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Year 3 - Surgery > 6.01 - Breast Disease > Flashcards

6.01 - Breast Disease Flashcards

1
Q

What is the breast triple assessment?

A

A hospital based assessment clinical that allows for the early and rapid detection of breast cancer.

Patients can be referred to this ‘one stop’ clinic by their GP if they meet the 2-week wait referral criteria, or if there is a suspicious finding on their routine mammogram.

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2
Q

What is the mainstay of imaging during the triple assessment?

A

Mammography to allow the detection of mass lesions or microcalcifications.

Ultrasound more useful in women <35yrs and men.

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3
Q

What is galactorrhoea?

A

Bilateral milky discharge, not associated with pregnancy or lactation.

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4
Q

Describe the physiology of lactation.

A

TRH and oestrogen stimulate the release of prolactin from the anterior pituitary, which regulates lactation.

Dopamine is released by the hypothalamus to inhibit prolactin secretion.

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5
Q

What are the causes of galactorrhoea?

A

Hyperprolactinaemia is the most common cause, which can itself be caused by:

  • idiopathic
  • pituitary adenoma
  • drug-induced (e.g. SSRIs)
  • hypothyroidism
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6
Q

What investigations should be conducted in a patient presenting with galactorrhoea?

A
  • exclude pregnancy
  • serum prolactin levels
  • MRI head with contrast if pituitary tumour is suspected
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7
Q

How is galactorrhoea managed?

A

Identify and treat the underlying cause.

If a pituitary adenoma is confirmed, a patient can be started on dopamine agonist therapy and referred to neurosurgery for trans-sphenoidal surgery.

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8
Q

What is mastalgia?

A

Breast pain

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9
Q

What are the common causes of mastalgia?

A
  • cyclical pain is associated with menstruation; can be managed using HRT
  • non-cyclical pain can be caused by medication, or extramammary pain (e.g. chest wall pain)
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10
Q

What features in history would indicate a pathological cause of mastalgia?

A
  • lumps
  • skin changes
  • fevers
  • discharge
  • association with menstrual cycle
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11
Q

How is mastalgia managed?

A

Reassurance and pain control (e.g. ibuprofen, paracetamol).

Referral to specialist if first-line does not work.

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12
Q

What is mastitis?

A

Inflammation of the breast tissue, which can be both acute or chronic.

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13
Q

What is the most common cause of mastitis?

A

Infection by Staphylococcus aureus

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14
Q

Describe the features of

a) lactational mastitis

b) non-lactational mastitis

A

a) more common and seen in up to 1/3 of breastfeeding women. Associated with cracked nipples and milk stasis.

b) less common but occurs in women with other comorbidities, with tobacco smoking being an important risk factor.

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15
Q

What are the clinical features of mastitis?

A
  • tenderness
  • swelling
  • erythema over area of infection
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16
Q

How is mastitis managed?

A

Systemic antibiotic therapy and simple analgesics.

In lactational mastitis, continued milk drainage or feeding is recommended.

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17
Q

What is a breast abscess?

A

A collection of pus within the breast lined with granulation tissue, commonly developing from acute mastitis.

Management is antibiotics and US-guided needle aspiration.

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18
Q

What are breast cysts?

A

Epithelial lined fluid-filled cavities, which form when lobules become distended due to blockage.

19
Q

What are the clinical features of breast cysts?

A
  • singular or multiple lumps

OE cysts are distinct smooth masses; may be tender.

20
Q

How are breast cysts investigated?

A
  • halo shape on mammography
  • ultrasound
  • aspiration
21
Q

What are the complications of breast cysts?

A

Increased risk of developing breast cancer in future.

22
Q

What is gynaecomastia?

A

A condition in which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity.

23
Q

What is the pathophysiology of gynaecomastia?

A

Commonly occurs in adolescence, resulting from delayed testosterone surge relative to oestrogen at puberty.

Pathological gynaecomastia can be caused by a lack of testosterone. increase oestrogen levels, or medications.

24
Q

What is the main differential of gynaecomastia?

A

Pseudogynaecomastia - adipose tissue in the breast region associated with being overweight.

25
Q

How is gynaecomastia investigated?

A

Only investigated if the cause is uncertain.

Can check the hormone profile (LH and testosterone).

26
Q

What is the significance of the following findings on a hormone profile?

a) LH high; testosterone low

b) LH low; testosterone low

c) LH high; testosterone high

A

a) testicular failure

b) increased oestrogen

c) androgen resistance or gonadotrophin secreting malignancy

27
Q

What is the treatment of gynaecomastia?

A

Largely dependent on cause, but often reassurance and surgical management used.

28
Q

What is the most common benign growth in the breast?

A

Fibroadenoma - have a very low malignant potential.

29
Q

What are the clinical features of a fibroadenoma?

A
  • women of reproductive age
  • highly mobile lesions
  • well-defined
  • rubbery
  • multiple and bilateral
30
Q

What is a ductal adenoma of the breast?

A

A benign glandular tumour, occuring in the older female population.

31
Q

What are the clinical features of a ductal adenoma of the breast?

A
  • nodular
  • easily mimic malignancy

Cases will undergo escalation for triple assessment often.

32
Q

What is a papilloma?

A

A benign breast lesion occuring in the subaereolar region.

33
Q

What are the clinical features of breast papilloma?

A
  • bloody / clear nipple discharge
  • appear similar to ductal carcinoma

Cases undergo escalation for triple assessment.

34
Q

What are the general clinical features of a benign breast lump?

A
  • more mobile
  • smoother borders
  • multiple
35
Q

How are breast lumps investigated?

A
  • breast examination
  • triple assessment
  • biopsy

May need to be excised / chemoradiotherapy if found to be cancerous

36
Q

What is a breast carcinoma in situ?

A

A neoplasm that is contained within the breast ducts and have not spread to surrounding breast tissue.

37
Q

What are the types of in situ breast carcinoma?

A
  • ductal carcinoma in situ
  • lobular carcinoma in situ
38
Q

What is the ductal carcinoma in situ?

A

The most common type of non-invasive breast malignancy, which affects the ductal tissue of the breast that is contained within teh basement membrane.

39
Q

How is ductal carcinoma in situ investigated?

A

Usually asymptomatic so incidentally found on mammography.

Diagnosis confirmed via core biopsy.

40
Q

How is ductal carcinoma in situ managed?

A

Surgical excision.

Can be done with breast conserving surgery or mastectomy depending on extent.

41
Q

What is the lobular carcinoma in situ?

A

A non-invasive lesion of the secretory lobules, contained within the basement membrane.

They are rarer than DCIS but are at greater risk of developing invasive breast malignancy.

42
Q

How is lubular carcinoma in situ investigated?

A

Usually asymptomatic so detected incidentally on mammography.

Confirmed using biopsy of breast.

43
Q

How is lobular carcinoma in situ managed?

A

Low grade LCIS is usually treated by monitoring rather than excision.

44
Q

Which genetic mutations are particularly associated with breast carcinomas?

A

BRCA1 / BRCA2

Year 3 - Surgery (30 decks)

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