Session 7: Breast Disease

Question 1

Clinical features of breast disease.

Answer 1

Physiological swelling and tenderness

Nodularity

Breast pain

Palpable breast lumps

Nipple discharge, galactorrhoea or blood e.g.

Breast infection and inflammation

Question 2

What is the most common benign breast disorder?

Answer 2

Fibrocystic change

Question 3

What is fibrocystic change in breast?

Answer 3

Usually affects women aged 20-50 and appears to be hormonal in aetiology.
Most often presents with pain and nodularity.

Question 4

Usual clinical presentation of nodularity.

Answer 4

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.

Question 5

Why does it matter whether the nodules are bilateral or unilateral?

Answer 5

Bilaterally symmetrical nodules are rarely pathological.

A unilateral nodule is more like to be pathological.

Question 6

What is cyclical mastalgia?

Answer 6

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.

Question 7

What are most benign palpable breast lumps?

Answer 7

Cysts or fibroadenomas.

Question 8

What are the usual features of a benign breast mass?

Answer 8

Three-dimensional

Smooth and mobile

Regular borders and is solid or cystic in consistency.

Question 9

In what ages are cysts most common?

Answer 9

Between ages 35-50.

Question 10

How are cysts distinguished from solid tumours on clinical examination?

Answer 10

They can’t.

Question 11

What are fibroadenomas?

Answer 11

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.

Question 12

Features of fibroadenomas.

Answer 12

Firm, non-tender and highly mobile palpable lumps.

Question 13

What do fibroadenomas rise from?

Answer 13

Breast lobules and are composed of fibrous and epithelial tissue.

Question 14

Increased risk of fibroadenomas

Answer 14

Hormone replacement therapy

Question 15

What is an intraductal papilloma?

Answer 15

A benign growth in a single milk duct leading to spontaneous discharge from one nipple only.

Excision can be performed.

Question 16

What is mammary duct ectasia?

Answer 16

Dilation of major ducts, filled with creamy secretion with periductal inflammation.

Question 17

Clinical presentation of mammary duct ectasia?

Answer 17

May be asymptomatic

Nipple discharge (bloody, serous, creamy white or yellow)

Retracted nipple

Acute inflammation

Recurrent chronic inflammation with abscess formation

Question 18

Treatment of mammary duct ectasia

Answer 18

Surgical excision of the major duct

Correction of nipple retraction.

Question 19

What is mastitis?

Answer 19

Generalised cellulitis of the breast that is treated with antibiotics.

Question 20

Clinical presentation of breast abscesses.

Answer 20

Point tenderness

Erythema

Fever

Generally related to lactation (mastitis as well)

Non lactational abscesses are more common in smokers.

Question 21

Common pathogen in breast abscesses.

Answer 21

Staph. aureus most commonly or strep bacilli

Question 22

When would you refer a patient to specialist breast clinic?

Answer 22

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.