Year 3 - Diseases > Breast > Flashcards

Breast Flashcards

(51 cards)

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1
Q

Define fibroadenoma

A
  • A benign breast lump most common in young women

- Arise in breast lobules, composed of fibrous and epithelial tissue

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2
Q

Describe epidemiology of fibroadenoma

A
  • Most common type of breast cancer below age 30
  • Generally arise age 20-24
  • 68% of breast masses
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3
Q

List risk factors for fibroadenoma

A
  • Thought to occur because of increased sensitivity to oestrogen
  • Young age
  • Obesity
  • Consumption of oral contraceptives before age 20
  • Family history
  • Increase in size during pregnancy, breastfeeding, and HRT but become smaller afterwards
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4
Q

List signs and symptoms of fibroadenoma

A
  • Firm, non-tender, highly mobile lumps
  • Simple are 1-3cm
  • Complex have different types of cells
  • Giant or juvenile are more than 5cm
  • Normal overlying skin, not fixed to surrounding parenchuma
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5
Q

List investigations for fibroadenoma

A
  • Triple assessment
  • Examination
  • Imaging (ultrasound below 40 - well circumscribed, round to ovoid or macrolobulated mass with uniform hypoechogenicity)
  • Needle biopsy (not required over age of 25)
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6
Q

Describe management of fibroadenoma

A
  • Most can be left
  • If they get bigger (giant or juvenile, or complex fibroadenoma) then they are removed
  • May be vacuum assisted, this can be done under local anaesthetic
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7
Q

Describe prognosis of fibroadenoma

A
  • Does not increase risk of breast cancer for most women

- If complex, risk is slightly increased

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8
Q

Describe complications of fibroadenoma

A
  • Rare
  • Slightly increased risk of breast cancer in some cases
  • Giant fibroadenomas continue growing and can become large
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9
Q

Define duct ectasia

A

A benign (non-cancerous) breast condition that occurs when a milk duct in the breast widens and its walls thicken. This can cause the duct to become blocked and lead to fluid build-up.

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10
Q

Describe epidemiology of duct ectasia

A
  • Occurs in perimenopausal women (age 45-55)

- Duct ectasia 5-9% of non-lactating women

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11
Q

List signs and symptoms of duct ectasia

A
  • Often causes no symptoms
  • May cause a thick nipple discharge
  • Red tender nipple and nearby breast tissue
  • Nipple may be pulled inward
  • Scar tissue around the abnormal duct causing a hard lump (firm, stable, painful, under nipple)
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12
Q

List risk factors for duct ectasia

A

Smoking, close to menopause, obesity

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13
Q

Describe investigation for duct ectasia

A
  • Mammogram
  • Ultrasound
  • Biopsy
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14
Q

Define intraductal papilloma

A

Solitary or multiple benign lesions that arise from the epithelium of the lectiferous breast ducts

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15
Q

Describe epidemiology of intraductal papilloma

A
  • Peak incidence 40-50 years
  • Multiple lesions more common when younger
  • Solitary lesions more common when older
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16
Q

List signs and symptoms of intraductal papilloma

A

Solitary lesion (central)

  • Bloody or serous nipple discharge (most common cause)
  • Palpable lump close to or behind the nipple or areola
  • Large central lesion

Multiple lesions

  • Usually asymptomatic, rarely discharge
  • Peripheral lesions which are smaller than solitary lesions
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17
Q

Describe investigations of intraductal papilloma

A
  • Core needle biopsy if lesion is palpable, rule out malignancy (fibroepithelial tumour, with papillary cells and fibrovascular core covered by epithelial and myoepithelial cells
  • Ductogram (mammogram with contrast, non specific findings such as ectasia and filing defects)
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18
Q

List examples of benign ductal disease

A
  • Duct ectasia

- Papilloma

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19
Q

Define mastitis and breast abscess

A
  • Inflammation of the breast with or without infection.
  • Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia).
  • Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions (e.g., foreign body reaction).
  • A breast abscess is a localised area of infection with a walled-off collection of pus. It may or may not be associated with mastitis.
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20
Q

Describe epidemiology of mastitis and breast abscess

A
  • Global prevalence of mastitis in lactating women up to 10%
  • Breast abscess in 2-11% of women with mastitis, with incidence of 0.1-3.0% in breastfeeding women
  • 50% of infants with neonatal mastitis will develop breast abscess
  • Tubecular mastitis is rare 0.1-3% incidence
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21
Q

