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Flashcards in Breast Deck (27):
1

what are the three forms of benign breast disease?

Duct ectasia (non-puerperal mastitis)

fibroadenoma

breast cyst

2

differentiate between the different types of benign breast disease

Duct ectasia (non-puerperal mastitis)
- blockage of the milk ducts
- peri-post menopausal women (40-50)

fibroadenoma
- benign breast tumour
- young women of ch8ild bearing age

breast cyst
- fluid filled sac within the breast
- pre menopausal women (30-40)

3

How do we describe a lump?

4 S’s, 3’s C’s, 3 T’s, 3 F’s
Site, size, skin, single?
Colour, contour, consistency
Tenderness, temperature, transilluminable
Fluctuant, fixed, feeling otherwise?

4

duct ectasia symptoms and signs

S: small lump behind nipple, nipple inversion
C: nipple discharge (watery/thick/blood stained/green), firm consistency
T: tender
F: fixed

5

fibroadenoma symptoms and signs

S: 1-5 cm, single
C: well demarcated, firm consistency, highly mobile
T: tenderless

6

breast cyst symptoms and signs

S: single
C: well demarcated, highly mobile
T: tenderless, transilluminable
f: fluctuant

7

benign breast disease investigations

CLINICAL DIAGNOSIS

duct ectasia- biopsy
fibroadenoma- FNA (fine needle aspiration biopsy). USS/mammography
breast cyst- FNA (fine needle aspiration biopsy). USS/mammography

8

benign breast disease management

duct ectasia- self limiting
fibroadenoma- Surgical: cryoablation (US guided), excision. Medical: Ormeloxifene

breast cyst- Fine needle aspiration/fluid drain

9

how common is breast cancer?

Most common type of cancer in the UK
Most common cause of death in women ages 35-55
1 in 8 women are diagnosed with breast cancer during their lifetime

10

breast cancer staging

Histopathology
– most are derived from epithelium lining of ducts/lobules (ductal/lobular carcinoma)

Grading
- appearance of breast Ca cells compared to normal tissue

TMN Staging
- Stage 0 = in situ, Paget’s disease of the breast, DCIS
- Stage 1-3 = within breast, regions LNs
- Stage 4 = metastatic cancer

11

breast cancer risk factors

Age

FHx – first degree relative
Obesity

Oestrogen exposure (Early menarche (<11), Late menopause (>55), HRT/OCP)

EtOH consumption

Fatty diet

Previous radiation to the chest

Nulliparity (not having any children)

Familial breast cancer – 5% of cases
- BRCA1 and BRCA2
- Harmful BRCA mutation 60-80% lifetime risk of developing Breast Ca
- Associations with Ovarian and Pancreatic Ca

12

breast cancer signs

S: increased size, lump in breast or armpit skin thickening, peau d’orange, skin dimpling, nipple discharge (bloody), nipple inversion.
C: hard lump, irregular margins, redness
T: tenderness, warm (inflammatory breast Ca)
F: tethered to underlying tissue

13

breast cancer triple assessment

1. History and Clinical Examination

2. Imaging
- Breast screening – early detection of breast Ca
- Women ages 50-70 invited for screening every 3 years
Mammography
- USS – better for denser breast tissue (younger patients)
- 2 week wait criteria

3. Pathology
- FNAC
- Core biopsy

14

breast cancer management

1. SURGERY
Removal of tumour and surrounding LNs
Mastectomy, lumpectomy, quadrantectomy
Breast reconstruction surgery

2. MEDICATION
ER antagonists e.g. tamoxifen
Aromatase inhibitors e.g. letrozole

3. CHEMOTHERAPY
Cyclophosphamide, doxorubicin

4. MONOCLONAL ANTIBODIES
Trastuzumab (HER2)

5. RADIATION
Post surgery, reduces risk of recurrence

15

what is mastitis/breast abscess

Mastitis = inflammation of the breast
Can lead to formation of a breast abscess = collection of pus within the tissue.
Rare complication of mastitis.

16

mastitis epidemiology

1. Breastfeeding women – milk stasis
2. Immunocompromised – HIV/AIDS, diabetes, chronic illness
3. Primiparous (given birth to 1 child)
4. Over 30 years old

Pathology = Straph and Strep infection

17

mastitis/abscess presentation

S: generalised swelling of the breast
C: redness, firm
T: very tender, warm to touch
F: flu like symptoms - fever, aches, fatigue, chills

18

mastitis/abscess investigations

Clinical diagnosis
USS
Biopsy

19

mastitis management

1. Encourage breastfeeding
2. Analgesia
3. Antibiotics (not needed in most cases)

Dicloxacillin or cephalexin
Avoid breastfeeding from the affected breast

20

breast abscess management

1. US guided FNA
2. Surgical incision and drainage

21

1. A 60 year old obese woman presents to her GP with a lesion on her breast. The lesion is red, crusted, around her right nipple. The most likely diagnosis is
A. Breast cyst
B. Breast abscess
C. Paget’s disease of the breast
D. Fibroadenoma
E. Fibrocystic disease

C. Paget’s disease of the breast

22

2. 22 year old woman presents to clinic with a three-month history of a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is:
A. Acute mastits
B. Breast abscess
C. Breast cyst
D. Fibroadenoma
E. Periductal mastitis

D. Fibroadenoma

23

3. A 21 year old woman presents to her GP with pain in her right breast. She has just given birth to her first child. On examination, right breast appears swollen, red and the patient finds palpation extremely painful. You do not suspect there are any abscesses present. The most appropriate management plan would be:
A. Antibiotics
B. Refer to surgeon for incision and drainage
C. Refer to breast feeding support group and prescribe analgesia
D. Watch and wait
E. Confirm diagnosis with USS

C. Refer to breast feeding support group and prescribe analgesia

24

4. Risk factors for developing breast cancer include:
A. Having only one child
B. Early menarche
C. Early menopause
D. Anaemia
E. HIV/AIDS

B. Early menarche

25

5. A 56 year old woman presents to her GP after noticing a breast lump 3 weeks ago. On examination, the lump is 3 cm in diameter, firm and tethered to the skin and immobile. There are no overlying skin changes. The next most appropriate investigation is:
A. Total mastectomy
B. Urgent mammogram
C. Urgent USS
D. FNAC
E. Core biopsy

B. Urgent mammogram

26

6. A 22 year old medical student presents to her GP complaining of ‘lumpiness’ in her breasts and nipple discharge for 2 weeks. She is concerned as her mother, who had breast cancer, had the same symptoms before she was diagnosed. What is the next most appropriate investigation?
A. Refer for urgent mammogram
B. Refer for urgent USS
C. Blood hCG levels
D. Reassure and discharge
E. CT Head

C. Blood hCG levels

27

7. BRCA gene mutations are associated with breast and which other type of cancer?
A. Biliary
B. Uterine
C. Gastric
D. Ovarian
E. Colon

D. Ovarian