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Year 3 Breast and Vascular Surgery > Breast > Flashcards

Breast Flashcards

1
Q

Triple assessment

A
  1. Clinical history and examination
  2. Imaging - mammography or USS
  3. Biopsy - Core biopsy, FNAC
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2
Q

RF for breast cancer

A 
Early menarche 
Late menopause 
Obesity
FHx 
Alcohol 
1st child after 30 yo `
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3
Q

Scoring

A 
M1 - normal ( for FNAC C1 - inadequate)
M2 - benign 
M3 - uncertain probably benign 
M4 - Uncertain probably malignant 
M5 - Malignant
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4
Q

Advantages of mammography

A

Visualise in 2 planes
Less user dependent
Helps plan mx

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5
Q

When is USS done first line?

A

Pt younger than 35 yo as breast tissue more dense

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6
Q

Other imaging modalities

A

MRI - when boundaries are hard to establish or if pt has implant

CT - mets

PET scan - bone mets

Liver USS - mets

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7
Q

FNAC limitations

A

Cannot grade
Cannot see if invasive or in situ
Only a few cells

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8
Q

When in FNAC used

A

Lymph nodes

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9
Q

History features

A 
Onset 
Skin or nipple changes 
Trauma 
Age of menopause and menarche 
Parity and age at first pregnancy 
Systemic symptoms - FLAWS
FHx
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10
Q

Presentation

A 
Lump 
Painless 
Nipple retraction 
Nipple disharge 
Skin changes - peau d'orange and rash 
Breast distortion 
Swelling
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11
Q

Breast eczema

A

Areola involvement normally sparring nipple or nipple presents later

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12
Q

Paget’s disease of breast

A

Rash of nipple spreads to areolar or areolar spared

Topical steroids do not work

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13
Q

Lobules

A

milk producing gland - epties via ductules into lactiferous ducts

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14
Q

Fibroadenoma presentation

A 
Benign 
Mobile and smooth 
Non tender
'Breast mouse' 
Prevalent in the younger population - under 30 yo
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15
Q

Breast cyst

A

Benign - distended involuted lobules

Smooth, fluid filled

Sometimes painful

May be visible

Halo shape on mammography

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16
Q

Sebaceous cyst

A

Has punctum

Confined to skin

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17
Q

Breast abscess

A

Often secondary to mastitis
More common in breast feeding female

Swollen, tender and red breast 
Fluctuant mass
Systemic symptoms such as fever 
Foul smelling 
\+/- pus
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18
Q

RF for breast abscess

A

DM
Smoking
Piercing
Recent pregnancy - breast feeding

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19
Q

Phyllodes tumour

A

Large, non tender and mobile
1/3rd progress to malignancy
40+ yo
Tendency to reoccur

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20
Q

Fibrocystic changes

A 
Multiple lumps bilaterally 
Thickening of breast tissue 
Firm and ropy 
May be painful 
Usually pre-menopausal and cyclical
  • does not increase risk of CA but may mask
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21
Q

Fat necrosis

A

History of trauma in obese women
Palpable lump
Older to middle-aged women
USS - Hyperechoic mass

22
Q

Breast cancer common type

A

Invasive ductal carcinoma

23
Q

Ductal carcinoma presentation

A

Hard, fixed, irregular and painless lump
Nipple inversion
Dimpling of skin, peau d’orange, skin tethering

24
Q

Breast screening

A

For 47 - 73 yo every 3 years

Mammography

25
Q

Breast conservation surgery

A

Wide local excision

26
Q

Axillary investigation

A

Sentinal node biopsy

if +ve - axillary clearance

27
Q

Receptors and treatment

A

ER+ve - Tamoxifen - SERM
HER2 +ve - Herceptin (trastuzumab) - monoclonal antibody
Post menopausal - aromatase inhibitor - anastrozole

28
Q

Risk stratification tool

A

Nottingham Blood Richardson

29
Q

Guidance for 2ww referral

A
  • aged 30+ with unexplained breast lump with to without pain
  • aged 50+ with unilateral nipple discharge, retraction or other symptoms of concern