Describe aetiology of mastitis and breast abscess

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A
  • With or without infection
  • Infectious mastitis and breast abscesses are usually caused by bacteria colonising the skin.
  • Cases due to Staphylococcus aureus are by far the most common, followed by those due to coagulase-negative staphylococci.
  • Breast infections may sometimes be polymicrobial (up to 40% of abscesses), with isolation of aerobes as well as anaerobes
  • Non-infectious mastitis may result from underlying duct ectasia (peri-ductal mastitis or plasma cell mastitis) and infrequently foreign material (e.g., nipple piercing, breast implant, or silicone).
  • Clogged ducts with milk stasis
22
Q

List risk factors of mastitis and breast abscess

Study These Flashcards
A
  • Female sex
  • Women aged >30 years
  • Poor breastfeeding technique
  • Lactation
  • Milk stasis
  • Nipple injury
  • Previous mastitis
  • Prolonged mastitis (breast abscess)
  • Prior breast abscess (breast abscess)
  • Shaving or plucking areola hair
  • Anatomical breast defect, mammoplasty, or scar
  • Other underlying breast condition
  • Nipple piercing
  • Foreign body
  • Skin infection
  • Staphylococcus aureus carrier
  • Immunosuppression
  • Hospital admission
  • Breast trauma
  • Primiparity
  • Overabundant milk supply
  • Post-maturity (breast abscess)
  • Complications of delivery
  • Maternal fatigue
  • Tight clothing
  • Antifungal nipple cream
  • Fibrocystic breast disease
  • Cigarette smoking
  • Vaginal manipulation (breast abscess)
  • Poor nutrition
  • Antiretroviral therapy
23
Q

List signs and symptoms of mastitis and breast abscess

Study These Flashcards
A
  • Fever
  • Decreased milk outflow
  • Breast warmth
  • Breast tenderness
  • Breast firmness
  • Breast swelling
  • Breast erythema
  • Flu-like symptoms, malaise, and myalgia
  • Breast pain
  • Breast mass
  • Fistula
  • Nipple discharge
  • Nipple inversion/retraction
  • Lymphadenopathy
  • Extra-mammary skin lesions
24
Q

