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Year 3 Surgery > Breast > Flashcards

Breast Flashcards

1
Q

What is a Fibroadenoma and in which patients are they most common in?

A

Benign growth of the breast
Proliferations of stromal and epithelial tissue of the duct lobules
Low mallignant potential
Common in women of reproductive age

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2
Q

Describe the findings on examination of a fibroadenoma

A

Highly mobile
Rubbery on palpation
Less than five cm
Multiple present, bilateral

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3
Q

What is the management of a fibroadenoma?

A

Reassuarance +/- excision if >3cm (or if patient prefers)

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4
Q

What is a ductal adenoma and which patients is it most common in?

A

Benign glandular tumour

Most common in older females

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5
Q

How does an adenoma present?

A

Nodular

Mimics mallignancy

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6
Q

What is an intraductal papilloma and which patients usually present with it?

A

Benign breast lesion
If multiductal risk of breast cancer
Females age 40-50

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7
Q

How do papillomas present

A

Larger lesion in the subareolar lesion
Rarely palpable lump
Nipple discharge - may be bloody or clear
Imagining is similar to microadeonma

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8
Q

Management of a papiloma?

A

Excision and biopsy

If multiple lesions remove

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9
Q

What is a lipoma?

A

Benign adipose tumour

Low mallignant potential

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10
Q

How does a lipoma present?

A

Soft
Mobile
Enlarging

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11
Q

What is the management of lipoma?

A

Removed only if causing symptomatic compressive or asthetic isssids
Reassuarnce

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12
Q

What is a phyllodes tumour and which patients usually present with?

A

Rare fibroelithelial tumour
Comprised of both stromal and epithelial tumour
Often rapid growing
Occur in older age group
Difficult to clinically and microscopically differentiate from fibroadenomas

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13
Q

What is the management of a Phyllodes Tumour and why?

A

Excision

1/3 mallignant potential

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14
Q

What features can help differentiate between a benign and mallignant breast lesion?

A 
Benign
- Smooth defined borders
- Tend to be monile
- Multiple lesions 
 Mallignant  
- Irregular borders
- Teathered to skin
- Immobile 
- Other changes such as nipple retraction, dimpling of the skin or axillary lymph node involvement
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15
Q

What does the triple assesment consist of?

A 
Examination 
Histology (usually core biopsy, FNA if recurrent cystic disease) 
Imaging
- Mammogram >35 years old 
- Breast ultrasound scan <35 years old
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16
Q

What two views are given in a mammogram?

A

Oblique

Cranial caudal

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17
Q

When may MRI imaging be useful in breast cancer?

A

Assesment of lobular breast cancers

Assessing response to neoadjuvant therapy

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18
Q

Why is core biopsy usually better for assesment than FNA?

A

Differentiates betwee invasive and insitu carcinoma

FNA only provides cytology

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19
Q

What are the values for grading maliignancy overall risk index?

A

P1-P5
M1-M5/U1-U5
B1-B5

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20
Q

Describe cyclical mastalgia

A

Usually in luteal phase
Bilateral
Can be caused by HRT
Due to hormonal changes

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21
Q

Causes of non-cyclical mastalgia?

A

SSRIs
OCP
Antipyschotics

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22
Q

Causes of galactorrhea

A

Pregnancy
Breast feeding
Maternal oestrogen
Hyperprolactinemia
Pituaitry adenoma
Drug induced (SSRIs, anti-psychotics, H2-antagonists)
Neurological: varicellazoster infection or spinal cord pathology (neurogenic oathwaya are activated to inhibit dopamine levels)
Hypothyroidism (elevated TRH)
Cushings disease, acromegaly, addisons
Renal or liver failure
Damage to the pituitary stalk - sarcoidosis surgical resection, TB, MS
Normoprolactinaemic galactorrhlea is rare

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23
Q

What is Padgets Disease of the breast?

A

Rare disease of the nipple, 50% of patients with this disease will have an underlying breast cancer.

Features

  • Eczema-like rash on the skin of the nipple and areola. This is may be itchy, red, crusty and inflamed.
  • Nipple discharge which may be bloody.
  • Burning sensation, increased sensitivity or pain
  • Nipple changes such as nipple retraction or inverted
  • In some cases there may be a palpable breast lump
  • There may be a skin ulcer which does not heal
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24
Q

What is fibrocystic disease?

A

Bilateral nodularity in a younger patient which worsens in relation
to their menstrual cycle.

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25
Q

Under what circimstances should a patient have a urgent referral for the three stop breast assesment clinic?

A

Any patient aged 30 or over with an unexplained breast lump or aged 50 or over with unilateral nipple changes should be urgently referred (appointment within 2 weeks) for further assessment.

