Breast cyst

Question 1

Definition

Answer 1

Fluid filled sacs that develop as a result of normal cyclical hormonal changes that affect the breast tissue

Question 2

Pathophysiology

Answer 2

Fluid is constantly produced and reabsorbed in the milk ducts of breasts. When the duct becomes blocked or the amount of fluid produced is more than that absorbed, fluid can accumulate and cause single or multiple cysts

Question 3

Classification

Answer 3

• Simple cysts: purely fluid-filled, no solid components or septations
• Complex cysts: have thick walls, septations, or solid components

Question 4

Epidemiology

Answer 4

• Age: 35-50
• Hormonal fluctuations: MC premenopausal women or those on HRT
• Nulliparity
• Late-age first pregnancy

Question 5

Signs

Answer 5

• Smooth, well-defined, mobile lump
• Possible increase in lump size premenstrual

Question 6

Symptoms

Answer 6

• Breast lump
• Tenderness, especially premenstrual

Question 7

Referral pathway

Answer 7

Referred using a suspected cancer (2-week wait) pathway if:
- 30 + with unexplained breast lump (+/- pain)
- 30 + with unexplained axillary lump
- 50 + with nipple discharge, retraction or other concerning changes in one nipple only
- Presence of skin changes suggestive of breast cancer

Question 8

Diagnosis

Answer 8

FIRST LINE = USS
Mammogram: For Px>40
Fine needle aspiration (FNA): if cyst is large, painful or complex, an FNA can be performed to remove fluid for relief + cytological examination in case of malignancy

Question 9

Treatment

Answer 9

FIRST LINE:
- Observation + reassurance
- Fine needle aspiration = symptom relief
SECOND LINE:
- Surgery: not indicated unless cysts are chronically recurrent despite therapeutic aspiration
- Hormonal manipulation: some women find relief with hormonal contraceptives.

Question 10

Complication

Answer 10

Pain and discomfort
Anxiety and distress due to fear of cancer