Breast conditions Flashcards
What is a breast abscess + types + RF + causes?
- Collection of pus within breast
- This may be a Lactational abscess (blocked duct) or Non-lactational abscess (infection)
RF:
- smoking, damage to nipples (e.g. eczema, candida infection, piercing), underlying beast disease e.g. Ca
Causes
- Staph aureus, strep, anaerobic bacteria
Syx of breast abscess
Dx made clinically. Acute onset:
- Swollen
- Fluctuant i.e. able move fluid around within lump
- Tender
- Generalised syx of infection: muscle aches, fatigue, fever, signs of sepsis
Ix + Mx of breast abscess
(1.) Confirm dx with USS
(2.) Abx if infection
(3.) Referral to surgical team for drainage/needle aspiration
(4.) MC&S of drained fluid
(5). Continue with breast feeding
WHat is a Fibroadenoma?
- Common benign tumours of stromal/epithelial breast duct tissue.
- They are not cancerous and does not inc ca risk
- They respond to female hormones (oestrogen and progesterone) + thus more common in younger women (20-40y) and often regress after menopause.
Clinical features of Fibroadenoma
Pt can present with multiple fibroadenomas
- Painless
- Smooth
- Round
- Well circumscribed (well-defined borders)
- Firm
- Mobile, ‘breast mice’ (moves freely under the skin and above the chest wall)
- Usually <3cm diameter
Ix and Mx for Fibroadenoma
Triple assessment (exam, imaging, biopsy)
- If <25yrs - needle biopsy not always necessary
- if <40y = USS
- if >40y = mammogram (breast XR)
Management
- Usually left alone
- Surgical excision if >40y or <40y plus lump >4cm diameter
What is Fibrocystic disease?
- Generalised lumpiness to breast this can be of normal variation
- The connective tissues (stroma), ducts and lobules of the breast respond to oestrogen and progesterone, becoming fibrous and cystic.
- These changes fluctuate with the menstrual cycle.
- Syx improve after menopause
Clinical features of Fibrocystic disease?
- Lumpy + fibrous -> cobblestone feel
- Breast pain or tenderness (mastalgia)
- Fluctuation of breast size
- Cyclical nature i.e. worse before periods
Investigations + Management of Fibrocystic disease?
Ix
- Triple assessment
- Dx of exclusion, r/o Ca
Management
Conservative (manage pain)
- Well-fitting bra
- Reduce caffeine + salt
- Apply heat to the area
- Analgesia
Medical
- Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance
Surgical
- Drainage if problematic
What is Mastitis? Causes?
- Mastitis refers to inflammation of breast tissue
- Complication: breast abscess
Causes
- lactational: accumulated milk due to blocked duct this may progress to s.aureus infection
- non-lactational: infection secondary to periductal mastitis (s.aureus, enterococci, anaerobic bacteria)
Presentation of Mastitis and when may you consider Ix?
Dx made clinically. Typically 1-6w postpartum
- Unilateral painful/tender breast
- Fever +general malaise
- Tender, red, swollen hard area of breast (often wedge shape distribution)
- +/- nipple discharge
Ix: Breast milk culture MC&S
- not routinely done
- if mastitis recurrent, or unsualy presentation
- Hospital-acquired infection is likely.
- There is severe deep ‘burning’ breast pain (indicative of ductal infection).
Management of Mastitis
(1.) Admission if sepsis, haem unstable, IMC, abscess. 2ww if breast ca.
Lactational Mastitis
(1.) Encourage breast feeding, expressing milk
(2.) Reassure won’t harm baby
(3.) Warm compress,
(4.) Analgesia
(5.) Consider Abx: flucloxacillin if infection or no improve/worsening, milk sample sent for MC&S
Non-lactational Mastitis
(1.) Warm compress
(2.) Identify any predisposing factors e.g. eczema, fungal infection
(3.) Analgesia
(4.) Abx PO co-amoxiclav - in all women with non-lactational mastitis
Most common type of breast ca and common metastases (4)
- Most common cancer in UK.
- Ductal carcinoma is most common breast ca type
- Breast ca metastasis sites (2Ls, 2Bs) = Lung, Liver, Bones, Brain.
RF for breast cancer.
What pt’s are classed as ‘high risk’?
(1.) Female (99%)
(2.) Increased oestrogen exposure
- earlier menarche and late menopause
- nulliparity or late first pregnancy
- COCP or HRT
(3.) Susceptibility gene mutations - BRAC1/BRAC2
(4.) Age
(5.) Obesity
(6.) Smoking
(7.) FH (first-degree relatives)
High risk patients
- A first-degree relative with breast ca <40y
- A first-degree MALE relative with breast ca
- A first-degree relative with BILATERAL breast ca, first dx <50y
- TWO first-degree relatives with breast cancer
When is breast cancer screening indicated?
3 yearly mammogram offered to women 50-70y
