Breast Flashcards
What are the symptoms of mastitis?
Nipple changes
Purulent nipple discharge (pus from the nipple)
Painful, swollen, tender, red hot breast
Hardening of the skin or breast tissue
Fever or general malaise
Pain during breastfeeding and decreased milk outflow
What feature suggests breast abscess?
Swollen, fluctuant, tender lump within the breast
How is mastitis treated?
Lactational mastitis: conservative management - continue breastfeeding, analgesia, warm compresses
Non-lactational mastitis: oral flucloxacillin (clarithromycin if allergic)
How is a breast abscess managed?
Antibiotics
Ultrasound (confirm diagnosis and exclude other pathology)
Drainage (needle aspiration or surgical incision and drainage)
MCS of drained fluid
What are the features of a breast cyst?
Most common cause of breast lump, most often between ages 30-50
Well-defined collection of fluid within breast that is influenced by hormonal changes
Can be painful
Smooth, well-circumscribed, mobile, possibly fluctuant lump
May vary in size over course of menstrual cycle
Single or multiple breast masses
Increased risk of malignancy
How is a breast cyst investigated?
Aspiration
Those which are blood-filled or persistently refill should be biopsied or excised
Breast ultrasound or mammography: ‘halo appearance’ on mammography, USS confirms fluid-filled nature
What are fibroadenomas?
Common benign tumours of stromal/epithelial breast duct tissue
How do fibroadenomas present on examination?
Painless, smooth, well-circumscribed breast lump
Firm
Mobile (moves freely under the skin and above the chest wall)
Rubbery on palpation
Most commonly solitary
How is fibroadenoma investigated?
Ultrasound (<35 years): well defined mass
Mammography (>35 years): well-defined mass that may have popcorn-like calcifications
Core needle biopsy or fine needle aspiration: fibrous or glandular tissue
How is fibroadenoma treated?
Regular check-ups
If >3cm, surgical excision
What are the risk factors for breast cancer?
Female
Increased oestrogen exposure (earlier onset of periods and later menopause)
More dense breast tissue (more glandular tissue)
Obesity
Smoking
FHx - BRCA genes
HRT and COP
How is breast cancer screened for?
Women between the ages of 50-70 are offered a mammogram every 3 years
How does breast cancer present?
Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)
Lymphadenopathy, particularly in the axilla
How is breast cancer investigated?
Ultrasound if <30 years
Mammogram if >30 years
Biopsy (fine needle aspiration or core biopsy)
Where are breast cancers most likely to metastasize to?
Lung
Liver
Bone
Brain