Consider if:

  • skin changes that suggest breast cancer
  • aged 30+ with an unexplained lump in axilla
30
Q

Mammary duct ectasia

A

Dilation of large breast ducts

Common around menopause

Presentation: 
Tender lump around areolar 
Nipple discharge - thick and green/black 
RF - smoking 
Possible nipple inversion

Ix:
Mammography - dilated calcified ducts
Biopsy - multiple plasma cells

Mx - Conservative or duct excision

31
Q

Medication causing gynaecomastia

A

Spironolactone

Metronidazole

32
Q

Intraductal papilloma

A

Benign
Wart-like lump in the milk duct
Clear or bloody spontaneous discharge

33
Q

Breast abscess mx

A

Refer urgently for general surgery - USS needle asperation

34
Q

Mastitis mx

A

Continue breastfeeding using affected breast

If systemic features, nipple fissure or symptoms do not improve after 12 hrs - flucloxacillin - 10 - 14 days

35
Q

Types of breast tumour

A 
Invasive ductal carcinoma 
Invasive lobular carcinoma 
Ductal carcinoma in situ 
Lobular carcinoma in situ 
Phyllodes tumour
36
Q

BRCA 1 and 2 gene location

A

BRCA 1 - Chromosome 17

BRCA 2 - Chromosome 13

37
Q

Common sites of breast metastasis

A

Lung
Liver
Bones
Brain

38
Q

Side effects of axillary clearance

A

Arm lymphoedema

39
Q

When to do a mastectomy

A

DCIS - 4+ cm
Central
Multifocal
Large lesion in small breast

40
Q

Before starting anastrozole what test is organised

A

DEXA scan for osteoporosis

41
Q

Ductal carcinoma in situ presentation an tx

A

Bloody nipple discharge
Mammography - calcification behind nipple areolar complex
Histology - comedo necrosis not breached basement membrane

Tx:
- Wide local excision

42
Q

Complication of free TRAM flap reconstructive surgery

A

Muscle taken from rectus abdominis therefore can get abdominal hernia

43
Q

Herceptin delivery

A

Every 3 weeks for 1 year following initial treatment

  • close monitoring of heart
  • contraindicated in women with HF

S/E - diarrhoea, breast pain and headaches

44
Q

Radiotherapy

A

Adjuvant therapy after WLE with clear margins in the affected breast only

45
Q

Surgical complications

A 
• Haematoma, seroma
• Frozen shoulder
• Long-thoracic nerve palsy - winged scapula
• Lymphoedema
• Upper inner arm numbness
- Intercostobrachial nerve injury
46
Q

Tamoxifen

A

SERM

  • antagonises breast and uterus ER
  • Agonist for endometrial ER - Increases endometrial CA risk and can cause menopausal symptoms
47
Q

Supportive treatment

A
  • Bone pain: DXT (deep xray therapy), bisphosphonates, analgesia
  • Brain: occasional surgery, DXT, steroids
  • Lymphoedema: decongestion, compression
48
Q

Lat dorsi myocutaneous flap

A

Usually if implant

49
Q

Types of mastalgia

A

Cyclical:

  • bilateral
  • associated with menstrual cycle
  • NSAIDs if not breastfeeding
  • Danazol - anti - gonadotropin

Non cyclical:

  • hormone contraceptives
  • antidepressants
  • antipsychotics

Extramammary pain:
- Shoulder or chest cause

50
Q

Mx of lobular carcinoma in situ

A

Low grade - monitor

BRCA1/2 - bilateral prophylactic mastectomy

51
Q

Invasive ductal carcinoma clinical features

A 
Breast lump
Asymmetry
Swelling 
Abnormal nipple discharge
Nipple retraction
Skin changes (dimpling/peau d’orange, or Paget’s-like changes)
Mastalgia
Palpable lump in the axilla.

Year 3 Breast and Vascular Surgery (8 decks)

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