Session 7: Breast Disease Flashcards
Clinical features of breast disease.
Physiological swelling and tenderness
Nodularity
Breast pain
Palpable breast lumps
Nipple discharge, galactorrhoea or blood e.g.
Breast infection and inflammation
What is the most common benign breast disorder?
Fibrocystic change
What is fibrocystic change in breast?
Usually affects women aged 20-50 and appears to be hormonal in aetiology.
Most often presents with pain and nodularity.
Usual clinical presentation of nodularity.
Symptoms are greatest about one week before menstruation and decrease when it starts (making it hormonal).
The nodules are often found in the upper outer quadrant of the breast.
Why does it matter whether the nodules are bilateral or unilateral?
Bilaterally symmetrical nodules are rarely pathological.
A unilateral nodule is more like to be pathological.
What is cyclical mastalgia?
The breasts are active organs and change throughout the menstrual cycle.
Degrees of tenderness and nodularity in the premenstrual phase is so common it may be considered normal. This is because it affect up to two thirds of all menstruating women.
It will rapidly resolve as menstruation starts.
What are most benign palpable breast lumps?
Cysts or fibroadenomas.
What are the usual features of a benign breast mass?
Three-dimensional
Smooth and mobile
Regular borders and is solid or cystic in consistency.
In what ages are cysts most common?
Between ages 35-50.
How are cysts distinguished from solid tumours on clinical examination?
They can’t.
What are fibroadenomas?
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.
Features of fibroadenomas.
Firm, non-tender and highly mobile palpable lumps.
What do fibroadenomas rise from?
Breast lobules and are composed of fibrous and epithelial tissue.
Increased risk of fibroadenomas
Hormone replacement therapy
What is an intraductal papilloma?
A benign growth in a single milk duct leading to spontaneous discharge from one nipple only.
Excision can be performed.
What is mammary duct ectasia?
Dilation of major ducts, filled with creamy secretion with periductal inflammation.
Clinical presentation of mammary duct ectasia?
May be asymptomatic
Nipple discharge (bloody, serous, creamy white or yellow)
Retracted nipple
Acute inflammation
Recurrent chronic inflammation with abscess formation
Treatment of mammary duct ectasia
Surgical excision of the major duct
Correction of nipple retraction.
What is mastitis?
Generalised cellulitis of the breast that is treated with antibiotics.
Clinical presentation of breast abscesses.
Point tenderness
Erythema
Fever
Generally related to lactation (mastitis as well)
Non lactational abscesses are more common in smokers.
Common pathogen in breast abscesses.
Staph. aureus most commonly or strep bacilli
When would you refer a patient to specialist breast clinic?
Aged >30 and unexplained breast lump with or without pain.
Aged >50 with any of the following symptoms in one nipple only:
Discharge
Retraction
Skin changes that suggest breast cancer
Aged >30 with an unexplained lump in the axilla.
