12. Breast Conditions Flashcards
(32 cards)
Categorise Breast Conditions by where they affect
Lobules:
- Fibroadenoma
- Lobular carcinoma
Milk Duct:
- Ductal Carcinoma
- Duct Ectasia
Fatty Tissues:
- Mastitis
- Abscess
What is included in Benign Breast Disease?
- Fibroadenoma
- Breast Cyst
- Duct Ectasia (Non-puerperal mastitis)
Describing Benign Breast Disease: SCTF
Site, size, skin, single?
Colour, contour, consistency
Tenderness, temperature, transilluminable
Fluctuant or fixed
Fibroadenoma Definition Epidemiology Signs Invx Mx
Definition: Benign breast tumours
Epidemiology: Young women of child-bearing age
S: 1-5 cm, singleC: well demarcated, firm consistency, highly mobileT: tenderlessF:
Invx:
FNA (fine needle aspiration biopsy). USS/mammography
Mx:
Surgical: cryoablation (US guided), excision. Medical: Ormeloxifene
Duct ectasia Definition Epidemiology Signs Invx Mx
Definition: Blockage of the milk ducts.
Epidemiology: Peri/post menopausal women (40-50+)
S: small lump behind nipple, nipple inversion
C: nipple discharge (watery/thick/blood stained/green), firm consistency
T: tender
F: fixed
Invx: Biopsy
Mx: Self limiting
Breast cyst Definition Epidemiology Signs Invx Mx
Definition: Fluid filled sac within the breast
Epidemiology: Pre menopausal women (30-40s)
S: singleC: well demarcated, highly mobileT: tenderless, transilluminablef: fluctuant
Invx: FNA (fine needle aspiration biopsy). USS/mammography
Mx: Fine needle aspiration/fluid drain
1. A 60 year old obese woman presents to her GP with a lesion on her breast. The lesion is red, crusted, around her right nipple. The most likely diagnosis is A. Breast cyst B. Breast abscess C. Paget’s disease of the breast D. Fibroadenoma E. Fibrocystic disease
C. Paget’s disease of the breast
A: More common in pre-menopausal women; single fluctuant lump
B: No risk factors such as breastfeeding, no symptoms of infection (fever, pain)
D: More common in younger women, single smooth mobile lump
E: More common in menstruating women, changes coicide with menstrual cycle
2. 22 year old woman presents to clinic with a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is: A. Acute mastits B. Breast abscess C. Breast cyst D. Fibroadenoma E. Periductal mastitis
D. Fibroadenoma
- A 21 year old woman presents to her GP with pain in her right breast. She has just given birth to her first child. On examination, right breast appears swollen, red and there is tenderness on palpation. You do not suspect there are any abscesses present. The most appropriate management plan would be:
A. Antibiotics
B. Refer to surgeon for incision and drainage
C. Refer to breast feeding support group and prescribe analgesia
D. Watch and wait
E. Confirm diagnosis with USS
C. Refer to breast feeding support group and prescribe analgesia
Breast cancer Epidemiology
Most common type of cancer in the UK
Most common cause of death in women ages 35-55
1 in 8 women are diagnosed with breast cancer during their lifetime
Risk factors for Breast Ca?
A FROGMAN Age Family history (1st degree relative) Radiation exposure (to chest) Obesity and OCP/HRT Genetics Menarche (<11) and menopause(>55) Alcohol, fatty diet Nulliparity
Familial breast cancer
5% of cases
BRCA1 and BRCA2
Harmful BRCA mutation 60-80% lifetime risk of developing Breast Ca Associations with Ovarian and Pancreatic Ca
Signs and Symptoms of breast cancer
S: increased size, lump in breast or armpit skin thickening, peau d’orange, skin dimpling/sores, nipple discharge (bloody, crusty), nipple inversion, growing vein
C: hard lump, irregular margins, redness
T: tenderness, red/warm (inflammatory breast Ca)
F: tethered to underlying tissue
Diagnosis of Breast Ca
- History and Clinical Examination
- Imaging
- Breast screening (50-70 every 3 years) – early detection
- Mammography
- USS – better for denser breast tissue (younger patients)
2 week wait criteria - Pathology FNAC + Core biopsy
Staging of Breast cancer
Staging
- Histopathology – most are derived from epithelium lining of ducts/lobules (ductal/lobular carcinoma)
Grading
- Appearance of breast Ca cells compared to normal tissue
TMN Staging
- Stage 0 = in situ, Paget’s disease of the breast, DCIS
- Stage 1-3 = within breast, regions LNs
- Stage 4 = metastatic cancer
Mx of Breast cancer
- SURGERY
- Removal of tumour and surrounding LNs
- Mastectomy, lumpectomy, quadrantectomy
- Breast reconstruction surgery - MEDICATION
- ER antagonists e.g. tamoxifen
- Aromatase inhibitors e.g. letrozole - CHEMOTHERAPY
- Cyclophosphamide, doxorubicin - MONOCLONAL ANTIBODIES
- Trastuzumab (HER2) - RADIATION
Post surgery, reduces risk of recurrence
4. Risk factors for developing breast cancer include: A. Having only one child B. Early menarche C. Early menopause D. Anaemia E. HIV/AIDS
B. Early menarche
- A 56 year old woman presents to her GP after noticing a breast lump 3 weeks ago. On examination, the lump is 3 cm in diameter, firm and tethered to the skin and immobile. There are no overlying skin changes. The next most appropriate investigation is:
A. Total mastectomy B. Urgent mammogram C. Urgent USS D. FNAC E. Core biopsy
B. Urgent mammogram
- A 22 year old medical student presents to her GP complaining of ‘lumpiness’ in her breasts and nipple discharge for 2 weeks. She is concerned as her mother, who had breast cancer, had the same symptoms before she was diagnosed. What is the next most appropriate investigation?
A. Refer for urgent mammogram B. Refer for urgent USS C. Blood hCG levels D. Reassure and discharge E. CT Head
C. Blood hCG levels
Why CT head? To rule out prolactinoma
Mastitis/Breast abscess
Definition and Epidemiology
Mastitis = inflammation of the breast (Pathology = Straph and Strep infection)
Rare complication: can lead to formation of a breast abscess = collection of pus within the tissue.
Epidemiology:
- Breastfeeding women – milk stasis(poor breastfeeding technique)
- Immunocompromised – HIV/AIDS, diabetes, chronic illness
- Primiparous (given birth to 1 child)
- Over 30 years old
Mastitis/Breast abscess Signs and Symptoms, Invx
S: generalised swelling of the breastC: redness, firmT: very tender, warm to touchF: flu like symptoms - fever, aches, fatigue, chills
Ix:
- Clinical diagnosis
- USSto distinguish tumour and abscess
- Biopsy (women not responding to treatment, or non puerperal mastitis)
Mastitis/Breast abscess Mx
Management of Mastitis:
- Encourage breastfeeding (not from affected breast)
- Analgesia
- Antibiotics - Dicloxacillin or cephalexin (not needed in most cases)
Management of breast abscesses:
- US guided FNA
- Surgical incision and drainage
7. BRCA gene mutations are associated with breast and which other type of cancer? A. Biliary B. Uterine C. Gastric D. Ovarian E. Colon
D. Ovarian
- A 30 year old female presents with a bruise on her breast. O/E The underlying tissue is tender and lumpy. When asked about trauma, she says she was injured whilst playing a rugby match. What is the most likely diagnosis?
A. Fibroadenoma B. Fat necrosis C. Paget’s disease of the breast D. Mastitis E. Duct ectasia
B. Fat necrosis
