Breast lumps (zero to finals)

Question 1

What tissue type is most common in the breast?

Answer 1

Fat (adipose) tissue

Question 2

How is milk produced by the breasts?

Answer 2

The areola surrounds the nipple. Behind the nipple are the ducts, which lead into the lobules, where breast milk is produced.

Milk is secreted through the ducts and out of openings on the nipple.

Question 3

What tests are used to exclude breast cancer as a differential?

Answer 3

Triple assessment, consists of:

• Clinical assessment (history and examination)
• Imaging (ultrasound or mammography)
• Histology (fine needle aspiration or core biopsy)

Question 4

What clinical features can indicate the presence of breast cancer?

Answer 4

Lumps that are hard, irregular, painless or fixed in place

Lumps may be tethered to the skin or the chest wall

Nipple retraction (inverted nipples are nipples that point inward or lie flat, rather than pointing out. It’s also called retracted nipples).

Skin dimpling or oedema (peau d’orange)

Question 5

What factors would warrant a 2 week referral for suspected breast cancer?

Answer 5

An unexplained breast lump in patients aged 30 or above

Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

An unexplained lump in the axilla in patients aged 30 or above

Skin changes suggestive of breast cancer

Question 6

What are fibroadenomas?

Answer 6

Common benign tumours of stromal/epithelial breast duct tissue.

Question 7

What is an unofficial name often given to fibroadenomas?

Answer 7

“Breast mouse”

Typically small and mobile within the breast tissue.

They are sometimes called a “breast mouse”, as they move around within the breast tissue.

Question 8

Most common ages for fibroadenoma and why?

Answer 8

More common in younger women, aged between 20 and 40 years.

They respond to the female hormones (oestrogen and progesterone), which is why they are more common in younger women and often regress after menopause.

Question 9

Features of fibroadenoma on examination?

Answer 9

Painless
Smooth
Round
Well circumscribed (well-defined borders)
Firm
Mobile (moves freely under the skin and above the chest wall)
Usually up to 3cm diameter

Question 10

What is fibrocystic breast changes (fibrocystic breast disease)?

Answer 10

The connective tissues (stroma), ducts and lobules of the breast respond to the female sex hormones (oestrogen and progesterone), becoming fibrous (irregular and hard) and cystic (fluid-filled).

These changes fluctuate with the menstrual cycle.

Question 11

Typical symptoms of fibrocystic breast disease?

Answer 11

Lumpiness
Breast pain or tenderness (mastalgia)
Fluctuation of breast size

Question 12

Management of fibrocystic breast changes?

Answer 12

Wearing a supportive bra

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

Avoiding caffeine is commonly
recommended

Applying heat to the area

Hormonal treatments (e.g., danazol
and tamoxifen) under specialist guidance

Question 13

What are breast cysts?

Answer 13

Breast cysts are benign, individual, fluid-filled lumps.

Question 14

What is the most common cause of breast lumps and what ages do they commonly occur in?

Answer 14

Breast cysts which occur most often between ages 30 and 50, more so in the perimenopausal period.

Question 15

Features of breast cysts on examination?

Answer 15

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

Question 16

Having a breast cyst may slightly increase risk of breast cancer. True/false?

Answer 16

True

Question 17

What can fat necrosis do to fat tissue in the breast?

Answer 17

Fat necrosis causes a benign lump formed by localised degeneration and scarring of fat tissue in the breast.

Question 18

What are the typical triggers for fat necrosis of the breast?

Answer 18

Commonly triggered by localised trauma, radiotherapy or surgery, with an inflammatory reaction resulting in fibrosis and necrosis (death) of the fat tissue.

Question 19

Fat necrosis increases risk of breast cancer. True/false?

Answer 19

False

Does not increase risk

Question 20

Features of fat necrosis

Answer 20

Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion

Question 21

Can ultrasound/mammogram differentiate fat necrosis from breast cancer?

Answer 21

No, ultrasound or mammogram can show a similar appearance to breast cancer.

Histology (by fine needle aspiration or core biopsy) may be required to confirm the diagnosis and exclude breast cancer.

Question 22

Fat necrosis is usually managed medically. True/false?

Answer 22

False

Fat necrosis is usually treated conservatively. It may resolve spontaneously with time. Surgical excision may be used if required for symptoms.

Question 23

What are lipomas?

Answer 23

Benign tumours of fat (adipose) tissue. They can occur almost anywhere on the body where there is adipose tissue, including the breasts.

Question 24

Features of breast lipoma on examination?

Answer 24

Soft
Painless
Mobile
Do not cause skin changes

Question 25

How are lipomas treated?

Answer 25

They are typically treated conservatively with reassurance. Alternatively, they can be surgically removed.

Question 26

What are galactoceles?

Answer 26

They are breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk.

Question 27

What women are galactoceles most common in?

Answer 27

Occur in women that are lactating (producing breast milk), often after stopping breastfeeding.

Question 28

What are the typical features of a galactocele and how does it present?

Answer 28

They present with a firm, mobile, painless lump, usually beneath the areola.

They are benign and usually resolve without any treatment.

It is possible to drain them with a needle. Rarely, they can become infected and require antibiotics.

Question 29

What are phyllodes tumours?

Answer 29

Rare tumours of the connective tissue (stroma) of the breast, occurring most often between ages 40 and 50.

Question 30

Are phyllodes tumours benign or malignant?

Answer 30

Can be both benign or malignant

They are large and fast-growing.

They can be benign (~50%), borderline (~25%) or malignant (~25%). Malignant phyllodes tumours can metastasise.

Question 31

Treatment of phyllodes tumours?

Answer 31

Treatment involves surgical removal of the tumour and the surrounding tissue (“wide excision”). They can reoccur after removal.

Chemotherapy can be used in malignant or metastatic tumours.