A patient got episodic breast pain after giving birth, months before her pregnancy and a week before her menstruation. What is the diagnosis?
Cyclical mastalgia
A patient has a hormone positive breast cancer with no mets, what is the treatment plan?
- local exicision
then - Whole breast radiotherapy to reduce risk of reaccurance
- then hormone therapy (as +ve) again to reduce risk
If a patient has palpable lymph nodes and ultrasound is positive, what is next step in treatment?
Perform axillary lymph node clearance
If they find no lymph node involvement in the ultrasound in breast cancer, what procedure should be done next and why?
- Sentinel lymph node biopsy (SLNB)
- the ultrasound only indicates the presence of mets however it does not detect any abnormal lymph nodes or rule out microscopic metastases.
- The SLNB is to provide an accurate assessment of mets
Patient has breast cancer and ultrasound confirms axillary node involvement, what are the 2 options for the patient?
- surgery to remove the lymph nodes
- Axillary radiotherapy
What are features of a breast abscess?
- fever and a tender, fluctuant mass on the affected breast
- Maybe systemically unwell
- Painful
What does a ‘snowstorm’ indicate?
Implant rupture
What is a complication of axillary node clearance?
arm lymphedema and functional arm impairment
What is a complication of mastitis + treatment?
- Breast abscess
- Incision + drainage
What is a side effect of aromatase inhibitors?
osteoprosis
What is a side effect of tamoxifen?
venous thromboembolism
What is a side effect trastuzumab?
cardiotoxic
What is first and second (only 2) treatment of mastitis?
Continue breastfeeding + (analgesia, warm compressions)
If no improvement after 12-24h then oral flucloxacillin for 10-14 days
Most caustive organism Staphylococcus aureus
What is the first most appropriate step in management of paget’s disease of the nipple?
Refer for a two week wait breast clinic appointment
cuz 50% of those with padget’s have cancer
What is the traid for intraductal papilloma?
- Commoner in younger patients
- May cause blood stained discharge
- There is usually no palpable lump -> a benign tumour of fibrovascular tissue that develops within the lactic ducts therfoer can’t feel
- Can be painful and grow
What is the traid for mammary duct ectasia?
Dilatation breast ducts.
Most common in menopausal women
Discharge typically thick and green in colour
Most common in smokers
What type of breast cancer are Aromatase inhibitors used for and give 2 exmaples?
Oestrogen-sensitive breast cancers in post-menopausal
Letrozole + Anastrozole
What type of breast cancer are Receptor modulators used for and give 1 example?
Oestrogen-sensitive breast cancers in pre-menapausal women
Tamoxifen
What warrants an urgent referral to breast clinic?
Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral
What would warrant a routine referral to breast clinic?
<30 y
unexplained breast lump
with or without pain
NOT URGENT
When would you use ultrasound instead of a mammogram to check for breast cancer?
<35 Y use ultrasound due to denser breast tissue
