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Breast surgery Flashcards

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1
Q

what would a lump suggestive of breast cancer be like

A

hard
irregular
painless
fixed
tethered to skin/chest wall
nipple retraction
skin dimpling/oedema=> peau d’orange

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2
Q

when put woemn on 2ww

A

unexplained breast lump 30 and over
unilateral nipple changes 50 and over

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3
Q

unexplained brst lump undeer 30s how refer

A

non urgent referal

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4
Q

breast lump:
painless
smooth
mobile
round
well defined
firm

A

fibroadenoma

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5
Q

whats fibroadnenoma

A

common benign tumour of stromal/ epithelilal breast duct tissue
typicall small and mobile- like mouse
common in younger women 20-40s snd regress after menopause

non cancerous
firm
small normally under 3cm diameter
painless
round
smooth
well defined(well circumbsised)
mobile - free to move under skin and above chest wall

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6
Q

lumpiness breast thats painful and gets 10 days before period and then gets better

A

fibrocytic breast changes

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7
Q

whats fibrocytic breast changes

A

stoma. ducts. lobules reposnd to oestrogen and progresterone - can become fibrous (irregular and hard) and cystic- fluid filled

bengin
fluctuate with mentrural cycle- usulaly reosve with menopause
often occur propr to mensutration (within 10 days and resolve once start)
lumpiness
breast tenderness/ breast pain
fluctation breast size

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8
Q

how to mangage fibrocytic breast changes

A

exclude cancer - imaging, clinical, histology
manage the cyclic breast pain = mastalgia =
supportive bra
NSAIDs
avoid caffeine
heat on area
hormonal by specialsit- tamoxifen/ danaxol

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9
Q

most common type of breast lum,p

A

breast cycst

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10
Q

breast lum,p:
mobile
well circumbised
smooth
painful

A

breast cycst

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11
Q

whats breast cysts like

A

bengin
smooth
well circumbsied
can vary in size
can be red and inflammed if infected
30-50 and perimenopause

can increase risk of breast cancer

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12
Q

treatment brest cysts

A

exclude cancer
aspiration if in pain
- may need culutre fluid

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13
Q

painless
firm
irregular
fixed
may have skin nsimpling and nipple inversion
differentials

A

fat necrosis lum,p
breast cancer

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14
Q

whats fat necrosis breast lump

A

benign
formed by localised degenration and scarring of fat tissue

casues:
loclaised trauma
radiothepray
surgery
infalmmation rxn
= all causing fibrosis and necroisis

o/e
painless
irregular
firm
fixed
can have skin simpling/nipple inversion

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15
Q

treat fat necorisis breast lump

A

us and mammogram may look like breast ancer
hsitology ay be needd to exclude breast cancer

once kow not cancer then conservative treamtnent/ can resolve spontaenously, can have surgically excised

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16
Q

breast lump:
soft
painless

mobile
no skin changes

A

lipoma

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17
Q

whats a lipoma

A

benign tumour of fat
can occur anywhere in body

soft
painless
mobile
no skin hcnaees

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18
Q

mangement lipoma

A

conservcative can resolve by self
can remove

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19
Q

lady just stopped breast feeding
firm
mpbile
oainless breast lump

A

galactocele

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20
Q

whats a galactocele

A

bengin
women lactating - often after stopping breastfeeding
lactiferous duct blocked
firm
mobile
painless
usually just below areola

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21
Q

treat galactocele

A

can drain
may need abx if infected

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22
Q

phyllodes tumour

A

rare tumour of connective tissue of bresat
large and fast growing
ca be benging, bordeline, malignant
can metatisise

treat=
removal and surround tossue removal
can recur
may need chemo

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23
Q

casues of gynaecomastia 5 main broad casues

A

normally due to hormonal imblaance bwtween oestrogen and androgens- testosterone

high oestrogen
low testosterone
medications/ drugs
idiopathic
physiological in adolescnets as oestrogen higher but resovles

