One page summaries for topics listed in the MLA Topic Map associated with general practice
Contents include: Breast Pain; Driving Advice; End of Life Care; Genetic Disorders; Fatigue; etc.
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Breast Lump/Pain - Benign Conditions
Anatomy & Risks
Fibroadenoma Fat necrosis - Normally affects
- No increase in risk - Normally first time mothers
of malignancy following trauma and hx mastitis in
- Originate from Duct papilloma pregnancy
lobules - No increased risk Lactational breast abscess
- Highest incidence of malignancy - Most common
in early 20s Fibrocystic breast disease organism = staph
Breast cyst - Cumulative effect aureus
- Small increased of cyclical - Milk stasis and
risk of breast hormones trauma from
cancer - Normally affects incorrect
Sclerosing adenosis 20-50yo latch/pump can
- Radial scar Duct ectasia contribute
- Distortion of distal - Normal variant of - Often history of
lobular unit breast involution mastitis
without Mastitis Cyclical mastalgia
hyperplasia - Can be with or - Common cause of
- Disorder of without infection breast pain in
involution - When associated younger women
- No increased post-partum =
malignancy risk puerperal mastitis
Symptoms & Complications
Fibroadenoma - Breast pain
- Mobile, firm breast lump - Sx worsen with menstrual cycle,
- Encapsulated and rounded peaking 1wk before
- ‘Rubbery’ consistency Duct ectasia
Breast cyst - Nipple discharge (from single or
- Smooth discrete lump multiple ducts)
- May be fluctuant - Often thick and green
Sclerosing adenosis Mastitis
- Breast lump / breast pain - Painful, tender, red and hot breast
Fat necrosis - Can have systemic features of
- Lump may increase in size initially infection
- Generally painless with skin - Generally unilateral
thickening - Presents within 1st week
- Overlying skin postpartum
redness/warmth/bruising - Can develop into a breast abscess
Duct papilloma Lactational breast abscess
- Discharge from single duct, can be - Systemic features of infection
bloody - Hx recent/ongoing mastitis
- Generally without a mass - Erythema over affected breast area
Fibrocystic breast disease - Possible fluctuant mass
- Bilateral ‘lumpy’ breasts normally
in upper outer quadrant
,Cyclical mastalgia - Not associated with point
- Varies in intensity according to tenderness of chest wall
menstrual cycle phase
Investigations
Sclerosing adenosis
- Causes mammographic changes which can mimic carcinoma
Treatment/Management & Side effects
Fibroadenoma
- Surgical excision if >3cm
- WLE for Phyllodes tumours
Breast cyst
- Aspiration
- Biopsy if blood stained/persistently refilling
Sclerosing adenosis
- Lesions biopsied
Fat necrosis
- Imaging and core biopsy
- Generally conservative management
Duct papilloma
- Microdochectomy
Fibrocystic breast disease
- Encourage soft but well-fitting bra for comfort
- Most cases resolve after menopause
Duct ectasia
- No specific treatment required
Mastitis
- Can continue to breastfeed
- Advise on facilitating milk removal e.g., manual expression
- Oral abx according to local protocol
Lactational breast abscess
- Needle aspiration for culture and drainage
- Abx according to culture and local protocol
- Overlying skin necrosis = indication for surgical debridement
Cyclical mastalgia
- Supportive bra
- Standard oral/topical analgesia
- Refer if persistent after 3mths treatment
, Malignant
Definition & DDx Anatomy & Risks
Most common type of cancer in women - Increased hormone exposure
and 2nd most common cause of cancer o Early menarche
death in UK o Late menopause
DDx o Nulliparity/late first
- Fibroadenoma pregnancy
- Cyst o Oral contraceptives
- Mastitis o HRT
- Lipoma - Gene mutations
o BRCA1/BRCA2
- Age
- Caucasian
- Obesity/lack of physical activity
- Alcohol/smoking
- Hx breast cancer
- Previous radiotherapy
Types - HER2+ve breast cancer
- Invasive ductal carcinoma (most o Human epidermal growth
common) factor receptor 2
- Invasive lobular carcinoma o Aggressive but responds
- Ductal carcinoma in situ (DCIS) well to HER2 blocking
o Pre-invasive cancer therapy
- Lobular carcinoma in situ (LCIS) - Phyllodes tumours
o Not cancer o Fast growing, rarely
o Abnormal cell growth metastasise
o Increases risk future breast o Can cause skin ulceration
cancer o Not associated with normal
- Inflammatory breast cancer risk factors for breast
o Rare but aggressive cancer
o Causes blockage in lymph
vessels of skin on breast Symptoms & Complications
- Triple negative breast cancer - Unexplained mass in ≥30yo
(TNBC) - Nipple discharge/ retraction/
o Lacks symptoms in ≥50yo
oestrogen/progesterone - Skin changes suggestive of breast
receptors cancer
o No excess of HER2 - Unexplained axillary mass in ≥30yo
o More aggressive - Paget’s disease of the nipple
o Fewer targeted treatments o Eczema-like change of
nipple associated with
underlying breast cancer
o Can also have nipple
sensation changes/
retraction/ inversion/
bloody discharge
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