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AN INTRODUCTIONTO BREAST PA THOLOGIES, SCREENING + EXAMINA TION IOANNISANDANIELABREAST LUMP HISTORY ¡ 58 year old 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 like? –smooth,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,RISK FACTORS,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,clean hands,chaperone ¡ Inspection –Asymmetry,lumps,scars,skin changes,nipple abnormalities ¡ Palpation – Start with asymptomatic breast, make sure to palpate all quadrants and also behind the nipple.ANATOMY ¡ Secretory lobules produce milk that drain into the 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 fasciaDESCRIBINGA LUMP ¡ 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?DIFFERENTIALS FOR BREAST LUMP ¡ 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)TRIPLEASSESSMENTIMAGING – MAMMOGRAMSAND ULTRASOUNDSCORE BIOPSY ¡ Usually done under US guidance ¡ Type of Cancer ¡ Grade ¡ Receptor StatusTYPES OF BREAST CANCERMANAGEMENT ¡ Surgery - Wide local excision vs Mastectomy ¡ Radiotherapy ¡ Chemotherapy ¡ Hormone therapy ¡ Targeted therapySCREENING - Women between the ages of 50-70,every 3 years - Women with higher risk can be screened earlier and more frequently - Used to screen for breast cancer in asymptomatic patients - Results within 2 weeks - 4 in 100 are called back - 1in those 4 will be diagnosed with breast cancer - Mammograms will be performed by women (nice counselling point for OSCE’s)QUESTIONS ¡ 21 year old female with painless,mobile,rubbery smooth lumpQUESTIONS ¡ 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?