Breast Flashcards
Fibroadenoma - Sy, Ix, Mx
Sy - common, firm, smooth, mobile lump, painless. Usually in younger women, especially on COCP.
Ix - USS conclusive.
Mx - reassure, excise if large.
Breast cyst - Sy, Ix
Sy - common, esp perimenopausal, benign fluid filled round lump, mobile, occasionally painful.
Ix - USS - fluid filled, confirmed by FNA clear fluid if risidual mass do core biopsy.
Infective mastitis/breast abscess - Path, sy, Mx
Path - staph aureus.
Sy - hot painful swelling of breast.
Mx - Abx, drainage if abscess.
Duct ectasia - Sy, Mx
Sy - typically perimenopausal, blocked ducts so secretions stagnate, green/brown/bloody d/c +- nipple retraction and lump.
Mx - none needed.
Fat necrosis - Sy, Ix, Mx
Sy - fibrosis and calcification following injury, firm lump.
Ix - USS/mammography.
Mx - none once confirmed.
Breast Ca - RF, path, Ix, staging, Mx, Screening
RF - FH, age, oestrogen exposure, obesity, BRCA genes.
Path - DCIS - premalignant, microcalcification on mamography. LCIS - rarer, multifocal. Invasive ductal more common than lobular.
Ix - all lumps should undergo triple assessment -
Clinical examination
Radiology (USS if <35, USS and mamography if over)
Histology/cytology - FNA if cystic lump - if clear reassure, if bloody cytology, if risidual lump core biopsy. Core biopsy if solid lump.
Staging - 1=breast, 2=LN, 3=muscle, 4=chest wall/distant mets.
Mx - Surgery - wide local excision or mastectomy with sentinal biopsy. Radiotherapy if invasive. Chemo - adjuvant/neoadjuvant. Herceptin (traztuzumab) if Her positive. If E positive tamoxifen, anastrazole (aromatase inhib - post menopausal), goserelin (GTRH anologue in pre).
Palliate if stage 3-4.
Screening - 2 view mammography every 3yrs for women 47-73. Ref to geneticist if one first degree relative female <40, male, bilateral <50, two first degree/one first on one second, esp if Jewish ancestry.
Mastalgia - Sy, cause, Mx
Sy - Usually cyclical starting a few days before menstruation in both breasts.
Cause - cyclical due menstruation, non-cyclical usually due to drugs (contraceptives, SSRIs) or MSK. Rarely cancer.
Mx - If reassuring no Ix are required, analgesia.
Pagets disease of the nipple - Sy, path, Mx
Sy - rough redness of the nipple, itchy, may ulcerate, painful caused by ductal skin mets. DDX eczema (normally spares the nipple, would never be first presentation).
Path - vast majority have underlying ductal cancer or DCIS.
Mx - surgical excision.
Gynaecomastia
C - Steroids, low testosterone, obesity, spironolactone.