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Year 6 - Surgery > Capsule: Breast > Flashcards

Capsule: Breast Flashcards

1
Q

Outline the components of triple assessment

A

Hx and exam, imaging (US/mammography), histology (core biopsy/FNA/VAM)

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2
Q

What are US useful for distinguishing b/w?

A

Solid vs cystic lump

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3
Q

What are the US features of breast ca

A

Ill-defined usually hypoechoic mass
Distal acoustic shadowing
Surrounding halo
Abnormal axillary nodes

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4
Q

If breast US confirms a ca where else should you US?

A

The axilla to help plan tx

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5
Q

Outline the NHS breast screening programme

A

Mammogram every 3yrs b/w 50-70y

Typically 4/100 will need further testing with 1/100 being diagnosed w cancer

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6
Q

Which views are taken during mammograms?

A

Oblique + Craniocaudal

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7
Q

What are the mammographic features of breast ca

A 
Ill-defined or spiculated mass
Parenchymal distortion
Overlying skin thickening
Malignant calcifications
Enlarged axillary lymph nodes
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8
Q

At which age do you perform a mammogram

A

> 40y

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9
Q

If the mammogram and US are equivocal what method of imaging should you perform next?

A

MRI

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10
Q

Why are core biopsies often preferred to FNA?

A

They provide more detail inc ER, PR and HER2 status

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11
Q

The most common histological subtype

A

Invasive ductal carcinoma

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12
Q

Ratio of invasive ductal:invasive lobular prevalence

A

17:3

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13
Q

How would you stage breast ca?

A

If pt has sx perform FBC, U&Es, LFTs, bone profile & if any are abnormal CXR, liver US, bone scan

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14
Q

Breast ca tx

A

If fit surgery, if not primary endo therapy, if >3cm neo-adjuvant chemo

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15
Q

Factors to consider when planning surgery

A

Pts choice, mass size relative to breast size, position

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16
Q

What is the most likely outcome if the tumour is behind the nipple?

A

Mastectomy

17
Q

When would you consider radiotherapy following mastectomy?

A

High risk of local recurrence e.g. involved margins, vascular/dermal invasion, heavily node positive

18
Q

RFs for Breast Cancer

A

Age, FHx, BRCA, Prev, Oestrogen: nulliparity, first preg >30yrs, early menarche, late menopause, HRT, obesity

19
Q

Mx of Mastitis

A

Encourage to continue breastfeeding; if sys unwell, nipple fissure, not improving after 12-24hrs start 2w flucloxacillin and continue feeding; if abscess incise and drain

20
Q

What conditions does ANDI encompass?

A

Fibroadenosis
Cyst Formation
Epitheliosis
Papillomatosis

21
Q

When do you perform a mastectomy > wide local excision for DCIS?

A

> 4cm

22
Q

What is the Nottingham Prognostic Index?

A

(Tumour Size x 0.2) + LN Score + Grade Score = NPI

23
Q

What is the most common type of breast cancer?

A

Invasive Ductal Carcinoma

24
Q

Why do we not routinely screen pts under 40?

A

Mammography has a red sensitivity in denser breast tissue

25
Q

When is MRI the ix of choice?

A

Pts w implants

Plus: in younger pts who might have a strong fhx and as second line imaging for breast masses

26
Q

Ddx for Solid Breast Mass

A

Localised benign area, carcinoma, cyst, fibroadenoma, periductal mastitis, duct ectasia, abscess

27
Q

Which subtype of fibroadenomas can recur and must be excised?

A

Phyllodes

28
Q

Which age group are breast cysts most common?

A

Perimenopausal

29
Q

Ddx of Spiculated Mass

A

Cancer + Radial Scar

30
Q

What age group can aromatase inhibitors be used for?

A

Post-Menopausal

31
Q

At what size should you core biopsy a fibroadenoma?

A

> 4cm

32
Q

What scan should be performed before starting a pt on an aromatase inhibitor?

A

DEXA

33
Q

Who should undergo a 2wk referral?

A

Aged >=30 who have an unexplained breast lump with or w/o pain and consider in those w an unexplained lump in the axilla

Aged >=50 who have unilateral nipple sx

34
Q

Ddx of Bloody Discharge

A

Carcinoma + Intraductal Papilloma

35
Q

Ddx of Duct Ectasia

A

Carcinoma + Periductal Mastitis

36
Q

Mx of Mastitis

A

The first line is to continue breastfeeding but if sys unwell, nipple fissure, sx not improving after 12-24hrs add flucloxacillin 10-14d

37
Q

Tx of Breast Abscess

A

Incision + Drainage

38
Q

How does Paget’s disease of the breast present?

A

An eczematoid change ie reddening and thickening of the nipple a/w underlying breast cancer

Year 6 - Surgery (27 decks)

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