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Obs and Gynae > Breast Conditions > Flashcards

Breast Conditions Flashcards

1
Q

What is galactorrhoea

A

Milky nipple discharge unrelated to normal milk production of breast feeding

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2
Q

What are the causes of nipple discharge

A

Hyperprolactinaemia
Mammary duct ectasia
Infection
Tumour
Fibrocystic disease
Pregnancy

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3
Q

Causes of hyperprolactinaemia

A

Prolactinoma (non cancerous tumour of pituitary gland causes increased prolactin and decreased sex hormones (testosterone and oestrogen)

Hypothyroidism
CKD
Liver disease

Drugs (anti psychotics, SSRI (selective seratonin reuptake inhibitors- antidepressants e.g. sertraline), marijuana)

Ask about mumps, fevers, colour of discharge and listed causes of prolactinoma in history

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4
Q

What is prolactin and what is hyperprolactinaemia

A

Hormone that stimulates breast milk production (lactation)

Hyperprolactinaemia- abnormally high levels of prolactin

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5
Q

Causes of diff coloured nipple discharge
- clear
- milky
- bloody
- brown
- yellow
- green

A

Clear - mammary duct ectasia (benign non proliferative breast disease)
Milky - breast feeding, hormone related, galactorrhoea
Yellow - infection
Green - fibrocystic disease
Brown - fibrocystic disease, mammary duct ectasia
Blood - RED FLAG - intraductal papilloma (benign tumour in breast ducts) - type of breast cancer

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6
Q

How does the cause of nipple discharge differ if discharge is unilateral vs bilateral

A

Bilateral - systemic cause

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7
Q

When do you know nipple discharge is associated to infection

A

Fever and chills part of associated symptoms

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8
Q

Investigations for nipple discharge

A

Age over 50 and unilateral discharge or other nipple changes = 2ww to breast clinic
Urine pregnancy test when appropriate
Serum prolactin (if elevated refer to endocrinology for pituitary MRI
TFTs
U&Es
LFTs
Breast imaging

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9
Q

What is mastitis

A

Inflammation of breast tissue

May have infective cause

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10
Q

What causes mastitis with infection

A

S aureus - present on skin and break in skin causes to get in and cause infection

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11
Q

Types and causes of mastitis

A

Lactation all - milk stains or overproduction and bacteria entering via traumatised nipple

Non lactational/non infectious - smoking, immunosuppression, underlying breast pathology, trauma

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12
Q

When is mastitis an emergency

A

If breast abscess forms

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13
Q

Signs and symptoms of mastitis

A

Malaise
myalgias
Breast redness/erythema (wedge shaped area - lactational cause)
Pain /tenderness
Warm
Swelling and firm
Purulent nipple discharge
Fever

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14
Q

Diagnosis and management of mastitis (lactational vs non lactational)

A

Clinical diagnosis

Culture and sensitivity is sever/recurrent
2ww if mass on palpating of inflamed area (inflammatory breast cancer can mimic mastitis)

Lactational mastitis management
frequent feedings/breast pumping, ibuprofen/paractetamol
Flucloxacillin (effective against s aureus) if Sx not improving after 12-24 hrs

Non lactational mastitis management
Ibuprofen/paracetamol
Warm compress
Co-amoxiclav

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15
Q

What is a breast abscess and how does it occur

A

Localised collection of pus within breast tissue secondary to infection

Usually S aureus
May follow antibiotic failure to treat mastitis or cellulitis

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16
Q

Symptoms and clinical signs of breast abscess

A

History of recent mastitis
FEVER
painful swollen breast
Erythema
Purulent Discharge
Warm to touch
Fluctance and tenderness on palpation

17
Q

Diagnosis and management of breast abscess

A

Refer urgently
Diagnosis - breast ultrasound and MCS of discharge for correct antibiotic

Management - surgical drainage / US guided needle aspiration
Antibiotics
Continue breastfeeding (if breastfeeding)

