Breast Flashcards
What is the two week wait referral for breast cancer
Unexplained breast/axilla lump in over 30s
Unilateral nipple changes in over 50s
Skin changes
What are the features of a fibroadenoma
Stromal/epithelial tissue
Small and mobile “breast mouse”
20-40
Painless, smooth, round, well circumscribed, firm, mobile, 3cm dm
What are the features of fibrocystic breast change
Common during menstruation (10 days before period)
Lumpy breasts
Varying size
Tenderness
Can give NSAIDs
Avoid caffeine
What are the features of breast cysts
30-50
Common in perimenopausal period
Smooth
Well circumscribed
Mobile
Fluctuant
Need investigated to exclude cancer
- may slightly increase risk of cancer
What are the features of fat necrosis
Triggered by local trauma, radiotherapy or surgery
Painless, firm, irregular, fixed in local structures, can be dimpling/ nipple inversion
USS/ Mammogram can show similar appearance to cancer so need FNA
What are the features of a galactocele
Occur in women lactating who stop breastfeeding
Breast milk filled cyst due to blocked duct
Firm mobile painless lump under nipple
What is a phyllodes tumour
CT tumours 40-50
Large and fast growing
Can met
Wide excision and they can recur
What are the causes and features of hyperprolactinaemia
Breast milk production without pregnancy
Amenorrhoea
Reduced libido
Erectile dysfunction
Gynaecomastia
Prolactinomas - associated with MEN 1
Endocrine disorders - hypothyroid/ PCOS
Antipsychotic meds
Treat with cabergoline or bromocriptine - dopamine agonists
What are the features of mammary duct ectastia
Dilation and inflam of ducts
Nipple tenderness
Discharge
Nipple retraction
Breast lump
SMOKING= risk factor
Perimenopausal women
Microcalcifications seen on mammogram
Resolves by itself
What are the features of an intraductal papilloma
Wart in breast duct
Clear/ blood stained nipple discharge
Benign tumours but can cause breast cancer
Tenderness or pain
Lump
Complete surgical excision
What are the features and management of lactational mastitis
Can be due to obstruction or infection (staph aureus)
Breastfeeding
Unilateral pain
Erythema , inflam
Nipple discharge
Fever
Heat packs warm showers and analgesia
Flucloxacillin/ erythromycin when allergic
Sample of milk sent for culture and sensitivity
Broad spectrum abx used
Co-amoxiclab
Erythromycin and metronidazole
Encourage to continue breast feeding- will not harm baby
What are the features of candida of nipple
Can happen after a course of abx, can cause recurrent mastitis
Sore nipples
Nipple tender/ itchy
Cracked, flaky, shiny areola
White patches in baby’s mouth
Mum and baby need treatment
-Topical miconazole 2% to nipple after each feed
Oral miconazole gel or nystatin for baby
What are the features and management of breast abscess
Smoking and damage to the nipple- risks
Staph aureus most common
Similar to mastitis but systemic infection symptoms
Swollen FLUCTUANT (can move fluid within it) tender lump
Refer to on call surgery
Abx
USS
Drainage
Microscopy and cultures
Continue breast feeding/ express milk
What are the risk factors for breast cancer
Increased oestrogen exposure - early periods/ late menopause
Dense breast tissue
Obesity
Smoking
Fam history
OCP- small risk - returns to normal after 10 yrs stoping
HRT increases risk- combined HRT
What are the 2 BRCA genes
BRCA1 - chromosome 17
Breast cancer, ovarian cancer, bowel and prostate
BRCA2- chromosome 13
Breast and ovarian
