Breast swelling

Breast swelling

1. Breast swelling Maryam AL-Qahtani

2. Learning objectives Definition of breast swelling Short anatomy of breast Differential Diagnosis of breast swelling Clinical Evaluations History Physical Examinations Investigations Management

3. Definition

4.  is an enlargement of the breast or both breasts compared to the regular breast size and may be accompanied by other symptoms like tenderness (soreness), pain, lump(s), changes of the areola or nipple and any secretion from the nipple. Definition Breast swelling

5. DDx

6. Pathological Puberty Menstruation Pregnancy Breastfeeding Contraceptives Menopause

7. Puberty Sx Increasing breast size Androgenic hair (pubic hair and/or hair of the armpits) Onset of menstruation (menarche) Fat accumulation on the thighs, buttocks and/or lower abdomen. Ddx Use of oral contraceptives. No reason to worry unless the pain becomes unbearable.

8. Menstruation Sx Irritability and mood changes Bilateral breast swelling and tenderness prior to menses Menstrual pain Discomfort or cramping Headache Vaginal discharge  Ddx Use of oral contraceptives. The tenderness usually diminishes within the first few days of the menstruation cycle or when it is over.

9. Pregnancy Sx Breast tenderness Amenorrhea  Nausea and vomiting (morning sickness) Clear vaginal discharge Darkening and/or enlargement of the areola Headache, Fatigue. Ddx Use oral contraceptives Gonadotropin releasing hormone drugs . Premature ovarian failure. Menopause.

10. Breastfeeding Sx Milk production and secretion Tender or sore breasts Palpable nodules in the breast. Ddx Would only be considered if there are other signs and symptoms like : Excessive pain Unilateral (one-sided) breast swelling pus secretion from the nipple.

11. Menopause Sx Amenorrhea Breast tenderness Weight gain Hot flushes/flashes Mood changes. Ddx  Pregnancy Premature ovarian failure Gonadotropin releasing drugs Hormone replacement therapy (HRT).

12. Contraceptives Women who use oral contraceptive pills can experience problems with their breasts because of the hormonal imbalance that pills can cause. This is usually not a reason for concern, but if it happens with unusual bleeding, bloating, headache and uneasiness, the woman should seek immediate medical care.

13. Physiological Fibroadenoma Fibroadenosis   Mastitis Fat Necrosis Breast abscess   Duct ectasia Benign Malignant Malignant

14. Fibroadenoma Definition are the most common breast lesions commonly found in women under the age of 30.  Sx Painless 

15. Fibroadenosis Definition Fibrosis is firmness in the connective tissues, and cysts are fluid-filled sacs. These changes often are affected by hormones. Sx Areas of lumpiness, thickening Tenderness Nipple discharge Pain

16. Mastitis Definition Bacterial infection and can cause inflammation around the nipple Often occurs when breastfeeding. Sx  Breast pain Fever Tenderness/soreness Redness Heat or warmth of affected area.

17. Fat Necrosis Definition After surgery or an injury to the breast heals and leaves scar tissue that can feel like a lump. Sx pain and tenderness Some drainage may occur in the nipple of the breast with the lump or the skin may dimple. 

18. Duct ectasia This happens when a milk duct becomes dilated, the walls thicken and then the duct fills with fluid. most often affects women in their 40s and 50s Sx Nipple discharge (green, black, thick, or sticky) redness of the nipple and area around the nipple Tenderness Or inflammation near the blocked duct. Definition

19. Breast abscess   Definition Is a collection of pus within the breast tissue.  Sx Severe breast pain Fever, chills Redness, heat/warmth Discharge of pus Deviated nipple Visible lump

20. Physiological Benign Malignant Benign Breast Cancer

21. Breast cancer Most common type of breast cancer : Inflammatory breast cancer

22. Symptoms and signs: painless lump in the breast.  Changes in the size or shape of a breast. Dimpling or thickening of some of the skin on a part of a breast. The nipple becoming inverted (turning in). Rarely, a discharge occurring from a nipple redness and warmth

23. The most commonly used tool that doctors use to describe tumor stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M).

