Makindo Medical Notes.com

Breast lumps are a common finding in clinical practice and can range from benign conditions to serious malignancies. For clinicians, the evaluation of a breast lump requires a methodical approach to ensure accurate diagnosis and appropriate management. Early detection and treatment are crucial, especially in cases of breast cancer. Below is a step-by-step guide for the proper approach to assessing breast masses.

Patient History

• Onset and duration: Whether the mass appeared suddenly or has been present for a prolonged period.
• Associated symptoms: Pain, nipple discharge, changes in skin texture, or recent trauma to the breast.
• Menstrual and hormonal history: Relationship of symptoms to the menstrual cycle, pregnancy, or hormone therapy.
• Family history: A history of breast cancer or other related cancers in close family members can increase risk.
• Personal history: Previous breast masses, surgeries, or other breast conditions.

Physical Examination: a thorough breast examination is critical

• Location: Identify the quadrant of the breast where the mass is located (upper outer quadrant is most common).
• Size and shape: Measure the dimensions of the mass, noting whether it is round, irregular, or lobulated.
• Consistency: Determine if the mass is soft, firm, or hard.
• Mobility: Assess if the mass is mobile or fixed to surrounding tissue, as immobile masses can be concerning.
• Tenderness: Evaluate for tenderness or pain when palpating the mass.
• Skin and nipple changes: Look for skin dimpling, retraction, or nipple inversion, which may suggest malignancy.

Causes

Diagnostic Investigations

• Mammography: The gold standard for breast imaging, particularly in women over 40, to assess the mass's characteristics.
• Ultrasound: Helpful in distinguishing between solid and cystic masses, especially in younger women with denser breast tissue.
• Fine needle aspiration (FNA): Can be used to aspirate cystic masses and provide cytological analysis.
• Core needle biopsy: Provides a larger tissue sample for histopathological analysis and is often used if malignancy is suspected.
• Breast MRI: Used in certain cases to evaluate the extent of disease, particularly in high-risk patients or those with inconclusive mammogram results.

Common Causes of Breast Masses

• Fibroadenoma: A benign, mobile, and firm mass commonly found in younger women.
• Breast cysts: Fluid-filled masses that may fluctuate with the menstrual cycle, often benign but sometimes painful.
• Fibrocystic changes: Benign changes in breast tissue that can cause lumpy or rope-like texture, often related to hormonal fluctuations.
• Breast cancer: Malignant tumours that are typically hard, immobile, and may present with skin or nipple changes. Early diagnosis and treatment are essential for the best outcome.
• Infections (mastitis or abscess): Can present with redness, swelling, and a painful mass, often associated with lactation.

Management

• Benign masses: Fibroadenomas and cysts may be monitored or surgically removed if they are symptomatic or growing.
• Breast infections: Antibiotics are typically prescribed, and abscesses may require drainage.
• Malignant masses: Breast cancer requires a multidisciplinary approach, including surgery, radiation, chemotherapy, and hormonal therapy, depending on the stage and type of cancer.

In summary, the evaluation of a breast mass requires careful history-taking, thorough physical examination, and appropriate diagnostic investigations. Prompt and accurate diagnosis is essential to ensure that both benign and malignant conditions are managed effectively.