Breast Flashcards
(38 cards)
Define benign ductal disease (duct ectasia & papilloma)
Breast tissue changes ranging from normal to abnormal, either in development, cyclical change or involution (shrinking down of an organ in old age) phases. Includes:
Duct ectasia - when central ducts become dilated with ductal secretions. These secretions may leak into periductal tissues and cause an inflammatory reaction (periductal masititis)
Intraductal papillomas - a small, benign tumour that forms in a milk duct
Explain the aetiology / risk factors of benign ductal disease (duct ectasia & papilloma)
Related to changes in hormone levels
Risk Factors
o May be less common in patients on the OCP
o SMOKING is a risk factor for periductal mastitis
Summarise the epidemiology of benign ductal disease (duct ectasia & papilloma)
VERY COMMON
Recognise the presenting symptoms of benign ductal disease (duct ectasia & papilloma)
- History of breast discomfort or pain (may be cyclical)
- Swelling or lump
- Nipple discharge
NOTE: if this is bloody, malignancy should be suspected
To assess risk factors for breast cancer, ask patient about:
o Family history
o Exposure to oestrogen (age of menarche, menopause, number of kids, breastfeeding, use of OCP/HRT)
Recognise the signs of benign ductal disease (duct ectasia & papilloma) on physical examination
Focal or diffuse nodularity of breast
Fibroadenoma - smooth, well circumscribed and mobile lumps (known as a ‘breast mouse’)
Duct Ectasia (a condition in which central ducts become dilated with ductal secretion due to a blockage of the lactiferous ducts) - causes yellow/green discharge
Features of malignancy will be ABSENT in benign breast disease:
o Dimpling
o Peau d’orange
o Enlarged axillary lymph nodes
Identify appropriate investigations for benign ductal disease (duct ectasia & papilloma) and interpret the results
Patients usually undergo TRIPLE ASSESSMENT:
Clinical Examination
Imaging
• Mammography (two-view)
NOTE: benign lumps are less likely to be calcified
• Ultrasound - in younger patients (< 35 yrs)
Cytology/Histology
• Fine Needle Aspiration - sent for cytological analysis
• Excision Biopsy - sent for histological analysis
Define breast cancer
Malignancy of breast tissue
o Most common type: invasive ductal carcinoma
Explain the aetiology / risk factors of breast cancer
- Genetics (e.g. BRCA-1 and BRCA-2 genes)
- Environmental factors
Risk Factors o Age o Prolonged exposure to oestrogen • Nulliparity (not having kids) • Early menarche • Late menopause • Obesity • COCP • HRT o Family history of breast cancer
Summarise the epidemiology of breast cancer
- Most common cancer in women (1/9 women in the UK)
* Peak incidence: 40-70 yrs
Recognise the presenting symptoms of breast cancer
• Breast lump (usually painless) o Changes in breast shape o Nipple discharge (may be bloody) o Axillary lump • Symptoms of malignancy: o Weight loss o Bone pain o Paraneoplastic syndromes
Recognise the signs of breast cancer on physical examination
• Breast lump o Firm o Irregular o Fixed to surrounding structures • Peau d'orange • Skin tethering • Fixed to chest wall • Skin ulceration • Nipple inversion
• Paget’s disease of the nipple - eczema-like hardening of the skin on the nipple
o Usually caused by ductal carcinoma in situ infiltrating the nipple
Identify appropriate investigations for breast cancer and interpret the results
TRIPLE ASSESSMENT o Clinical examination o Imaging: • Ultrasound (< 35 yrs) OR • Mammogram (> 35 yrs) o Tissue Diagnosis: • Fine Needle Aspiration OR • Core Biopsy
Sentinel Lymph Node Biopsy
o A radioactive tracer is injected into the tumour and a scan identifies the sentinel lymph node
o This node is then biopsied to check the extend of spread
Staging
o CXR
o Liver ultrasound
o CT (brain/thorax)
Bloods: FBC, U&Es, calcium, bone profile, LFTs, ESR
Define breast cysts
Benign fluid-filled sacs
Explain the aetiology / risk factors of breast cysts
Usually disappear after menopause – related to hormone changes
Exact cause unknown
Summarise the epidemiology of breast cysts
Occurrence is usually after 35 years of age and up to the menopause
Recognise the presenting symptoms of breast cysts on physical examination
Small breast lump – smooth, distinct border, firm to lax consistency (depending on fluid pressure within), immobile, not fixed
o Causes breast pain
o Tenderness
o Increased lump size and tenderness just before menstruation
Recognise the signs of breast cysts on physical examination
Fluid-filled, rounded lump; not fixed to surroundings; easily movable; smooth
Identify appropriate investigations for breast cysts and interpret the results
As with any lump, they should be subjected to triple assessment: o Clinical examination o Imaging o Cytology
Define fibroadenoma
Benign overgrowth of collagenous mesenchyme of one breast lobule
Explain the aetiology / risk factors of fibroadenoma
Formed of a mixture of stromal and epithelial tissue
o Early reproductive age (15-25 years)
o Multiple or large fibroadenomas are more common in Afro-Caribbean women
Summarise the epidemiology of fibroadenoma
Most common cause of breast lump in females <30 years
1/3 regress; 1/3 stay the same; 1/3 get bigger
Recognise the presenting symptoms and signs of fibroadenoma on physical examination
Painless, firm, mobile, slow growing lump
May be multiple
Described as a breast mouse
Identify appropriate investigations for fibroadenoma and interpret the results
As with any lump, they should be subjected to triple assessment: o Clinical examination o Imaging o Cytology
Generate a management plan for fibroadenoma
Provided all investigations support a diagnosis of fibroadenoma, small
lesions can be left alone
• Larger lesions (>4cm) or those in older women may be better removed
