S7 L1 Breast Disease Management Flashcards
What are some typical presenting features of breast disease?
- Swelling and tenderness
- Nodularity
- Mastalgia (cyclical and non-cyclical)
- Palpable breast lumps
- Nipple discharge (including galactorrhoea)
- Mastitis
What type nipple discharge is a red flag?
Unilateral blood stained
How can benign breast lumps be classified histologically?
- Non proliferative disorders: no increased risk of cancer
- Proliferative disorders: mild to moderate increased risk
- Atypical hyperplasia: increase in risk of 4.1-5.3
Why is some physiological breast swelling that occurs in adolescence?
During puberty thelarche occurs and this can be unilateral or bilateral
What are the two most common benign palpable breast lumps?
- Fibrocystic changes: presents with pain and nodularity in women 20-50. Responds to hormones so cyclical
- Fibroadenomas: benign breast mass common in 20-30s. Made of fibrous and epithelial tissue. Firm, non tender, highly mobile lump with regular borders and is cystic in consistency. Hormones involved so HRT increases incidence
What is nodularity of the breast and when is it abnormal?
- Lumpy glandular tissue often in upper outer quadrant of breast that is worst about a week before menstruation and decreases when it starts
- Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper quadrant of the breast
- If bilaterally symmetrical rarely pathological but if there is asymmetry review after one or two menstrual cycles seeing her mid cycle and enquire about family history
What is cyclical mastalgia and how do we treat it?
- Pain and nodularity that occurs in the breast in the premenstrual phase which rapidly resolves when menstruation starts
- Breasts are active organs - 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
- Wear a supportive bra and analgesia
What does a benign breast lump feel like?
- Smooth
- Mobile
- Regular borders
- Solid or cystic
What are the 4 quadrants of the breast used to describe the location of breast pathology?
How do you distinguish fibrocystic changes from a solid tumour?
- Can’t on examination so have to do fine needle aspiration biopsy but do not do this is you strongly suspect cancer as this provides a path for the cancer
- Often biopsy drains cyst and resolves it but may refill later
How do we treat fibroadenomas?
Observe every 3 months with an ultrasounds
What is a benign cause of bloody nipple discharge?
- Intraductal Papilloma and usually only unilateral
- Can often have pain as well as blocked milk duct
- Leaves patient susceptible to infection
What is mammary duct ectasia and how does it present?
When a milk duct becomes dilated and filled with creamy secretions causing periductal inflammation
What is mastitis and how do we treat it?
- Generalised cellulitis of the breast, often due to overfilling of the breasts from irregular nursing
- Cracks in the nipples can allow bacteria to get in and sometimes an abscess forms
- Treat with antibiotics and by expressing milk from unused breast
What patients need to be referred via the 2 week wait for breast changes?
- Skin changes that suggest breast cancer
- >30 with unexplained lump in axilla
- Anyone under 30 with unexplained breast lump with or without pain can be a non-urgent referral
What is the Kubler Ross change curve?
Last three changes can often be called acceptance
What are some benign conditions causing nipple discharge?
- Duct ectasia
- Mastitis
- Intraductal Papilloma
What is a radical mastectomy?
Surgical procedure involving the removal of breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla
What are cysts?
- 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 and clinical examination