18
Q

What is fibroadenoma

A

Benign solid tumour containing glandular and fibrous tissue

19
Q

Typical presentation and clinical signs of fibroadenoma

A

20-30s
Maybe hormonal and may have family history of breast cancer

Breast mass not painful - may become painful before menstruation

Mass is well delineated, firm, non tender and mobile

20
Q

Diagnosis and management of fibroadenoma

A

Refer to breast clinic - 2ww for over 30 and non urgent is under 30

Mammography and breast ultrasound

Fine needle aspiration or core needle biopsy for definitive diagnosis

Management - no treatment - surgical excision if large or symptomatic (becomes tender)

21
Q

What is fibrocystic disease

A

Lumpy breasts associated with pain and tenderness that FLUCTUATES WITH MENSTRUAL CYCLE

Leads to fluid filled sacs and scar like tissue

22
Q

Typical presentation of fibrocystic breast disease

A

Bilateral (not likely to be cancer)
Several lumps (lumpy breasts)
Pain and tenderness changes with menstrual cycle (cyclical)
Generalised dull breast pain

Lumps blend into surrounding tissue (not clear and discrete)
May have nipple discharge

23
Q

Diagnosis of fibrocystic breast disease

A

Refer 2ww is over 30, non urgent referral if under 30

Mammogram and breast ultrasound
Fine needle aspiration and biopsy

24
Q

Management of fibrocystic breast disease

A

Supportive bra, limit caffeine and sodium (worsens breast pain), paracetamol / ibuprofen

Cystic aspiration for symptomatic cyst
Refer to breast surgeon if nipple discharge also present

25
Q

Difference between in situ and invasive breast cancer

A

In situ - malignancy cells confined to breast duct - may develop into invasive
Invasive - malignancy cells penetrated basement membrane

26
Q

Risk factor of breast cancer

A

Increasing age
Females
Family history
Genetics (BRCA1 BRCA2 mutations)
Hormone replacement therapy - used in post menopausal- risk increases with longer use - CONTRAINDICATION IN PATIENT EITH BREAST CANCER - tell pt about risk before starting it

Alcohol
Radiation exposure history (other cancer treatment in area e.g. for thyroid cancer)
Obesity
Smoking cigarettes

27
Q

Breast cancer symptoms and clinical signs

A

Breast lump (may or may not have pain) - firm, immobile, clear borders, irregular shape but may be regular
New breast asymmetry
Nipple changes (retraction, discharge, rash)
Breast skin changes (peak d’orange, erythema, ulceration, dimpling, nipple scaling)
Axillary lymphadenopathy

28
Q

When to refer for breast cancer symptoms

A

2ww for >30 with lump, >50 with UNILATERAL nipple changes , >30 with Axillary lump, skin changes symptoms of breast cancer

Non urgent referral <30 with breast lump

29
Q

Breast cancer diagnosis

A

Mammogram (ultrasound or MRI if mammogram doesn’t show anything)

Definitive diagnosis - biopsy
Staging - affected lymph node biopsy

30
Q

Breast cancer management

A

Lumpectomy or mastectomy
Chemotherapy
Radiotherapy

Tamoxifen (to stop oestrogen if cancer is hormone positive - grows with hormone exposure)
Aromatise inhibitor (aromatase normally converts androgens to oestrogen)

31
Q

When is breast cancer screening offered

A

Mammography every 3 years from 50-70s women
Refer if strong family history of breast or ovarian cancer - may start screening and genetic testing earlier)

32
Q

When is genetic screening for BRCA1 and BRCA2 given what is done if screening is positive

A

Known family member with gene mutation or strong family history of breast/ovarian cancer

If positive, annual MRI breast csncer screening form 30 onwards
May have double mastectomy and bilateral salingo-oophorectomy (ovaries and fallopian tubes removed)

Obs and Gynae (5 decks)

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