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Breast Surgery > (B)- Breast Lumps > Flashcards

(B)- Breast Lumps Flashcards

1
Q

What is the standard practise for a breast lump?

A

Triple assessment

  • Clinical assessment
  • Imaging
  • Histology (fine needle aspiration or core biopsy)
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2
Q

What clinical features suggest breast cancer?

A
  • Hard lumps, irregular, painless
  • Lumps tethered to the skin or chest wall
  • Nipple retraction
  • Skin dimpling or peau d’orange
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3
Q

What do NICE guidelines recommend a two week wait referral for with suspected breast cancer?

A
  • Unexplained breast lump in patients 30 or above
  • Unilateral nipple changes in patients 50 or above

Consider for
- Unexplained lump in axilla in patients 30 or above
- Skin changes suggestive of breast cancer

Non-urgent referral for unexplained breast lumps in under 30s

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4
Q

When is a mammogram used vs an ultrasound?

A

Mammogram more for older women e.g. over 50

Ultrasound for younger women

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5
Q

What is a fibroadenoma?

A

Common benign tumours of stromal duct tissue

  • Small
  • Mobile
  • 20-40 years old
  • Respond to oestrogen and progesterone hence why more common in younger women
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6
Q

How do fibroadenomas present?

A

Painless

Smooth

Round

Well circumscribed

Firm

Mobile

3cm in diameter

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7
Q

Are fibroadenomas cancerous?

A

No

Not associated with increased breast cancer risk

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8
Q

What are fibrocystic breast changes?

A

Connective tissues, duct and lobules respond to oestrogen and progesterone

Becomes fibrous and cystic, fluctuates with menstrual cycle

Benign condition, can vary in severity and affect patients quality of life

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9
Q

When do women usually experience symptoms of fibrocystic breast change?

A

Within 10 days prior to menstruating

Resolves once menstruation begins

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10
Q

What are the symptoms of fibrocystic breast change?

A

Lumpiness
Mastalgia
Fluctuation of breast size

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11
Q

How is fibrocystic breast change managed?

A
  • Supportive bra
  • NSAIDs
  • Avoiding caffeine
  • Applying heat
  • Hormonal treatments, last-line e.g. danazol and tamoxifen
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12
Q

What are breast cysts?

A

Benign, fluid-filled lumps

Most common cause of breast lumps

30-50, more in perimenopausal period

Pain and fluctuate in size over menstrual cycle

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13
Q

How do breast cysts appear on examination?

A

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

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14
Q

How are breast cysts treated?

A

Further assessment to exclude cancer

Aspiration or excision if symptomatic

Slightly increases risk of breast cancer

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15
Q

What is fat necrosis of the breast?

A

Triggered by trauma, radiotherapy and surgery

Inflammatory reaction causing fibrosis and necrosis of the fat tissue

Does not increase risk of breast cancer

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16
Q

How does fat necrosis present on examination?

A

Painless
Firm
Irregular
Fixed in local structures
Dimpling or nipple inversion

17
Q

How is fat necrosis diagnosed?

A

Triple assessment

Ultrasound or mammogram shows similar appearance to breast cancer, use histology

18
Q

How is fat necrosis treated?

A

Conservatively

May resolve spontaneously

Surgical excision if required for symptoms

19
Q

What is a lipoma?

A

Benign tumours of fat tissue

Can occur anywhere where there is adipose

20
Q

How do lipomas present on examination?

A

Soft
Painless
Mobile
Does not cause skin change

21
Q

How are lipomas treated?

A

Conservatively with reassurance

Can be surgically removed

22
Q

What is a galactocele?

A

Breast milk filled cysts

Occurs when lactiferous duct is blocked and prevented from draining milk

23
Q

How do galactoceles present?

A

Firm
Mobile
Painless lump
Underneath areola

24
Q

How do you manage a galactocele?

A

Usually resolve without treatment

Can drain with needle

May become infected and require antibiotics

25
Q

What is a phyllodes tumour?

A

Rare tumours of connective tissue of the breast

Large and fast-growing

26
Q

What age group is affected most commonly by phyllodes tumours?

A

40-50s

27
Q

Are phyllodes tumours malignant?

A

50% benign

25% borderline

25% malignant

Can metastasise

28
Q

How are phyllodes tumours treated?

A

Wide excision
Surgical removal of tumour and surrounding tumour

Can reoccur after removal

Chemotherapy
Malignant or metastatic tumours

Breast Surgery (9 decks)

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