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AN INTRODUCTIONTO BREAST PA THOLOGIES, SCREENING + EXAMINA TION IOANNISANDANIELABREAST LUMP HISTORY ¡ 58 yearold female presenting with a breast lump ¡ What questions should you ask?HPC ¡ S -Where is the lump? ¡ O-When did you notice it? ¡ C–What does it feel–sm iko?th,rubbery,fixed ¡ R–Any lumps in the other breast, axilla, neck ¡ A– Pain,nipple discharge/inversion,skin changes e.g.dimpling,redness,ulceration,eczema ¡ T– Has it grown, does it change with menstrual cycle ¡ E – Exacerbating/relieving factors ¡ S – Severity ¡ Systems review – weight loss, night sweats, bone pain,RISKFA CTO RS,PMH ¡ PMH – Early menarche,late menopause,nulliparity,first pregnancy >30 years old,not breast feeding,previous cancers ¡ Meds – HRT,COCP ¡ FH – breast/ovarian cancer,BRCA1,BRCA2 ¡ Social – Smoking and alcoholMORE HISTORY ¡ Patient noticed a lump on her right breast 3 weeks ago. ¡ Feels irregular and fixed,not painful,no discharge or overlying skin changes,no hx of trauma ¡ No weight loss/night sweats ¡ PMH – nothing significant,menarche at 13,menopause at 55 ¡ No FH of cancerEXAMINATION ¡ Introduction – Consent, clea n ha nds, cha perone ¡ Inspection –Asymmetry, lumps, scars, skin changes,nipple abnormalities ¡ Palpation – Start with asymptomatic breast, makesuretopalpateallquadrantsandalso behindthenipple.ANATOMY ¡ Secretory lobules produce milk that drain intothe ducts ¡ The ducts lead to and open at the nipple ¡ Breast tissue mainly consists of fatty tissue but also has suspensory ligaments which help secure it to the underlying fasciaDESC RIBIN GALUMP ¡ Site – where is it? breast is divided into 4 quadrants ¡ Size ¡ Shape ¡ Contour – smooth/irregular ¡ Consistency – firm,rubbery ¡ Tenderness ¡ Mobility – movable/tethered ¡ Overlying skin changes – erythema,ulceration,dimplingEXAMINETHEAXILLA & SUPRACLAVICULAR NODESWHAT ISTHIS?WHAT ISTHIS?WHAT ISTHIS?DIFFEREN TIALS FO RBREASTLUMP ¡ Fibroadenoma ¡ Malignancy ¡ Fibrocystic change ¡ Cyst ¡ Abscess ¡ Fat necrosis ¡ Lipoma ¡ GalactoceleEXAMINATION FINDINGS ¡ 2-3cm lump in right upper outer quadrant ¡ Lump is firm,craggy,fixed to underlying chest wall and non-tender ¡ No overlying skin changes and no enlarged lymph nodes in axillaNEXT STEPS ¡ 2 week wait referral – suspected breast cancer ¡ Nice guidelines Ø >30 unexplained breast lump Ø >50 unilateral nipple changes (retraction,discharge etc)TRIPLEASSESSMETIMAGING – MAMMOGRAMSAND ULTRASOUNDSCO RE BIO PSY ¡ Usually done underUS guidance ¡ Ty p e o f Ca n c e r ¡ Grade ¡ Receptor StatusTYPES OF BREAST CANCERMANAGEMENT ¡ Surgery - Wide local excision vs Mastectomy ¡ Radiotherapy ¡ Chemotherapy ¡ Hormone therapy ¡ Targeted therapySCREENING - Wo m e n b e t w e e n t h e a7g,eseryf3 ye0rs - Wo m e n w i t h h i g h e r ri s k c a n b e s c re e n e d e a rl i e r a n d m o re frequently - Used to screen forbreast cancerin asymptomatic patients - Results within 2 weeks - 4 in 100 are called back - 1in those 4 will be diagnosed with breast cancer - Mammogramswillbeperformedbywomen(nice counselling point for OSCE’s)QUESTIONS ¡ 21 yearold female with painless,mobile,rubbery smooth lumpQUEST IONS ¡ 47 year old female complains of unilateral dry,flaky skin around the nippleQUESTIONS ¡ What nerve is damaged during a mastectomy andANS can cause winging of the scapula?