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Year 3 Breast and Vascular Surgery > Breast > Flashcards

Breast Flashcards

1
Q

Triple assessment

A
  1. Clinical history and examination
  2. Imaging - mammography or USS
  3. Biopsy - Core biopsy, FNAC
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2
Q

RF for breast cancer

A 
Early menarche 
Late menopause 
Obesity
FHx 
Alcohol 
1st child after 30 yo `
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3
Q

Scoring

A 
M1 - normal ( for FNAC C1 - inadequate)
M2 - benign 
M3 - uncertain probably benign 
M4 - Uncertain probably malignant 
M5 - Malignant
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4
Q

Advantages of mammography

A

Visualise in 2 planes
Less user dependent
Helps plan mx

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5
Q

When is USS done first line?

A

Pt younger than 35 yo as breast tissue more dense

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6
Q

Other imaging modalities

A

MRI - when boundaries are hard to establish or if pt has implant

CT - mets

PET scan - bone mets

Liver USS - mets

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7
Q

FNAC limitations

A

Cannot grade
Cannot see if invasive or in situ
Only a few cells

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8
Q

When in FNAC used

A

Lymph nodes

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9
Q

History features

A 
Onset 
Skin or nipple changes 
Trauma 
Age of menopause and menarche 
Parity and age at first pregnancy 
Systemic symptoms - FLAWS
FHx
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10
Q

Presentation

A 
Lump 
Painless 
Nipple retraction 
Nipple disharge 
Skin changes - peau d'orange and rash 
Breast distortion 
Swelling
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11
Q

Breast eczema

A

Areola involvement normally sparring nipple or nipple presents later

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12
Q

Paget’s disease of breast

A

Rash of nipple spreads to areolar or areolar spared

Topical steroids do not work

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13
Q

Lobules

A

milk producing gland - epties via ductules into lactiferous ducts

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14
Q

Fibroadenoma presentation

A 
Benign 
Mobile and smooth 
Non tender
'Breast mouse' 
Prevalent in the younger population - under 30 yo
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15
Q

Breast cyst

A

Benign - distended involuted lobules

Smooth, fluid filled

Sometimes painful

May be visible

Halo shape on mammography

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16
Q

Sebaceous cyst

A

Has punctum

Confined to skin

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17
Q

Breast abscess

A

Often secondary to mastitis
More common in breast feeding female

Swollen, tender and red breast 
Fluctuant mass
Systemic symptoms such as fever 
Foul smelling 
\+/- pus
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18
Q

RF for breast abscess

A

DM
Smoking
Piercing
Recent pregnancy - breast feeding

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19
Q

Phyllodes tumour

A

Large, non tender and mobile
1/3rd progress to malignancy
40+ yo
Tendency to reoccur

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20
Q

Fibrocystic changes

A 
Multiple lumps bilaterally 
Thickening of breast tissue 
Firm and ropy 
May be painful 
Usually pre-menopausal and cyclical
  • does not increase risk of CA but may mask
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21
Q

Fat necrosis

A

History of trauma in obese women
Palpable lump
Older to middle-aged women
USS - Hyperechoic mass

22
Q

Breast cancer common type

A

Invasive ductal carcinoma

23
Q

Ductal carcinoma presentation

A

Hard, fixed, irregular and painless lump
Nipple inversion
Dimpling of skin, peau d’orange, skin tethering

24
Q

Breast screening

A

For 47 - 73 yo every 3 years

Mammography

25
Breast conservation surgery
Wide local excision
26
Axillary investigation
Sentinal node biopsy | if +ve - axillary clearance
27
Receptors and treatment
ER+ve - Tamoxifen - SERM HER2 +ve - Herceptin (trastuzumab) - monoclonal antibody Post menopausal - aromatase inhibitor - anastrozole
28
Risk stratification tool
Nottingham Blood Richardson
29
Guidance for 2ww referral
- aged 30+ with unexplained breast lump with to without pain - aged 50+ with unilateral nipple discharge, retraction or other symptoms of concern Consider if: - skin changes that suggest breast cancer - aged 30+ with an unexplained lump in axilla
30
Mammary duct ectasia
Dilation of large breast ducts Common around menopause ``` Presentation: Tender lump around areolar Nipple discharge - thick and green/black RF - smoking Possible nipple inversion ``` Ix: Mammography - dilated calcified ducts Biopsy - multiple plasma cells Mx - Conservative or duct excision
31
Medication causing gynaecomastia
Spironolactone | Metronidazole
32
Intraductal papilloma
Benign Wart-like lump in the milk duct Clear or bloody spontaneous discharge
33
Breast abscess mx
Refer urgently for general surgery - USS needle asperation
34
Mastitis mx
Continue breastfeeding using affected breast | If systemic features, nipple fissure or symptoms do not improve after 12 hrs - flucloxacillin - 10 - 14 days
35
Types of breast tumour
``` Invasive ductal carcinoma Invasive lobular carcinoma Ductal carcinoma in situ Lobular carcinoma in situ Phyllodes tumour ```
36
BRCA 1 and 2 gene location
BRCA 1 - Chromosome 17 | BRCA 2 - Chromosome 13
37
Common sites of breast metastasis
Lung Liver Bones Brain
38
Side effects of axillary clearance
Arm lymphoedema
39
When to do a mastectomy
DCIS - 4+ cm Central Multifocal Large lesion in small breast
40
Before starting anastrozole what test is organised
DEXA scan for osteoporosis
41
Ductal carcinoma in situ presentation an tx
Bloody nipple discharge Mammography - calcification behind nipple areolar complex Histology - comedo necrosis not breached basement membrane Tx: - Wide local excision
42
Complication of free TRAM flap reconstructive surgery
Muscle taken from rectus abdominis therefore can get abdominal hernia
43
Herceptin delivery
Every 3 weeks for 1 year following initial treatment - close monitoring of heart - contraindicated in women with HF S/E - diarrhoea, breast pain and headaches
44
Radiotherapy
Adjuvant therapy after WLE with clear margins in the affected breast only
45
Surgical complications
``` • Haematoma, seroma • Frozen shoulder • Long-thoracic nerve palsy - winged scapula • Lymphoedema • Upper inner arm numbness - Intercostobrachial nerve injury ```
46
Tamoxifen
SERM - antagonises breast and uterus ER - Agonist for endometrial ER - Increases endometrial CA risk and can cause menopausal symptoms
47
Supportive treatment
* Bone pain: DXT (deep xray therapy), bisphosphonates, analgesia * Brain: occasional surgery, DXT, steroids * Lymphoedema: decongestion, compression
48
Lat dorsi myocutaneous flap
Usually if implant
49
Types of mastalgia
Cyclical: - bilateral - associated with menstrual cycle - NSAIDs if not breastfeeding - Danazol - anti - gonadotropin Non cyclical: - hormone contraceptives - antidepressants - antipsychotics Extramammary pain: - Shoulder or chest cause
50
Mx of lobular carcinoma in situ
Low grade - monitor BRCA1/2 - bilateral prophylactic mastectomy
51
Invasive ductal carcinoma clinical features
``` Breast lump Asymmetry Swelling Abnormal nipple discharge Nipple retraction Skin changes (dimpling/peau d’orange, or Paget’s-like changes) Mastalgia Palpable lump in the axilla. ```

Year 3 Breast and Vascular Surgery (8 decks)

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