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24
Q

what can casues high oestrogen leading to gynaemcosmastia

A

obesity- aromatase convert androgen to oestrogen
testicular cancer - oestrogen secretion from leydig cell yumour
liver cirrhoisis liver failure
hyperthryoidsim

hCG secreting tumour - small cell lung cancer

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25
what two cancers can casue gynaecomastia
testicular cancer- leydig cell tumour small cell lung cancer
26
what can casue low testosterone casuing gynaecomastia
testosterone deficicency in older age kleinfelter syndrome XXY hypothalamus/pituitary condition that dec FSH and LH eh. tumour, srugery, radiotherpay orchittis - casue eg mumps testicular damage- torsion/trauma
27
what infection can casue orchitits
mumps
28
whats medications/drugs can casue gynaecomastia
spirinolactone - iinhibit tesoterone prodcutions and block testosterone receptors digoxin- stimulate oestrogen r anabolic steroids- increase oestrogen opiates- heorin use weed alcohol antipsycotics- dopamine antagonist--> increase [rolactin
29
how do antipsycoitcs can casue gynaecomastia
dopamine antagoist block dopamine prodcution dopamine inhibits prolactin but less dopamine so prolactin increases prolactin stiulats glandular breast tissue development
30
what hormones can be abnomrla that can casue gynaecomastia
testosterone / androgens= inhhibiorry effect on breast tissue developmebt oestrogen - stimulate breast tissue development prolactin - - stimulate glandular breast tissue development dopamine antagonsit - block dopamine so increase prolactin cus dopamine hibits prolactin
31
if male has gynaecomastia what other examination may you want to do
testicular examination assess for signs of liver disease
32
how to asses for gynaecomastia
cehck its not adipose tissue- adipose be soft and even glandular be firm tissue behind arelolar ask age, duration changes anabolic steroids, drug use, alchol any sex dysfucntion- may show if low testosteone exclude breast cancer - lum,ps? testicualr lumps? meds on uni or bilateral lumps, lymphadenopathy bmi testicualr examination signs of low testosterone- less pubic hair signs liver disease signs hyperthryoidsim
33
pt sweating tachycardia weight loss gynaecomastia casue
hyperthroidism
34
investigfations gynaecomastia
if teenage ok check and wull resolve in unexpalined rapid onset check u and e lft tft testosterone sex hormone binding globulin oestrogen prolactin beta hCG and alpha feto protein- tessticualr cancer tumour markers genetic karyotype LH AND FSH
35
imaging may want to do for gynaecomastia
us - diagnose mammorgram- if ?cancer biopsy if ?cancer cxr- ?lung cancer testicualr us- ?cancer
36
whats most common form breast pain - cyclical or non cyclical pain
cyclical pain
37
whats cyclical breast pain
more common related to hormonal fluctuations pain normally worse 2 weeks before menstruatation (luteal phase) then settles during period may have pther symptoms of prementrual syndrome- low mood, fatigue, bloating, headaches
38
s and s of cyclical breast pain
bilateral generalsied heviness aching
39
whats non cyclical breast pain
more common women 40-50 more localised often no cause may originate from other palce- chest wall- costochondritits - skin- shingles/ post herpetic neuralgia casues: meds- HRT infection -mastitis pregnacy
40
how to diangose breast pain
diary can help if cyclical diagnose exclude breast cancer- do history and examination check for signs infection- mastitis do preg test
41
management of cyclical breast pai
supportive bra reasure warm NSAIDS avoid caffeine hormonal treatment by speciclaist - tamoxifen danazol
42
whats galactorrhea
breast milk production no associated with pregnacy/breast feeding
43
where prolactin produced
anterior pituitary
44
whats action of dopamine
block prolactin
45
whe and how does breast milk production occur during pregnacy and what stimulates and inhibits the prodcution
production starts 2/3 rd trimester - small amounts can get leakage oestrgoen and progesterone inhibits prolactin secretion oxytocin stimulates milk excretion milk prudction stops once breast feeding stops
46
casue of galactorrhea
