Breast Disease

Breast Disease and Examination Dr. Tim Coughlin

Objectives • Describe the main pathologies of the breast

• Understand the predisposing factors

• Describe the examination of the breast

Inflammatory Disorders

Mastitis / Abscess • Associated with lactation and S.aureus

• Initial infection causes acute mastitis

• May develop into an abscess • If unresolved may develop chronic inflammation

Mastitis

http://www.faqs.org/nutrition/Kwa-Men/Mastitis.html

Abscess

http://www.surgical-tutor.org.uk/pictures/images/breast/breast_abscess.jpg

Fat Necrosis • Follows trauma (may be minor) • Necrosis of adipose tissue and inflammatory response

• Produces hard irregular breast lump • Mimics breast carcinoma

Mammogram

http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat3=34&stype=d

Duct Ectasia • Dilatation of large ducts • Parous women, peri-menopausal • Inflammatory destruction of elastic support tissues

• Firm lump or discharge • Fibrosis and chronic inflammation around ducts

• Common cause of periareolear abscess

Single Duct

http://www.wisc.edu/wolberg/breast.html

Multiple Ducts

Benign Proliferative Diseases

Fibrocystic Change • Common; 10% symptomatic and

40% asymptomatic in ALL women

• Incidence peak around menopause • Hyperplastic overgrowth of mammary unit

• Epithelial overgrowth of lobules / ducts

• Range of solid and cystic nodules

http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat3=36&stype=d

Fibroadenoma • Benign localised proliferation of ducts and stroma

• Rarely larger than 2 - 3 cm • Incidence peak women aged 25 35

• Mobile lump, firm rubbery, well defined

http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Text/Breast/fibroadenoma.htm

Neoplastic Breast Disease

Benign Breast Tumors • Lipoma / Leiomyomas • Harmatomas • Duct Papillomas • Adenomas • Phyllodes Tumors

Malignant Tumours • Affects 1 in 12 women • Usually occur over the age of 30 • Four common presentations: • Palpable lump • Mammography • Incidental histological finding • Metastatic disease

Intraductal Carcinoma • Non invasive (CIS) • Incidence peak 40 - 60 years • Tumour fills and distends small and medium ducts

• 30% become invasive if untreated

Invasive Ductal Carcinoma • Most common • Invade tissue with desmoplastic response creating dense fibrous stroma

• Most intermediate or high grade poorly differentiated tumours

Invasive Lobular Carcinoma • Often multifocal and frequently bilateral

• Again desmoplastic response • Tumour cells compressed into narrow cords

Paget’s Disease • Pattern of spread of a ductal carcinoma

• Thickening and reddening of skin of nipple and areolear

• Resembles eczema

Causes of Breast Cancer

• Geographical : 5x higher in west • Familial: 5% associated with genetic predisposition

• Early menarche: age 10 carries 3x risk

• Late parity: age 35 carries 3x risk • Late menopause: age 55 carries 3x risk

• Exogenous hormones: HRT • Dietary factors: obesity, high EtOH

Breast Examination Images from: http://www.operationalmedicine.org/ed2/Enhanced/Breast.htm

IPEEP • Introduce yourself to the patient • Ask Permission to perform the

examination and ask for chaperone to be present

• Explain what you want to do • Expose the patient adequately correctly • Position the patient + PAIN

Inspection • Position : Sitting

with arms by side

• Symmetry • Visible masses • Dimpling • Redness • Nipple retraction

Inspection • Ask patient to

raise arms and place hands behind head

• Watch for skin tethering

Inspection • Ask patient to put hands on hips and push inwards

• Flexes pectorals • Again look for

contour of breast

Palpation

Palpation • First examine sitting

• Examine

‘normal’ side first

• Place hand

behind head

• One quadrant at a time

Palpation • Next palpate the axilla

• Support patient’s arm

• Lymphadenopath y

Palpation • Examine lying down

• Use one or two hands to elicit lumps

• If felt define lump with fingertips

Palpation • Finally palpate nipple

• Stripping of the ducts for secretions

Thankyou http://web.mac.com/timcoughlin/