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Surgery finals > Breast > Flashcards

Breast Flashcards

1
Q

List some common benign breast conditions

A 
Fibroadenoma
Duct ectasia
Mastitis
Breast cysts (fibrocystic breasts)
Papilloma
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2
Q

Describe the classic features of fibroadenoma

A

Affects younger women

Rubbery, very mobile, smooth and well circumscribed lump

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3
Q

Describe the classic features of duct ectasia

A

Affects older women (normal breast aging)
Caused by duct dilatation + thickening
Presents with greenish nipple discharge

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4
Q

Describe the classic features of mastitis

A

Two main types. Lactational and non-lactational.
Presents with a hot, tender, swollen, erythematous section of breast tissue- often described as ‘wedge-shaped’
-> can progress to abscess (fluctuant lump)

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5
Q

Describe the classic features of breast cysts

A

Usually affects women 30+

Multiple firm lumps bilaterally that cause cyclical aching pain as they enlarge

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6
Q

Describe the assessment of breast lumps

A

Triple assessment:

1) Examination
2) Imaging: USS or mammogram
3) FNA or biopsy

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7
Q

Describe the classic features of ductal papilloma

A

Bloody nipple discharge, usually no lump/mass

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8
Q

Describe the management of fibroadenoma

A

Conservative: if asymp + small
-Reassurance, do nothing

Surgical: if >2.5cm, changing, symptomatic
-Excision

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9
Q

Describe the management of duct ectasia

A

Follow up

Surgical excision if troublesome

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10
Q

Describe the management of mastitis

A

Breast-feeding: PO fluclox, continue breastfeeding/express, hot compress, paracetamol

Non-lactational: broad spectrum ABx

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11
Q

Describe the classic features of fat necrosis

A

Post-trauma -> hard, painless, non-mobile mass

Mimics cancer

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12
Q

Describe some pre-malignant breast conditions

A

Phyllodes tumour: large, painless fast growing mass
DCIS: microcalcification on mammogram. Asymp. Risk of cancer in same breast.
LCIS: incidental finding. Risk of cancer in both breasts.
Paget’s disease: nipple eczema, affects areola. Assoc with DCIS or invasive cancer

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13
Q

Describe the management of pre-malignant breast conditions

A

All should have surgical management

  • WLE eg. DCIS, Phyllodes
  • Mastectomy if extensive
  • Bilateral in LCIS
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14
Q

Describe the causes of gynaecomastia

A
  • Physiological at puberty
  • Obesity
  • Chronic liver disease
  • Drugs: digoxin, spironolactone
  • Congenital: Klinefelter’s
  • Endocrine: prolactinoma, testicular tumour
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15
Q

Describe the epidemiology of breast cancer

A

Most common cancer in F- 1/8 affected lifetime

2nd commonest cause of cancer deaths

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16
Q

Describe the presentation of breast cancer

A
  • Lump: typically painless, hard, craggy, tethered, increasing in size
  • Nipple changes: inversion, itching, bleeding, discharge
  • Skin changes: dimpling, peau d’orange
  • Metastases: lymphadenopathy, headaches, seizures, abdo pain, pathological fractures etc
17
Q

Describe the types of breast cancer

A

1) Invasive ductal carcinoma
2) Invasive lobular
Medullary
Mucinous
Papillary

18
Q

Describe the screening program for breast cancer

A

From the age of 50-71, all women offered screening 3 yearly

19
Q

Describe when to refer to secondary care for breast pathology

A

2WW:
>30 years with unexplained breast lump
>50 years with unilateral nipple changes
Consider if skin changes suggestive of cancer
Consider if unexplained axillary LN >30 years

20
Q

When should USS and mammography be used?

A

<40 years or pregnant/lactating: USS 1st line
-> mammography if highly suspicious/confirmed cancer

> 40 years: mammography

USS of axilla in all suspected or confirmed cancer

21
Q

Describe the management of breast cancer

A 
Depends on stage and receptors 
Medical: for stage 3+4 and as adjuvant 
-Radiotherapy: adjuvant to surgical
-Chemotherapy: HER2+ have trastuzumab 
-Endocrine therapy (for ER/PR +): tamoxifen, anastrazole
Surgical: for stage 1 and 2
-Wide local excision + radiotherapy
-Mastectomy +/- reconstruction (flaps)
\+ Sentinel LN biopsy 
-If negative and normal LNs on imaging, no need to remove all
-If positive: axillary clearance
22
Q

Describe some complications of breast surgery

A

Immediate: bleeding, damage to local structures (long thoracic nerve)
Early: haematoma, wound infection
Late: lymphoedema, fat necrosis, recurrence

Surgery finals (16 decks)

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