normally due to high prolactin levels = hyperprolactinameia
47
casyes of hyperprolactinameia - galactorhea
prolactinomas - pituitary glad tumour endocrine disorders- hypothryoidism, PCOS meds- dopamine antagonsits eg. antipsycotics
48
s and s of gallactorhea
prolactin supresses GnRH and so also then get low FSH and LH so hyperprolactinameia also presents with: menstrual irregularities esp amenorrhea reduced libido erectile dysfucntion in men gyanecomastia in men
49
what gene can prolactinomas be assocaited with
MEN1
50
macroprolactinomas are larger than 10mm. what sympotms can they have other than hyperprolactinameia
headaches bitemporal heminanopia
51
patient has symptoms of hyperprolactinameia - WHAT OTHER EXAMINATION DO YOU NEED TO DO
asses visual fields as prolactinoma can press on optic chaism
52
investigations for galactorrhea
LFT TFT U AND E preg test serum prolactin MRI if suspect pit tumour visual field examiantion
53
manage galactorrhea
treat casue dopamin agonst can help- bromocriptine, cabergoline transpshenoidal removal pit tumour
54
what differentiasl are there for galactorhea- non milk discharge
mammary duct ectasia duct papilloma pus from breast abscess
55
whats mammary duct ectasia
benign dilation of laege ducts in breast. inflammation leads to intermittent discharge from nipple
56
presentation of mammary duct ectasia
nipple discharge- white, grey, green tenderness/ pain nipple retraction/ inversion breast lump may be present - if press on it discharge may come out nipple more frequent in perimenopasual women
57
whatsa big risk factor for mammary duct ectasia
smoking
58
how to diagnose mammary duct ectasia
eclude breast cancer- triple assesment- clinical, imaging, histology microcalcification of mammogram - not specific to this though may use: ductography= contrast and mammorgram nipple discharge cytology ductoscpy
59
mammary duct ectasia see what on ammorgram
microcalcification
60
managment mammary duct ectasia
may resovle by self reassurance symptomatic managemnt of mastalgia- warm, supportive bra, nsaids antibiotics if infection surgical excision of duct if bad - microdochetomy
61
whats intraductal papilloma
warty lesion that grown within the ducts in the breast
62
cause of intraductal papilloma
proliferation of epithelial cells bengin can be associated with atypical hyperplasia/ breast cancer!
63
presentation of intraductal papilloma
nipple discharge- clear/ blood stained tnederness/ oain palpable lump
64
diangosis of intradcutal papilloma
triple assesment for breast cancer ecxclusion ductography- contrast into abnormal duct- see filling defect
65
management of intraductal papilloma
surgical excision examine it once removed for atypical signs that may not be seen on biopsy
66
whats lactational mastitis
inflammation of breast tisue common complication of breast feeding can occur with or without an infection
67
cause sof lactational mastitis
obstruction infection
68
whast most common infection casuse of lactational mastitis
staphylcoccus aureus
69
presentation lactational mastitis
woman breast feeding nippled discahrge nreast tenderness/pain uilateral eythema in focal area local warmth and inflammation fever - suspect cause is infection
70
complciation of lactational mastitis
breast abscess
71
management of lactational mastitis
if casue is a blockage- conservcative management - continue breast feeding, breast massage, warmth, simple anaglesia if conservative not working or suspect infection is the casue - antibiotics- flucloxacillin or erythromycin if penacillin allergic sample milk for culture and sensitivities fluconazole can be used if casue is candidal infection continue breast feeding - wont harm baby and will help clear infection
72
whats casue of candidal infection of nipple
often after course of antibiotics cracks in nipple can lead to recurrent mastitis associated with oral thrush/candidal nappy rash in baby
73
presentation of candidal infection of nipple
sore nipples - bilaterally especialy sore after breast feeding nipple tnederness and itching cracked, flaky, shiny areola baby may have cancdical nappy rash or white spots in mouth/tongue
74
managment of candical nippleinfection
