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
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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
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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
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/379/a_image_thumb.jpeg?1583405780)
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
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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
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/384/a_image_thumb.png?1583406123)
What does a benign breast lump feel like?
- Smooth
- Mobile
- Regular borders
- Solid or cystic
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/385/a_image_thumb.png?1583406224)
What are the 4 quadrants of the breast used to describe the location of breast pathology?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/387/a_image_thumb.png?1583406274)
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
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/389/a_image_thumb.jpeg?1583406468)
How do we treat fibroadenomas?
Observe every 3 months with an ultrasounds
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/392/a_image_thumb.png?1583406595)
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
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/394/a_image_thumb.png?1583407049)
What is mammary duct ectasia and how does it present?
When a milk duct becomes dilated and filled with creamy secretions causing periductal inflammation
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/396/a_image_thumb.jpeg?1583407183)
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
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/880/397/a_image_thumb.jpeg?1583407479)
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
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