skin of an orange”
Caused by Inflammatory breast cancer- ductal carcinomaà invades surrounding areas which blocks lymphatic drainage (stage 3 by the time Peau d’orange occurs).
- High proportion of metastasis
- Swelling causes it; usually because of fluid build-up in the subcutaneous layer due to poor lymphatic drainage- oedema. The top layer of your skin (called the epidermis) expands to make room for the swelling.
Fungating breast mass
features of a malignant breast mass
- consistency: hard
- painless (90%)
- irregular margins
- fixation to skin or chest wall
- skin dimpling may occur
- discharge: bloody, unilateral
- nipple retraction may be present
features of a benign breast mass
- consistency: firm or rubbery
- painful (conssitent with beningn breast condition)
- regular or smooth margins
- mobile and not fixed
- skin dimpling unlikely
- discharge: no blood and bilateral. Green or yellow colour
- no nipple retraction
The journey- Kubler Ross Model of Grief
Palpable benign breast lumps- Most benign lumps will be either
cysts or fibroadenomas
- Benign mass is usually three-dimensional , mobile and smooth, has regular borders and is solid or cystic in consistency’s
(1) Fibrocystic benign tumour
- Fibrocystic change is the most common benign breast disorder
- Usually affects women aged 20-60 and appears to be hormonal in aetiology
- Most often present with pain and nodularity
- Cysts are most common between the ages of 35 and 50. They are palpable as discrete lumps and may be recurrent.
- They cannot be reliably distinguished from solid tumours on clinical examination
treatment of fibrocystic benign tumour
Aspiration can reduce cyst so much it dissapears- usign US to guide
(2) Fibroadenomas
- These are benign tumours that are common in young women, with incidence peaking at 20-24 years of age.
- They are the most common type of breast lesion.
- Fibroadenomas arise in breast lobules and are composed of fibrous and epithelial tissue. They present as firm, non-tender, highly mobile palpable lumps. Hormones seem to be involved in aetiology, and hormone replacement therapy (HRT) increases the incidence.
anatomy of human breast
(3) Benign intra-ductal wart like-growth – papilloma
An intraductal papilloma is a small, wart-like growth that bumps out into the breast ducts near the nipple. This causes a bloody or sticky discharge. Any slight bump or bruise near the nipple can also cause the papilloma to bleed.
(4) Mammary duct ectasia
- nipple retraction
- chronic inflammation with abscess formation
Mastitis
- Generalised cellulitis of the breast
- Treated with antibiotics
concluding points