Describe investigations for mastitis and breast abscess

Study These Flashcards
A
  • Breast ultrasound (hyperechoic lesion, well circumscribed, macrolobulated, irregular, ill defined)
  • Diagnostic needle aspiration drainage (purulent fluid indicates breast abscess)
  • Cytology of nipple discharge or sample from fine-needle aspiration
  • Milk, aspirate, discharge, or biopsy tissue for culture and sensitivity
  • Histopathological examination of biopsy tissue (infection, granulomatous inflammation or malignancy)
  • Pregnancy test
  • Blood culture and sensitivity
  • Mammogram
  • Milk for leukocyte counts and bacteria quantification
  • Culture from swab/aspirate from infant’s and mother’s oral cavity and nasopharynx
  • FBC
  • Tuberculin skin test (purified protein derivative)
25
Describe treatment of mastitis and breast abscess
Lactational mastitis - Effective milk removal and supportive care (paracetamol and ibuprogen) - Antibiotic therapy (flucloxacillin 10-14 days) if pain and severe symptoms, or lasting more than 12-24 hours. Continue breastfeeding bilaterally, as this reduces chance of abscess formation - Antifungal therapy for candidiasis - If systemic signs or prolonged, non beta-lactam antibiotic - For breast abscess, surgical intervention (needle aspiration with local anaesthesia with or without ultrasound guidance to drain an abscess) + IV or oral antibiotics (flucloxacillin) + paracetamol Non lactating - co-amoxiclav for 10-14 days
26
List complications of breast abscess and mastitis
- Cessation of breastfeeding - Abscess (complicating mastitis) - Sepsis - Scarring - Functional mastectomy - Breast hypoplasia - Necrotising fasciitis - Extra-mammary skin infection - Fistula
27
Describe prognosis of breast abscess and mastitis
- When treated promptly most resolve within 2-3 days with appropriate antibiotic therapy - Lactational abscess easier to treat than non-lactational - Most patients can continue to breastfeed - Recurrence in delayed or inappropriate therapy, candidiasis, poor breastfeeding technique - Granulomatous mastitis 50% recurrence
28
Define breast cyst
Fluid filled lump in the breast
29
Describe epidemiology of breast cyst
- Common over 35 years, especially in perimenopausal women | - Affect 7% of western women (common)
30
List risk factors for breast cysts
- Postmenopausal women taking HRT | - Perimenopausal
31
List symptoms and signs of breast cysts
- Fluid filled - Not fixed to the surrounding tissue - Occasionally painful - May be soft or hard
32
Describe investigation of breast cysts
- Mammogram or ultrasound - Identifies a fluid filled lump - Fine needle aspiration confirms diagnosis (brown, green, tan or clear fluid)
33
Define breast cancer
- Malignant neoplasm of the breast | - Commonly adenocarcinomas. These may be invasive ductal (70-80%) or invasive lobular
34
Describe epidemiology of breast cancer
- Affects 1 in 8 women, most common malignancy of women - 60000 new cases per year UK with incidence rising - Rare in men, men make up 1% of all breast cancers - 2nd most common cancer worldwide
35
List risk factors for breast cancer
- Family history (BRCA gene, li fraumeni syndrome - 5-10% genetic) - Age - Uninterrupted oestrogen exposure (nulliparity or 1st pregnancy over 30, early menarche/late menopaise and taking HRT therefore all risk factors) - Not breastfeeding - Past breast cancer - Lifestyle factors : low fibre, high fat diet, smoking, alcohol, obesity in postmenopausal women
36
Describe aetiology of breast cancer
- BRCA1 or BRCA2 gene mutations are autosomal dominant - Associated with increased risk of breast (70%) and ovarian cancer - BRCA positive women develop cancer 15-20 years earlier. Found in 5-10% of all women with breast cancer
37
List types of breast cancer
- Non-invasive ductal carcinoma in situ is premalignant, seen as a microcalcification on mammogram, 25% of all newly diagnosed breast cancers. - Non-invasive lobar carcinoma in situ is rarer, tends to be multifocal - Invasive ductal carcinoma 70% invasive breast carcinomas - Invasive lobar carcinoma 10-15% invasive breast carcinomas - Medullary cancers (5%) tend to affect younger women, and colloid/mucoid (2%) the elderly - Others include papillary, tubular, adenoid cystic and pagets (ductal which infiltrates the nipple) - 60-70% oestrogen receptor positive, better prognosis - 30% express HER2 (more aggressive)
38
List symptoms and signs of breast cancer
- Developed late at advanced tumour stages - Changes in breast size or shape (asymmetric breasts) - Palpable mass (single, non-tender, firm mass with poorly defined margins, most commonly in the upper outer quadrant) - Skin changes (retractions or dimpling, peu d'orange due to obstruction of lymphatic system - reddness, oedema and pitting of hair follicles) - Nipple changes (inversion/blood-tinged discharge) - Axillary lymphadenopathy (firm, enlarged lymph nodes fixed to the skin or surrounding tissues - Ulcerations if advanced - Pagets disease of breast - Thrombophelbitis
39
Describe investigations of suspected breast cancer
- Triple assessment - clinical examination, histology/cytology and mammogram if over 35/ultrasound if under 35 - Core biopsy of solid lump - Aspiration of cystic lump, if bloody cytology (if suspicious core needle biopsy needed to confirm diagnosis) - Malignant: focal mass with poorly defined margins, clustered microcalcifications - Determine whether oestrogen/ progestrone/ HER2 positive (via immunohistochemistry - best prognosis oestrogen+progresterone positive, HER2 negative)
40
Define fine needle aspiration
- A procedure where a thin needle is used to draw out cells or fluid from a lump or mass under the skin. - This is then analysed to look for any cancer cells - Often guided by ultrasound
41
List indications for fine needle aspiration
- Investigate and diagnose breast lumps where the nature is uncertain - Monitor breast cancer response to treatment - Also has use in thyroid, lymph nodes, lung, bone, liver, GI samples
42
List complications of fine needle aspiration
- Bleeding - Infection - Lung biopsy: pneumothorax
43
Define fibrocystic change
Benign breast condition encompassing fibrous changes, cysts and adenosis that occurs bilaterally
44
Describe epidemiology and risks of fibrocystic change
- Premenopausal 30-50 - Obesity - Nulliparity - Late menopause - Increased E2
45
List symptoms and signs of fibrocystic change
- Multiple lumps - Smooth, regular, bilateral, symmetrical - Normal nipples, fluctuates with periods - Tender, rubbery, fluctuant, mobile, slow growing - Fibrous lumps hard and rubbery while cysts are oval or round and fluctuant
46
List investigations for fibrocystic changes
- US or mammogram | - FNA (straw coloured)
47
Define fat necrosis
Fat tissue is damaged secondary to trauma. Occurs at any age, though it is rare
48
List symptoms and signs of fat necrosis
- Skin retraction/thickening. May be bruised or irregular | - Hard, tender, fixed
49
List risk factors for fat necrosis
- larger breasts | - Previous FNA, biopsy or surgery
50
List investigations for fat necrosis
- US or mammogram | - FNA
51
Describe breast cancer screening
- All women age 50-71 who register for a GP are eligible for screening every 3 years using a mammogram - If at high risk, age 40-50 annual mammography is used
Year 3 - Diseases
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