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Nodular or lumpy breasts Patients who present with painful tender nodularity with mastalgia should be treated for breast pain, as outlined in Table 58.2 . Patients with breast nodularity without pain should undergo triple assessment ( Figure 58.2 ). The Cardi ...

Paget’s disease Paget’s disease is a unique type of DCIS arising in the nipple. It presents as erosion of the nipple that slowly destroys the nipple and encroaches on the areola ( Figure 58.19 ). It may become invasive with metastasis to the axillary lymph n...

Papilloma of the nipple Papilloma of the nipple has the same features as any cutaneous papilloma and should be excised with a tiny disc of skin. Alter natively , the base may be tied with a ligature and the papilloma will spontaneously fall o ff .

Pathology This can be considered in three phases: lobule development at 15–25 years, cyclical changes at 15–50 years and involution at 35–55 years of age. It is believed that lobular proliferation leads to the formation of fibroadenoma and involution leads to...

Polymazia Accessory breasts ( Figure 58.22 ) have been recorded in the axilla (the most frequent site), groin, buttock and thigh. They have been known to fluctuate in response to hormones in a physiological manner, such as pubertal enlargement and lactation. Th...

Positron emission tomography Positron emission tomography (PET) scans are used as a staging investigation in patients with T3, T4, N2, N3 breast cancer and in patients with T1, T2, N0, N1 breast cancer in the presence of symptoms/signs suggestive of metastas...

Retention cyst of a gland of Montgomery These glands, situated in the areola, secrete sebum. If they become blocked a sebaceous cyst forms. Rarely they may become infected and need excision.

Risk factors There are several factors known to increase the RR for developing breast cancer. These are called the risk factors and can be divided into modifiable (those that can be modified by adopting a healthy diet and lifestyle) and non-modifiable risk factor...

Sarcoma Sarcomas, most commonly fibrosarcoma and angiosarcoma, may arise de novo from the mesenchymal tissues of the breast. Enrico Sertoli , 1842–1910, Italian physiologist, discovered the Sertoli cells of the testis in 1865. Thomas Hodgkin , 1798–1866, lect...

Screening for breast cancer Screening for breast cancer involves a highly sensitive diagnostic test to detect the disease in either the preclinical detectable phase or a high-risk precancerous lesion. In most high-income countries population-based mammographic...

Spread of cancer Local spread The tumour increases in size and invades adjacent breast parenchyma. It may involve the skin, leading to ulceration and satellite nodules, and/or involve pectoralis major, serratus anterior and even the chest wall. The tumour cell...

Staging of breast cancer Staging refers to the process of finding out the extent of tumour. The eighth edition of the Union for International Cancer Control (UICC)–American Joint Committee on Cancer (AJCC) TNM staging system is currently used ( Table 58.6 In...

Subacute and chronic inflammation of the breast Non-lactational mastitis Non-lactational mastitis may be defined as inflammation of the breast tissue in a nulliparous woman or occurring after a minimum of 6 months after cessation of lactation. Various forms of ...

THE NIPPLE Absence of the nipple is rare and is usually associated with amazia (congenital absence of the breast). Supernumerary nipples are not uncommon and occur along a line extend ing from the anterior fold of the axilla to the upper chest ( Figure 58.1...

Treatment of breast cancer The treatment of breast cancer is multimodal (includes surgery , systemic treatment [chemotherapy , targeted therapy , hormonal therapy] and radiotherapy); hence, specialist breast Key points of the eighth edition of the AJCC TNM st...

Triple assessment Patients presenting with a breast lump, nipple discharge or other symptoms are assessed by a combination of clinical examina - tion, radiological imaging and tissue sampling taken for either cytological or histological analysis. This combined...

Ultrasonography Ultrasonography is the primary imaging modality in young women with dense breast tissue in whom mammograms are di ffi cult to interpret. Ultrasonography can distinguish cystic from solid lesions. Simple cysts do not require further work-up and fo...

Vacuum-assisted biopsy The sampling error decreases as the biopsy volume increases and using 8G or 11G needles allows more extensive biopsies to be taken. This is useful in the management of microcalcifi - cations and removal of benign lumps such as fibroadenom...