Breast Flashcards
(29 cards)
What is duct ectasia?
When central ducts become dilated with ductal secretions
Secretions may leak into periductal tissues and caused an inflammatory reaction (periductal mastitis)
Summarise the epidemiology of duct ectasia
Peri- or post-menopausal women
Explain the aetiology of duct ectasia
Caused by normal breast changes that happen with age
Ducts behind the nipple shorten and widen
Smoking
What are the risk factors for duct ectasia?
Smoking
What are the presenting symptoms and signs of duct ectasia?
Nipple retraction Nipple inversion Nipple pain Classic green-brown discharge Lump behind nipple
What are the appropriate investigations for benign ductal disease?
Breast examination Mammogram US FNA Core biopsy
What is an intraductal papilloma?
A wart-like lump that develops in 1 or more of the milk ducts in the breast
Summarise the epidemiology of intraductal papilloma
Most common in women over 40
Very rare in men
Explain the aetiology of intraductal papilloma
Develops naturally as breast ages and changes
What are the presenting symptoms of intraductal papilloma?
Small, wart-like lump
Clear or blood-stained nipple discharge
Usually not painful
Summarise the epidemiology of breast cancer
Most common cancer in women - 1/9 in UK
Peak incidence: 40-70 years
Explain the aetiology of breast cancer
Genetics - BRCA-1 and BRCA-2
Environmental factors
What are the risk factors for breast cancer?
Age Prolonged exposure to oestrogen: - nullparity - no kids - early menarche - late menopause - obesity - COCP - HRT FHx
What are the presenting symptoms of breast cancer?
Painless breast lump Changes in breast shape Nipple discharge - may be bloody Axillary lump Malignancy: weight loss, bone pain, paraneoplastic syndromes
What are the signs of breast cancer O/E?
Breast lump:
- firm
- irregular
- fixed to surrounding structures
Peau d'orange Skin tethering Fixed to chest wall Skin ulceration Nipple inversion Paget's disease of nipple - eczema-like hardening of nipple skin (usually caused by ductal carcinoma in situ infiltrating nipple)
What are the appropriate investigations for breast cancer?
TRIPLE ASSESSMENT:
- Clinical examination
- Imaging: US < 35yo, mammogram > 35yo
- Tissue diagnosis: FNA or Core biopsy
Also:
Sentinel LN biopsy
Staging - CXR, liver US, CT brain/thorax
Bloods: FBC, U+Es, Ca, bone profile, LFTs, ESR
What is the most common type of breast cancer?
Invasive ductal carcinoma
What is a breast cyst?
Fluid-filled sac in breast tissue
Who are breast cysts most common in?
Women over 35
Women approaching menopause
Women using HRT after menopause
What do breast cysts feel like?
Soft or hard
Any size - mm to cm
Uncomfortable/painful
How do breast cysts change before a period?
Become larger
Sore
Tender
What is fine needle aspiration?
A type of biopsy procedure
A thin needle is inserted into an area of abnormal-appearing tissue or body fluid
Sample taken can help make a diagnosis or rule out conditions
What are the indications for fine needle aspiration?
Swellings or lumps just under the skin
Cysts - fluid-filled lumps
Nodules or masses - solid lumps
Enlarged LNs
What are the possible complications of fine needle aspiration?
Infrequent
Infection
Haematoma
