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Y6 Senior Surgery COPY > Breast > Flashcards

Breast Flashcards

(56 cards)

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1
Q

what is duct ectasia

A

lactiferous ducts become blocked → secretions stagnate → central ducts become dilated → nipple discharge +/- nipple retraction +/- lump

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2
Q

epidemiology for duct ectasia

A

common around menopause (as ducts shorten and dilate),

more common in smokers

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3
Q

S/S of duct ectasia

A

tender lump near areola
green / yellow/ brown/ multiduct nipple discharge

nipple retraction

often bilateral

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4
Q

ix for duct ectasia and intraductal papilloma

A

triple assessment

send discharge for MC+S

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5
Q

management of duct ectasia and intraductal papilloma

A

generally conservative
if troublesome, consider total duct excision (surgery)

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6
Q

what is Intraductal papilloma

A

non-cancerous growth which occurs within the milk ducts – can be solitary or multiple growths

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7
Q

how does Intraductal papilloma present

A

usually no palpable lump but large papillomas may present w a mass near nipple

blood stained discharge.

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8
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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9
Q

what happens in fat necrosis

A

common in obese women with large breasts
after trauma

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10
Q

how does fat necrosis present

A

firm, round, hard irregular lump

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11
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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12
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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13
Q

risk factors for mastitis/ abscess

A

smoker
breastfeeding
diabetic

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14
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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15
Q

how does a breast abscewss present

A

discrete hot red lump
walled off collection of ppus

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16
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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17
Q

what is a fibroadenoma

A

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

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18
Q

who is fibroadenoma common in

A

common in women <30 years old

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19
Q

what is mx of fibroadenoma

A

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

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20
Q

how do you investigate a fibroadenoma

A

US and biopsy

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21
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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22
Q

how do you manage fibrocystic change

A

conservative

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23
Q

who do intraductive papillomas affect

Study These Flashcards
A

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

24
Q

how doe intraductal papillomas presend

Study These Flashcards
A

blood-stained discharge

25
what is a phylloides tymour
most benigh, few very aggressive enlarging mass in women \>50
26
intraductal papilloma mx
duct excision
27
how does breast cancer present
POST MENOPAUSAL WOMAN * **lump**: **painless, irregular, fixed to surrounding** structures (skin tethering) * **palpable LN in axilla** * skin changes: **Paget's, Peau d'orange, ulcreation** * nipple changes**: discharge, inversion**
28
what are RF for breast cancer
* genetics (BRCA genes, p53 mutation) * age * FH: 1st degree relative * radiation exposure * obesity * prolonged exposure to oestrogen: * nulliparity * 1st preg \>30yo * Early menarche * Late menopause * COCP and combined HRT * past breast cancer * not breastfeeding
29
what are protective factors for BC
multiparity breastfeeding
30
how does breast cancer present externally on the nipple
Paget's disease of the nipple - eczematous change - pruritic
31
what screening is done for breast cancer
mammogram offered every 3 years from 50-71 years old * **Craniocaudal and oblique views** * Biplanar digital mammography
32
what assessment do you do for Breast cancer
triple assessment - hx and exam - imaging (USS\<40, mammography \>40) - pathology (FNA, core biopsy ) * core biopsy = solid lump * FNA = cystic lump
33
what other info does histology (immunohistochemistry) tell you about breast cancer?
Receptor status * Oestrogen receptor * Progesterone receptor * HER2 receptor
34
types of breast cancer
* **Non-invasive** * **ductal carcinoma in situ (DCIS**) – pre-malignant * **lobular carcinoma in situ (LCIS**) - rarer * **Invasive** * **Ductal carcinoma** – 70% (infiltrating) * **Lobular carcinoma** – 10-15%
35
what are the two most common types of breast cancer
Invasive ductal carcinoma (most common) invasive lobular carcinoma (second most common)
36
What additional Ix do you need to do for breast cancer patients? what does this mean for future ix
USS axilla if normal - sentinel node biopsy if abnormal - axillary node clearance of ALL LYMPH NODES
37
what further investigation is needed in woman \<40 with breast cancer after she's had triple test, US etc
CALL BACK for mammography and MRI
38
what lymph system do breast cancers drain to
75%: lateral axillary nodes 25%: parasternal nodes or opposite breast
39
How do you manage BC surgically
**MASTECTOMY vs WIDE LOCAL EXCISION** (patient's choice) **Wide Local Excision + radiotherapy** (80%): - solitary, peripheral tumour - small lesion in large breast! **Mastectomy**: - multifocal / central tumour - large lesion in small breast !
40
What othher therapies are available for breast cancer tx
Radiotherapy Hormone therapy Chemo
41
When is radiotherapy recommended
after WLE after mastectomy in \>4xm, +ve LN
42
when can you do hormone therapy in breast cancer
ONLY if ESTROGEN receptor +ve
43
wat is prognostic index for chemo
nottinghham prognostic index
44
When MUST you refer for 2ww pathway
* \>30 with unexplained breast lump * \>50 with nipple discharge, retraction or other changes (think PAGET'S)
45
What hormone therapies can you give depending on age
* ***Pre/peri***menopausal: **tamoxifen** (SERM) * ***post***-menopausal: **anastrozole/letrozole** (aromatase inhibitiors)
46
side effects of tamoxifen
menopausal symptoms (e.g amenorrhoea) endometrial cancer VTE
47
side effects of anastrozle /letrozole and why
**OSTEOPOROSIS** because they are aromatase inhibitorrs, so they reduce oestrogen synthesis, causing osteoporosis
48
example of biological therapy used for breast cancer
* **Trastuzumab** (**Herceptin**) * Contraindicated in heart disorders
49
when can you give BIOLOGICAL therapy
if HER2 positive
50
when do you give chemotherapy for breast cancer
if LN involved or Triple neg / HER2+ve
51
why can you give NEOadjuvant chemo (i.e. before surgery)
to shrink tumour size before surgery /(this may allow to do WLE rather than mastectomy)
52
which condition causes blood stained discharge without a palpable mass?
intraductal papilloma! it is essentially just some local epithelal proliferation
53
cx of axillary node clearance
lymphoedema functional arm impairment
54
what is inflammatory breast cancer
type of IDC (Invasive Ductal Carcinoma) cancerous cells block the lymph drainage, causing an inflamed appearance of the breast
55
what does inflammatory breast cancer look like
SWOLLEN AND RED BREAST but inflammatory markers are normal
56
how does **Intraductal papilloma present**
usually no palpable lump but large papillomas may present w a mass near nipple **blood stained discharge**.

Y6 Senior Surgery COPY (11 decks)

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