Breast lump (oxford clin cases)

Question 1

What are the 4 common diagnoses when someone presents with a breast lump

Answer 1

Fibroadenoma
Abcess
Benign cystic change
Carcinoma

Question 2

What is a breast lump likely to be if someone is under 30 years old?

Answer 2

Benign cystic change

Galactocele/other breast feeding issue if they are breast feeding

Question 3

What is a breast lump likely to be in someone over 60?

Answer 3

Carcinoma

Question 4

In what age group is a fibroadenoma the most common diagnosis for breast lump?

Answer 4

Under 30s

Question 5

In what age group is carcinoma the most common diagnosis for breast lump?

Answer 5

Over 60s

Question 6

What diagnoses will you only see in breastfeeding women for breast lump?

Answer 6

Galactocele or mastitis

Question 7

What are the 2 biggest risk factors for developing breast cancer?

Answer 7

Being female

Increasing age

Question 8

What are some risk factors for developing breast cancer?

Answer 8

Female sex
Increasing age
Family history
Pmx of breast, endometrial, bowel, ovarian cancer 
Prolonged oestrogen exposure
Previous radiation to the chest

Question 9

When would you be concerned about breast cancer in the family history?

Answer 9

When there are 3 blood relatives who have had it
When there are 2 blood relatives under 60
When theres 1 blood relative under 40
When any blood relative has had it bilaterally
When any male blood relative has had it

Question 10

What are some reasons someone may have had prolonged oestrogen exposure?

Answer 10

Early menstruation
Late menopause 
HRT (especially if oestrogen and progesterone) 
First child after 30 
Not breastfeeding 
Use of OCP
Obesity

Question 11

If a breast lump has being growing slowly what diagnoses is more likely?

Answer 11

Carcinoma

Question 12

If a breast lump has being grown very fast what diagnoses is more likely?

Answer 12

Cyst

Question 13

If a breast lump changes with the menstrual cycle or cyclically in general what diagnosis is more likely and what is less likely?

Answer 13

Benign cyst is more likely

It is unlikely to be a carcinoma

Question 14

How fast will a benign breast cyst grow?

Answer 14

Very fast, can appear almost overnight

Question 15

What complications does breast trauma increase the risk of?

Answer 15

Infection

Fat necrosis

Question 16

If a breast lump is painful what is the diagnosis more or less likely to be?

Answer 16

More likely to be mastitis or cyst

Less likely to be carcinoma

Question 17

What does erythematous or warm skin on a breast lump indicate?

Answer 17

Infection eg mastitis or abcess

Question 18

What does peau d’orange indicate when theres a breast lump?

Answer 18

Carcinoma until proven otherwise

Question 19

What is peau d’orange?

Answer 19

Puckering of the skin that overlays the breast or overlays a lump

Question 20

What does recent distortion of the nipple suggest?

Answer 20

Carcinoma

Question 21

What is milky discharge from a nipple likely to be?

Answer 21

Galactocele

Question 22

What is green/brown/yellow discharge from a nipple likely to be?

Answer 22

Mastitis/infection

Question 23

What is bloody discharge from a nipple likely to be?

Answer 23

Carcinoma

Question 24

What symptoms besides from breast lump will a carcinoma present with?

Answer 24

Usually none- systemic symptoms like fever, weight loss, night sweats are unlikely
There may be some symptoms of mets eg back pain due to spinal mets

Question 25

What symptoms might accompany a breast lump?

Answer 25

Usually none, they often present by themselves

Question 26

What are some questions you might ask about the lump in a history when someone present with breast lump?

Answer 26

When did the lump appear? Has the lump grown in size? If so how fast is it growing Do they notice it changing with their menstrual cycle? Is it painful? Is there any discharge from the nipple? If yes what colour is it Are they having any other symptoms? Have they noticed any changes to the skin of the breast? Have they noticed any changes to the nipple?

Question 27

What should you look for when you inspect the breast?

Answer 27

Contours- any disruptions in the natural curvature? Asymmetry- this is natural but look for new asymmetry Discharge Changes to the nipples- inversion is natural but check if its new or if their nipples have always been inverted Dimpling or peau d'orange

Question 28

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a solitary cyst on the breast

Answer 28

``` Surface= smooth Border= well defined Consistency= firm to lax Mobility= no Fixity= no Lymphadenopathy= no ```

Question 29

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a fibroadenoma on the breast

Answer 29

``` Surface= smooth Border= well defined Consistency= rubbery Mobility= yes Fixity= no Lymphadenopathy= no ```

Question 30

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a carcinoma on the breast

Answer 30

``` Surface= irregular Border= not well defines Consistency= hard Mobility= no Fixity= maybe Lymphadenopathy= maybe ```

Question 31

What type of breast lump will have mobility?

Answer 31

Fibroadenoma

Question 32

What will a cyst on the breast feel like- explain why

Answer 32

They will be either firm or lax, depending on the pressure of fluid inside them

Question 33

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a benign cystic change on the breast

Answer 33

``` Surface= irregular Border= not well defined Consistency= mixed Mobility= no Fixity= no Lymphadenopathy= no ```

Question 34

What is a fibroadenoma?

Answer 34

Aberrations of normal breast tissues containing stromal or epithelial cells

Question 35

How are fibroadenomas managed?

Answer 35

Usually they resolve by themselves If they are increasing in size, are painful/uncomfortable or the patient really wants them gone they can be removed via excisional biopsy

Question 36

How are lumps investigated in the breast clinic?

Answer 36

Triple assessment

Question 37

What does triple assessment at a breast clinic involve?

Answer 37

Clinical examination Radiography FNA

Question 38

What radiography is done for those under 35? Why?

Answer 38

Ultrasound because their breast tissue is too dense to view via mammography

Question 39

What radiography is done for those over 35? Why?

Answer 39

Mammography because their breast tissue is not too dense and will be visible

Question 40

On a mammogram what will indicate a cancer?

Answer 40

Regions of increased density, spiculations (look like shards of glass), irregular margins

Question 41

What is the difference between fine needle aspiration and core biopsy when investigating a breast lump?

Answer 41

FNA= only tells you info on the types of cells and whether they are dysplastic or not Core biopsy= gives you info on the local architecture of the tissue too