General Surgery (Breast)

Question 1

What is Mastitis?

Answer 1

Inflammation of breast tissue

Question 2

What are the two types of Mastitis

Answer 2

Lactational Mastitis - usually presents during the first 3 months of breast feeding or during weaning

Non Lactational Mastitis - occurring in Women with other conditions such as duct ectasia

Question 3

What is the link between Tobacco and Breast disease?

Answer 3

Tobacco causes damage to sub-areolar duct walls predisposing to bacterial infection

Question 4

Give three clinical features of Mastitis

Answer 4

Tenderness
Swelling
Erythema

Question 5

How is Mastitis managed?

Answer 5

Simple Analgesia
Antibiotics
If breast feeding - encouraged to continue

Question 6

Name a complication of Mastitis

Answer 6

Breast Abscess

Question 7

What is a Breast Abscess?

Answer 7

Collection of pus within the breast lined with granulation tissue
Presents with systemic symptoms of fever and lethargy

Question 8

What are Breast Cysts?

Answer 8

Epithelial lined fluid filled cavities, formed when lobules become distended due to blockage
Normally affects peri-menopausal age group
Can be single/multiple distinct smooth masses

Question 9

Describe two investigations for Breast Cysts

Answer 9

Mammography (classic halo shape)
Needle Aspiration (sent for cytology)

Question 10

How are Breast Cysts managed?

Answer 10

Generally self resolving
Can be aspirated for aesthetic reasons

Advise patient to monitor as they do have a higher risk of Breast Cancer

Question 11

What is Mammary Duct Ectasia?

Answer 11

Dilation and shortening of lactiferous ducts common in the peri-menopausal age group

Question 12

Give 3 clinical features of Mammary Duct Ectasia

Answer 12

• Green/Yellow nipple discharge
• Palpable Mass
• Retracted Nipple

Question 13

Describe two investigations for Mammary Duct Ectasia

Answer 13

Mammography (dilated calcified ducts with no other features of malignancy)
Biopsy (multiple plasma cells)

Question 14

How would you manage Mammary Duct Ectasia?

Answer 14

Conservative unless persistent discharge (duct excision)

Question 15

What is Fat Necrosis of the breast?

Answer 15

Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules

Question 16

Name 3 causes of Fat Necrosis

Answer 16

Trauma
Previous Surgery
Previous Radiation

Question 17

How does Fat Necrosis present?

Answer 17

Normally presents asymptomatically/as a lump

Less commonly can present with fluid discharge/skin dimpling/pain/nipple inversion

Question 18

Fat Necrosis may mimic malignancies on mammograms, so what investigations coud you do?

Answer 18

Core Biopsy

Ulstrasound (Hyperechoic mass)

Question 19

Name five types of benign breast lumps

Answer 19

Fibroadenoma
Adenoma
Papilloma
Lipoma
Phyllodes Tumour

Question 20

How does a Fibroadenoma present?

Answer 20

Highly mobile, well defined and rubbery mass (breast mouse)

Question 21

Where do Papillomas present?

Answer 21

Typically in sub-areolar region

Often with bloody/clear nipple discharge

Question 22

What are Phyllodes Tumours?

Answer 22

Rare fibroepithelial tumours that grow rapidly

Should be excised as 1/3 have malignant potential

Question 23

What is Gynaecomastia?

Answer 23

When males develop breast tissue due to imbalanced ratio of oestrogen and androgen
Usually benign but breast cancer can develop in 1%

Question 24

Describe the physiological causes of Gynaecomastia

Answer 24

Adolescent - delayed testosterone surge in response to Oestrogen
Elderly - Decreasing testosterone levels

Question 25

Describe the pathological causes of Gynaecomastia

Answer 25

Lack of testosterone (Klinefelters, Androgen Insensitivity) Increased Oestrogen (Liver Disease) Medication (Digoxin, Metronidazole, Spironolactone)

Question 26

How is Gynaecomastia managed?

Answer 26

Treat underlying cause | Tamoxifen can alleviate symptoms

Question 27

What is Carcinoma In-Situ?

Answer 27

Tumour contained within basement membrane so seen as a pre-malignant condition

Question 28

What are the two types of Carcinoma In-Situ?

Answer 28

Ductal (more common, lower chance of invasive disease) | Lobular (rarer, higher chance of invasive disease)

Question 29

What is the most common type of Invasive Breast Cancer?

Answer 29

Over 75% ductal carcinoma | Almost all subtypes arise in the terminal lobular duct

Question 30

Give 5 risk factors for Breast Cancer

Answer 30

``` Female BRCA1/2 FH Obesity Exposure to unopposed oestrogen ```

Question 31

Give 5 features of Breast Cancer

Answer 31

``` Breast Lump/Asymmetry Nipple Discharge (may be bloody) Nipple retraction Peau D'Orange Axillary Lump ```

Question 32

What is a Triple Assessment?

Answer 32

Methods of investigation for concerning breast lumps | Examination, Imaging, Histology/Cytology

Question 33

How is the prognosis of Breast Cancer calculated?

Answer 33

Nottingham Prognostic Index | Receptors (ER,PR,HER2)

Question 34

Who is screened for Breast Cancer?

Answer 34

Women aged 50-70 every 3 years

Question 35

What is Paget's Disease of the Nipple?

Answer 35

Malignant cells migrate from ducts to nipple's surface causing roughening/reddening and ulceration of the nipple

Question 36

What is Sentinel Node Biopsy?

Answer 36

Removing first lymph node that the breast tissue drains to, found by injecting blue radioactive dye

Question 37

For Oestrogen receptor positive cancers, name two hormonal treatments

Answer 37

Tamoxifen (SERM) - Premenopausal | Letrozole (Aromatase Inhibitors) - Postmenopausal

Question 38

For HER2 receptor positive cancers, name a biological treatments

Answer 38

Herceptin

Question 39

Describe three oncoplastic reconstruction techniques for Breast Cancer

Answer 39

Lat Dorsi - for smaller breasts, can be free or pedicled TRAM - Transverse Rectus Abdominal Muscle DIEP - Deep Inferior Epigastric Perforator

Question 40

Describe the T of TNM staging for Breast Cancer

Answer 40

``` T1 <2cm T2 2-5cm T3 >5cm T4a Invaded chest wall T4b Invaded skin T4c Invaded chest wall and skin T4d Inflammatory ```

Question 41

What is Fibroadenosis?

Answer 41

Painful/Nodular condition of the breast

Question 42

Name a side effect of Aromatase Inhibitors

Answer 42

Osteoporosis

Question 43

In what mechanism is the BRCA gene inherited?

Answer 43

Autosomal Dominant