S7 L1 Breast Disease Management Flashcards Preview

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Flashcards in S7 L1 Breast Disease Management Deck (19)
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1
Q

What are some typical presenting features of breast disease?

A
  • Swelling and tenderness
  • Nodularity
  • Mastalgia (cyclical and non-cyclical)
  • Palpable breast lumps
  • Nipple discharge (including galactorrhoea)
  • Mastitis
2
Q

What type nipple discharge is a red flag?

A

Unilateral blood stained

3
Q

How can benign breast lumps be classified histologically?

A

- Non proliferative disorders: no increased risk of cancer

- Proliferative disorders: mild to moderate increased risk

- Atypical hyperplasia: increase in risk of 4.1-5.3

4
Q

Why is some physiological breast swelling that occurs in adolescence?

A

During puberty thelarche occurs and this can be unilateral or bilateral

5
Q

What are the two most common benign palpable breast lumps?

A

- Fibrocystic changes: presents with pain and nodularity in women 20-50. Responds to hormones so cyclical

- Fibroadenomas: benign breast mass common in 20-30s. Made of fibrous and epithelial tissue. Firm, non tender, highly mobile lump with regular borders and is cystic in consistency. Hormones involved so HRT increases incidence

6
Q

What is nodularity of the breast and when is it abnormal?

A
  • Lumpy glandular tissue often in upper outer quadrant of breast that is worst about a week before menstruation and decreases when it starts
  • Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper quadrant of the breast
  • If bilaterally symmetrical rarely pathological but if there is asymmetry review after one or two menstrual cycles seeing her mid cycle and enquire about family history
7
Q

What is cyclical mastalgia and how do we treat it?

A
  • Pain and nodularity that occurs in the breast in the premenstrual phase which rapidly resolves when menstruation starts
  • Breasts are active organs - change throughout the menstrual cycle and some degree of tenderness and nodularity in the premenstrual phase is so common that it may be considered as normal
  • Wear a supportive bra and analgesia
8
Q

What does a benign breast lump feel like?

A
  • Smooth
  • Mobile
  • Regular borders
  • Solid or cystic
9
Q

What are the 4 quadrants of the breast used to describe the location of breast pathology?

A
10
Q

How do you distinguish fibrocystic changes from a solid tumour?

A
  • Can’t on examination so have to do fine needle aspiration biopsy but do not do this is you strongly suspect cancer as this provides a path for the cancer
  • Often biopsy drains cyst and resolves it but may refill later
11
Q

How do we treat fibroadenomas?

A

Observe every 3 months with an ultrasounds

12
Q

What is a benign cause of bloody nipple discharge?

A

- Intraductal Papilloma and usually only unilateral

  • Can often have pain as well as blocked milk duct
  • Leaves patient susceptible to infection
13
Q

What is mammary duct ectasia and how does it present?

A

When a milk duct becomes dilated and filled with creamy secretions causing periductal inflammation

14
Q

What is mastitis and how do we treat it?

A
  • Generalised cellulitis of the breast, often due to overfilling of the breasts from irregular nursing
  • Cracks in the nipples can allow bacteria to get in and sometimes an abscess forms
  • Treat with antibiotics and by expressing milk from unused breast
15
Q

What patients need to be referred via the 2 week wait for breast changes?

A
  • Skin changes that suggest breast cancer
  • >30 with unexplained lump in axilla
  • Anyone under 30 with unexplained breast lump with or without pain can be a non-urgent referral
16
Q

What is the Kubler Ross change curve?

A

Last three changes can often be called acceptance

17
Q

What are some benign conditions causing nipple discharge?

A
  • Duct ectasia
  • Mastitis
  • Intraductal Papilloma
18
Q

What is a radical mastectomy?

A

Surgical procedure involving the removal of breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla

19
Q

What are cysts?

A
  • Cysts are most common between the ages of 35 and 50
  • They are palpable as discrete lumps and may be recurrent
  • They cannot be reliably distinguished from solid tumours and clinical examination