Fibroadenoma: definition, demographic, s&s, treatment
- Definition: Benign overgrowth of one lobule of the breast, usually solitary
- Demo: 25-35 y/o
- S&S: Painless, or v. localised pain Highly mobile, firm, smooth lumps that evade palpation
- Treatment: 1/3 regress, 1/3 stay the same, 1/3 enlarge -generally don’t require treatment -remove if >4cm
Fibroadenosis/Fibrocystic disease: definition, demographic, s&s, treatment
- Definition: Benign combination of localised fibrosis, inflammation, cyst formation and hormone driven breast pain
- Demo: Menstruating women, 35-50 y/0
- S&S: round or oval, movable lumps, with or without pain, may change with menstruation, may have discharge usually clear/cloudy
- Treatment: Reassurance, Anti-inflammatories, Topical evening primrose oil, Hormone manipulation (COC)
Breast Cyst: definition, demographic, s&s, treatment
- Definition: Cavities lined by flattened epithelium derived from the ductal unit, filled with watery fluid
- Demo: Perimenopausal
- S&S: Round symmetrical lumps, occasionally w/ pain, may vary with menstruation
- Treatment: Drain w/ USS guidance -if fluid suspicious sent away from cytology
Mastalgia: definition, treatment
- Definition: If alone benign sx, Breast Pain Either cyclical/non-cyclical
- Treatment: Evening primrose oil, Tamoxifen/danazol if cyclical pain
Ductal ectasia: definition, demographic, s&s, treatment
- Definition: Normal shortening and widening of breast ducts with age. Sometimes this may cause discharge and uncommonly pain
- Demo: >35 y/o
- S&S: Discharge - Thick or watery, variable in colour, sometime blood stained. Inverted nipple. Lump behind nipple. Uncommonly pain.
- Treatment: Don’t squeeze, simple analgesia, usually self-resolving
Breast Abscess: definition, demographic, s&s, treatment
- Definition: painful build-up of pus in the breast caused by an infection
- Demo: Breast-feeding
- S&S: painful, red and warm breast. Lump or swelling. Systemic infection sx
- Treatment: Drainage and Abx
Duct Papilloma/ Intraductal papilloma: definition, demographic, s&s, treatment
- Definition: Benign wart like lump in duct, usually near nipple
- Demo: >40
- S&S: Small lump +/- clear/blood stained nipple discharge
- Treatment: Surgery
Fat necrosis: definition, s&s
- Definition: Lump formed following breast tumour
- S&S: Usually painless, firm, round lump. Skin: red, bruised, dimpled. Nipple inversion. May form cyst
Periductal mastitis: definition, demographic, s&s, treatment
- Definition: Infection of ducts beneath nipple
- Mastitis alone means infection of the breast
- Demo: smokers, nipple ring
- S&S: a tender, hot or reddened breast. Nipple dischage either bloody or non-bloody. Lump behind the nipple. Retracted nipple. Occasionally abscess.
- Treatment: Flucloxacillin
Breast Carcinoma: 2 main types, definitions, s&s, risk factors
- Invasive ductal carcinoma
- Definition: Ca in the breast ducts that have spread
- S&S: initially none; lump, swelling, Peau d’orange, mastalgia, pagets, nipple discharge, tethering, nipple retraction, deep fixation of lump to pectoralis
- Ductal carcinoma in-situ (DCIS)
- Definition: Ca in the breast ducts that hasn’t spread, may turn into invasive cancer
- S&S: Usually no S&S, if anything a lump or discharge
- RF of breast Ca
- FHx (BRACA), early menarche/late menopause, nulliparity, geriatric mother, not breast feeding, HRT, obesity, smoking
Paget’s disease of the breast: definition, s&s
- Definition: Spread of intra-ductal carcinoma leading to eczematous changes around nipple
- S&S: red scaly rash on areola, itching and burning nipple, sometimes ulcers
Name of receptors the make a cancer suitable to oestrogen treatment
HER2
ER
progesterone receptors
Where does breast met to
lungs, spine, pelvis and liver
How are all breast lumps investigated?
- 2WW
- triple assessment
- clinical exam
- imaging (USS or mammography if >35)
- if needed cytology (FNAC if cystic, biopsy if solid)
Breast Ca screening programme
Women ages 50-71
Screened using mammogram
Every 3 years