24. Gynecomastia Risk factors Definition Is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Older age obese Use of anabolic steroids or androgens to enhance athletic performance Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and Klinefelter syndrome

25.  SHOULD BE CLEARLY DIFFERENTIATED FROM ENLARGED PECTORAL MUSCLES IN MUSCULAR MALES.

26. Simon Cowell Break Time

27. Clinical evaluation

28. Family history History of trauma Family history Associated symptoms Gynaecological history Medications Medical comorbidities History taking

29. Risk Factors Previous history of breast cancer. Family history of breast cancer in a first-degree relative Age Never having borne a child or first child after the age of 30 Not having breast-fed Not having breast-fed Continuous combined HRT Radiation to chest Being overweight after the menopause

30. Physical examination Risk Factors

31. Inspect with the patient sitting and then with their hands raised above head. Inspection

32. Look for: lump Variations in breast size and contour. nipple : Location nipple retraction discharge if so, is it unilateral or bilateral? Overlying skin changes: Any oedema Redness or retraction of the skin. Dimpling of the skin (called peau d'orange )

33. Palpation

34. Don't forget

35. Family history Discharge Location Regularity Lymphadenopathy Mobility Important aspects of the examination include:

36. Clinical features of palpable breast masses Malignant breast masses Benign breast masses Consistency: hard Consistency: firm or rubbery Painless (90%) Often painful (consistent with benign breast conditions) Irregular margins Regular or smooth margins Fixation to skin or chest wall Mobile and not fixed Skin dimpling may occur Skin dimpling unlikely Discharge: bloody, unilateral Discharge: no blood and bilateral discharge. Green or yellow colour Nipple retraction may be present No nipple retraction

37. Mass fixed to the skin or chest wall Stony hard, irregular mass Skin dimpling Matted or fixed axillary lymph nodes Bloody nipple discharge Thickened, erythematous skin Red flags

38. Investigation Mammogram. This is a special X-ray of the breast tissue. Ultrasound scan  of the breast. MRI scan  of the breast. This is more commonly performed on younger women, who may have denser breast tissue. Radiological imaging

39. Investigation -to confirm the diagnosis Biopsy

40. Investigation The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited mutations in these genes face a much higher risk of developing breast cancer DNA analysis

41. Investigation Human epidermal growth factor receptor 2 (HER2).   This tumor marker is a specialized protein on breast cancer cells that helps control cancer growth and spread Blood Marker Tests

42. Investigation an ultrasound scan of the liver chest X-ray, a bone scan or other types of scan. Assessing the extent and spread

43. Management

44.  Treatment options for breast swelling vary depending on the underlying etiology. Treatment

45. Angelina Jolie Break Time

46. 61-year-old woman who presents to her internist alarmed by a lump in her right breast that she discovered while showering. She report painless, swelling, and skin changes. She has not experienced fever, weight loss, headache, nausea, vomiting, dizziness, or bone pain. PMH ( past medical history ):  SM is moderately overweight, but otherwise in good health. experienced menopause at age 55. She took hormone replacement therapy from age 54 until age 59. FH ( family history ):  history of malignancy in first-degree relatives. CASE SCENARIO

47. Summary Most of causes are self-limited and benign. Physiological : premenstrual syndrome is a common cause of breast swelling. Pathological : fibroadenoma is the most common breast lesion. The initial approach to the adolescent patient with a breast mass includes a careful history and physical examination. Imaging may be necessary to differentiate

48. References Uptodate ; Overview of breast masses in children and adolescents. Healthline ; breast-swelling. Patient education website ; Breast cancer. The Merck Manual, Professional Edition. National Cancer Institute; Breast Cancer. American Cancer Society ;Breast Cancer. Medlineplus ; Premenstrual breast changes. Med-health; Swollen Breast.

49. Thank you