Lecture 12 - Breast Disease (Primary Care) Flashcards
Label breast on slide 3
What are some examples of benign breast lumps?
Intraduct papilloma
Adenoma
Lipoma
Fibroadenoma
Fibroadenoma
Phyllodes tumours
What is cyclical mastalgia?
Pain of breast usually in the cycle of the menstrual cycle
Look at case 1 slide 6
What is the most likely diagnosis?
How would it be managed?
Fibroadenoma
Reassure its fine
What is the most common type of breast lump in young women??
Fibroadenoma (BENIGN)
How do breast cysts present?
Palpable of discrete lumps
Non mobile
Often get referred down cancer pathway to exclude cancer
How does an Intra ductal papilloma present?
Unilateral blood stained nipple discharge
Lump is tender
Essentially when benign tumour grows in single milk duct
What is mammary duct ectasia?
Dilation of large and intermediate breast ducts
Leads to shortening and dilation of subareola ducts as they. Involute
May get breast lumps or nipple discharge
What is fibrocystitc change?
When the breast have increased amount of fibrous connective tissue and cysts
What is mastitis and when is it most common?
When milk ducts get blocked leading to breast inflammtion
Can have it with infection or without
BREAST FEEDING//PREGNANT WOMEN
What advice is give to someone with mastitis?
Continue to breast feed
What abx is usually given to a mastitis with infection?
??
Flucloxacillin or erythromycin if penicillin allergic
What are some importnat questions to ask in a patient Hx in. Primary care?
When first noticed
Change in size
Nipple changes
Discharge
Skin changes
Menstrual history
Changes through menstrual cycle
FHx
Risk factors
What do you examine in a breast exam?
Mass assessed:
-location
-size
-mobility
-lymph nodes
Assses in a clock like fashion
What is the NICE referral criteria for the urgent 2 week pathway from breast cancer?
30+ with unexplained breast lump +- pain
50+ unilateral discharge, retraction or other changes
Skin changes or 30+ with unexplained Axillary lump
What are the major risk factors for breast cancer?
-Older (50+)
-Previous breast cancer
-FHx (BRCA1 and 2)
-Dense breast tissue
-Benign breast disease
-Hormonal factors (HRT early menarch and late menopause)
-lifestyle (OBESITY, ALCOHOL and SMOKING)
How do breast cancers often present?
Lump
Normally painless
Nipple symptoms
Skin changes
What is the clinical sign on slide 21:
Peau D’Orange
Looks like the skin of an orange
What is pagets disease?
Presentation of breast cancer that is associated with ductal carcinoma in situ or invasive carcinoma
Looks like eczema on the nipple
What is the screening program for breast cancer?
Mammograms every 3 years from 50-71
Earlier screening if FHx
How do malignant breast masses typically differ to benign breast masses?
Malignant:
Hard
Painless
Irregular margins
Fixed
Benign:
Firm/rubbery
Painful
Regular or smooth margins
Mobil and not fixed
