Breast Lump

Question 1

What are the 4 most common diagnoses for breast lump?

Answer 1

1. Benign cystic change
2. Fibroadenoma
3. Cyst
4. Carcinoma

Question 2

Age is v important when looking at ddx for breast lump. What are the ddx for different age groups?

Answer 2

<30: normal lumpy breast, benign cystic change, abscess/galactocele (both if breast feeding)
30-45: benign cystic change, abscess (if smoker), carcinoma
45-60: cyst, abscess (smoker), carcinoma
60+: carcinoma

Question 3

MUST EXCLUDE BREAST CANCER AS A DDX. Or you could get a malpractice claim.

Which diagnoses would you only encounter in breastfeeding women?

Answer 3

Galactocele - can occur during/just after lactation

Lactating women also predisposed to mastitis

Question 4

What are the main RFs for breast cancer

Answer 4

1. Previous breast cancer
2. FHx of breast cancer
3. Previous ovarian / endometrial / bowel cancer
4. Irradiation to chest wall
5. Increased exposure to oestrogens

Question 5

What aspects of the HPC are important

Answer 5

1. How long has lump been there? Abscess/cyst appears rapidly. Tumours grow slowly.
2. Any breast trauma? Predisposes to e.g. abscess
3. Lump bigger/smaller/same size? - Abscess and cyst can rapidly increase in size.

Question 6

Lumps that undergo cyclical changes in size/character (e.g. becoming more tender) are likely to be?

Answer 6

Benign cystic breast disease

Question 7

What information about the breast or lump should be ascertained

Answer 7

1. Is lump painful? - pain = benign cystic breast, acute mastitis, abscesses. Carcinomas usually non-tender lumps.
2. Skin changes on breasts? - white erythematous skin = infective/inflammatory cause. Puckering of overlying skin = carcinoma until otherwise proven. Nipple distortion suggests carcinoma.
3. Nipple discharge? - bloody = carcinoma. Serous/seosanguinous = intraductal papilloma. Green/brown/yellow discharge = periductal mastitis. Milky discharge = galactocele
4. Is the patient fit and well? - febrile = mastitis/abscess. Back pain may indicate metastasis to spinal cord

Question 8

What are the key features to look for in a breast exam

Answer 8

Asymmetry - new changes are significant
Contours
Skin changes - erythema/ulceration/dimpling/puckering/radiotherapy tattoos
Nipple changes/discharge

Question 9

What kind of surface does a solitary cyst/fibroadenoma have?

What about benign cystic change / carcinoma?

Answer 9

Solitary cyst/fibroadenoma = smooth surface

Benign cystic change / carcinoma = irregular surface

Question 10

What kind of border does a solitary cyst / fibroadenoma have?

What about benign cystic change / carcinoma?

Answer 10

Solitary cyst /fibroadenoma = distinct borders

Benign cystic change/fibroadenoma = indistinct borders

Question 11

What consistency does a carcinoma have?

Answer 11

Hard

Question 12

What type of lump is typically quite mobile

Answer 12

Fibroadenoma

Question 13

What kind of consistency does a fibroadenoma have?

Answer 13

Rubbery

Question 14

Where do breast carcinomas metastasise to?

Answer 14

Lung
Liver
Bone
Brain

Question 15

Out of fibroadenomas and cysts, which are painful

Answer 15

Cysts are painful