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Y6 Senior Surgery > Breast > Flashcards

Breast Flashcards

1
Q

What happens in duct ectasia

A

dilatation of large breast ducts
common around menopause (as ducts shorten and dilate), accumulating green / yellow fluid
may cause slit like retraction of the nipple

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2
Q

S/S of duct ectasia

A

tender lump near arola
green / yellow multiduct nipple discharge

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3
Q

management of duct ectasia

A

generally conservative
if troublesome, consider total / partial duct excision

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4
Q

presentations of nipple discharge and what condition they suggest

A

green nipple discharge > duct ectasia in smoker
yellow nipple discharge > duct ectasia in PM women
milky, multi duct > prolactinoma
Cancer, DICS, papilloma > blood stained

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5
Q

what happens in fat necrosis

A

common in obese women with large breasts
after trauma

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6
Q

how does fat necrosis present

A

firm, round, hard irregular lump

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7
Q

what is acute mastitis

A

infection of the breast usuallly caused by staph aureus
affects 1 in 10 breastfeeding women
associated with NIPPLE INJURY and SMOKING

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8
Q

what are S/S of acute mastitis

A

coryzal symptoms
nipple dischaarge
red tender breast - with cellulitis and generalised soreness

CONSIDER POSSIBILITY OF ABSCESS

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9
Q

risk factors for mastitis/ abscess

A

smoker
breastfeeding
diabetic

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10
Q

how do you manage acute mastitis

A

non-severe / lactational:

  • simple analgesia
  • warm complress
  • continue breastfeeding

severe / non-lactational:
- fluclox 500mg QDS 10 days

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11
Q

how does a breast abscewss present

A

discrete hot red lump
walled off collection of ppus

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12
Q

how do you manage a breast abscess

A

US diagnostic - confirms walled off collection of pus
Then: US guided aspiration + antibiotics + review in 24-48h

If necrotic abscess / skin necrosis: incision and drainage + fluid culture

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13
Q

what is a fibroadenoma

A

“breast mouse” (discrete, non tender, mobile)

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14
Q

who is fibroadenoma common in

A

common in women <30 years old

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15
Q

what is mx of fibroadenoma

A

<4cm: conservative (will shrink)
>4cm, surgical excision

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16
Q

how do you investigate a fibroadenoma

A

US and biopsy

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17
Q

how does fibrocystic change / fibroadenosis present

A

lumpy breast
may be painful
bilatral
changes with menstruation

in middle aged women

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18
Q

how do you manage fibrocystic change

A

conservative

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19
Q

who do intraductive papillomas affect

A

40-60yo
local areas of epithelial proliferation in large mammary ducts

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20
Q

how doe intraductal papillomas presend

A

blood-stained discharge

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21
Q

what is a phylloides tymour

A

most benigh, few very aggressive
enlarging mass in women >50

22
Q

intraductal papilloma mx

A

duct excision

23
Q

how does breast cancer present

A

POST MENOPAUSAL WOMAN

fixed mass

skin tethering, dimpling

palpable LN in axilla

24
Q

what are RF for breast cancer

A

genetics (BRCA genes, p53 mutation)
FH: 1st degree relative pre-menopausal breast cancer
oestrogen exposure (nulliparity, 1st preg >30yo, early menarche, late menopause, COCP, combined HRT)
past breast cancer
not breastfeeding
radiation
obesity

25
Q

what are protective factors for BC

A

multiparity

breastfeeding

oral contraceptives (controversial)

26
Q

how does breast cancer present externally on the nipple

A

Paget’s disease of the nipple

  • eczematous change
  • pruritic
27
Q

what screening is done for breast cancer

A

50-71 years old
every 3 years
mammogram

28
Q

when do you do urgent 2ww referral for bc

A

>30, unexplained breast lump with / without pain
>50 if single nipple discharge or retraction

29
Q

what assessment do you do for BC

A

triple assessment

  • hx and exam
  • imaging (USS<40, mammography >40)
  • pathology (FNA, core biopsy)
30
Q

what other info does histology tell you about breast cancer?

A

Receptor status

  • Oestrogen receptor
  • Progesterone receptor
  • HER2 receptor
31
Q

what are the two most common types of breast cancer

A

Invassive ductal carcinoma (most common)

invasive lobular carcinoma (second most common)

32
Q

What additional Ix do you need to do for breast cancer patients? what does this mean for future ix

A

USS axilla

if normal - sentinel node biopsy

if abnormal - axillary node clearance of ALL LYMPH NODES

33
Q

what further investigation is needed in woman <40 with breast cancer after she’s had triple test, US etc

A

CALL BACK for mammography and MRI

34
Q

what lymph system do breast cancers drain to

A

75%: lateral axillary nodes

25%: parasternal nodes or opposite breast

35
Q

How do you manage BC surgically

A

MASTECTOMY vs WIDE LOCAL EXCISION

overall, this should be up to patient choice

Mastectomy:

  • muttifocal / central tumour
  • large lesion in small breast !

WLE:

  • solitary, peripheral tumour
  • small lesion in large breast!
36
Q

What othher therapies are available for breast cancer tx

A

Radiotherapy

Hormone therapy

Chemo

37
Q

When is radiotherapy recommended

A

after WLE

after mastectomy in >4xm, +ve LN

38
Q

when can you do hormone therapy in breast cancer

A

ONLY if ESTROGEN receptor +ve

39
Q

wat is prognostic index for chemo

A

nottinghham prognostic inded

40
Q

When MUST you refer for 2ww pathway

A

>30 with unexplained breast lump

>50 with nipple discharge, retraction or other changes (think PAGET’S)

41
Q

When can you give Hormone therapy in beast cancer=

A

If ER +ve ONLY

42
Q

What hormone therapies can you give depending on age

A

Pre/perimenopausal: tamoxifen (SERM)

post-menopausal: anastrozole/letrozole (aromatase inhibiitiors)

43
Q

side effects of tamoxifen

A

amenorrhoea

endometrial cancer

PV bleed

VTE

44
Q

side effects of anastrozle /letrozole and why

A

OSTEOPOROSIS

because they are aromatase inhibitorrs, so they reduce oestrogen synthesis, causing osteoporosis

45
Q

when can you give BIOLOGICAL therapy

A

if HER2 positive

46
Q

when do you give chemotherapy for breast cancer

A

if LN involved of Triple neg / HER2+ve

47
Q

why can you give NEOadjuvant chemo (i.e. before surgery)

A

to shrink tumour size before surgery /(this may allow to do WLE rather than mastectomy)

48
Q

which condition causes blood stained discharge without a palpable mass?

A

intraductal papilloma! it is essentially just some local epithelal proliferation

49
Q

cx of axillary node clearance

A

lymphoedema

functional arm impairment

50
Q

what is inflammatory breast cancer

A

type of IDC (Invasive Ductal Carcinoma)

cancerous cells block the lymph drainage, causing an inflamed appearance of the breast

51
Q

what does inflammatory breast cancer look like

A

SWOLLEN AND RED BREAST

but inflammatory markers are normal

Y6 Senior Surgery (10 decks)

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