treat mum and infant as otherwise keep comin bacl mum- topical miconazole 2% after breast feeding each time baby- oral miconazole gel / nystatin
75
whast breast abscess
collection of pus in area of breast. can be lactational or non lactational
76
cause of breast abscess
usually due to bacterial infection mastitis infection may precede abscess
77
what bacteria responsible for breast bascess
staphylcoccus aureau! most common enterococcus species streptococcal speicies = these are gram positive so penicillins simple ones will work- flucloxacillin/amoxicillin anaerobic bactiera - bacteroides species anerobic streptococci = use broader penicillin- co- amoxicclin/ metronidazole
78
presentation of breast abscess
acute usually swollen fluctuant - fluid move in lump tender lump symptom s of infection: fever fatigue muscle aches sepsis- tachycardia, tachypnoea, conducsion
79
symptoms mastitis with infection
nipple changes hardening of skin / breast tissue localised apin warmth tenderness erythema swllinh
80
managemtn of non lactational mastitis
braad spectrum antibiotics- co-amoxiclav erythromycin/ clarithromycin + metronidazole treat casue eg. candidal infection/excema analgeisa
81
managment of breast abscess
antibiotics ultrasound - confrim diagnosis draiangae- needle aspiration. incision and drainage microscopy, culture and sensntives of drained fluid refer surgucal team
82
risk factors breast abscess/ masittis
smoking damage to nipple- nipple excema , candidal infection, nipple piercing breast disease eg. cancer that blocks drainage of breast so predispose to infection
83
breast abscess/ mastitis should women keep breast feeding?
yes even if infected if too painful breast feed then express milk
84
risk facrtors breast cancer
female smoking obesitiy faulty BRCA 1, BRCA2 gene fam hist - first degree relative COCP- small increase risk. once not been on it for 10 years risk normal HRT - oestrogen combined increase of oestrogen exposure- early periods, late menopasue high dense breast tissue- glandular
85
BRCA1 faulty gene increase risk of what BRCA2 fulty gene increase risk of what
BRCA1 on CHR17 increase risk breat, ovarian cancer. increase risk of prostte and bowel cancer BRCA2 increase risk breast and ovarian cancer chr 13
86
whens screening for breast cancer
age 50-70 every 3 yr mammogram
87
presentation breast cancer
hard, fixed, irregular, painoess lump tethered to skin/chest wall nipple retraction peau d'orange - oedema casue swelling so dimples of pores lymphodenopathy- esp axiall
88
types of breast cancer
DCIS - pre cancerous. cancerous of brest ducts localised potetial to become invasve good prognosisi lobular carcinoma in situ - precancerous in perimenopasual women asymptomatic undetecatble on mammorgran close monitring NST- invasive ductal carcinoma breaast ducts 80% of breast cancers can see on mammorgramn invasive lobular carcinoma 10% of breast cancer s breast lobules not alwasy seen on mamorgram pagets disease of nipple - look like exzema of nipple / areola erythematous, itcht, scaly rash breast cancer involve nipple inflammatory breast cancer 1-3% like abscess/mastitis swollen, warm, tneder breast, peau d'orange doesnt repsond to antibiotics
89
who are high risk patients of rbeast cancer
frist degree relative with it under 40 got male first degree relative with brst cancer got 2 first degree relatives with it for goirst degree relative with bilateral cancer first diangosied under 50 may offer oophectory, mastectomy chemorpevention
90
investigations for breast cancer
triple asssesment clincal, imaging, biospy us for women under 30 mammorgram women older - see calcifications not seen on us mri - screen women at high risk and stage , see size, feature of the cancer lymph node asssesment - us of axialla, us guided biopsy of nodes, sentinel node biospy during the srugery
91
where can breast cancer metasise to
ay where! so can have primary breast cancer for any thing most common: liver, lungs bones, brain
92
person had breast cancer surgery. what need think about when taking blood/cannula
dont take from side of the surgery as may have lyphoedema - so this side be more prone to infection

Surgery (7 decks)

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