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26
Q

What’s the drug of choice for HER2 receptor positive breast cancer?

A

Trastuzumab, a monoclonal antibody

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27
Q

What drug is used for oestrogen receptive breast cancers in post-menopausal women?

A

Trastuzumab

28
Q

What drug is used for oestrogen receptive breast cancers in pre-menopausal women?

A

Tamoxifen

29
Q

What is the first line treatment of infective mastitis?

A

Flucloxacillin

30
Q

How does late menopause affect the risk of breast cancer?

A

Increases

31
Q

How does early menarche affect the risk of breast cancer?

A

Increases?

32
Q

What is seen in DCIS on USS?

A

Multiple calcifications

33
Q

What is seen in a breast cyst on USS?

A

Halo sign

34
Q

What commonly perscribed drug class can cause mastalgia?

A

SSRIs
Hormonal contraceptives
Antipsychotic drugs like haloperidol

35
Q

What age ranges are invited to breast cancer screening and how often?

A

50-70 every three years

36
Q

What is the single most prognostic factor for breast cancer?

A

Nodal status

37
Q

What classification is used to classify breast cancer?

A

Bloom Richardson

38
Q

What is Paget’s disease of the nipple?

A

Features of Paget’s includes itching or redness of nipple/areola, flaking and thickened skin and ulceration, which is often painful and sensitive. The nipple may also be flattened and have a yellow/bloody discharge. Nearly all those with Paget’s disease of the breast will have an underlying malignancy.

39
Q

Lactational mastitis?

A

First few months of breast feeding or weaning
Cracked nipples milk stasis
Encourage breast feeding
Analgesia
Systemically unwell nipple fissure or no improvement - abx - flucloxacillin to cover staph aureus

40
Q
A

Periductal mastitis more common in those with duct entasis
Smoking. If risk factor
Analgesia and abx - flucloxacillin

41
Q

What medication can be given in a patient who wants to stop breast feeding to stop lactation?

A

Cabergoline (dopamine agonist)

42
Q

When might a punctum be seen in the breast (small hole)

A

Abscess

Give abx and USS guided FNA or incision and drainage if advanced

43
Q

What will be seen on mammogram of a breast with fibrocystic changes

A

Halo sign on mammogram

44
Q

Causes of galactorrhea?

A 
Hyperprolactinaemia 
Drug induced - SSRIs antipsychotics H2 antagonists 
Acromegaly 
Hypothyroidism 
Pituitary adenoma 
Pregnancy test
Idiopathic
45
Q

Duct ectasia

A

Dilation and shortening or major lactiferous ducts
Menopausal women
Green and a yellow discharge
Palpable mass and may cause nipple inversion or retraction
Usually conservative may need abx, some pts treated surgically

46
Q

What is radical scar

A

Proliferating breast lesion that can mimic breast cancer on mamorgram

47
Q

Mx of gynaecomastia

A

Treat underlying condition
Tamoxifen
Surgery

48
Q

Which conditions that can cause increased oestrogen and therefore gynaecomastia

A

Hyperthyroidism
Liver disease
Obesity
Adrenal tumours

49
Q

Medications that can cause gynaecomastia?

A 
digoxin, 
Metronidozole, 
spironolactone,
finesteride, 
chemo, 
anti-psychotics
50
Q

Which pts have a fibroadenoma biopsied?

A

Over 25

51
Q

Most common breast cancer

A

DCIS and Carcinoma insitu

52
Q

How does DCIS and carcinoma insitu appear on mammogram

A

Multiple calcifications looks like a city

53
Q

Where is papilloma found

A

Sub areolar region

BLOODY DISCHARGE

54
Q

Eczema vs pagets

A

Eczema is nipple sparing

55
Q

Why do you need to do a punch biopsy in Paget’s disease?

A

97% of these patients will have underlying neoplasms either in situ or invasive disease

56
Q

Types of hormonal breast cancer

A

Oestrogen receptor positive

Her 2 receptor positive

57
Q

What do pre menopausal patients with breast cancer receive

A

Tamoxifen

58
Q

What are post menopausal women with breast cancer given

A

Anastrozole

59
Q

Tamoxifen side effects

A

VTE
endometrial
Hot flushes
Menstursl disturbance

60
Q

Herceptin most serious side effect

A

Cardio toxicity

61
Q

Anastrozole side effects?

A

Osteoporosis

62
Q

What hormone treatment is given to patients with HER 2 receptor positive breast cancer

A

Biologicals

Herceptin

63
Q

Indications for wide local incisions in breast cancer surgical management?

A

Solitary lesion
Peripheral lesion
Small lesion in a large breast
DCIS<4 cm

64
Q

Indications for mastectomy in management of breast cancer?

A

Multifocal tumour
Focal tumour
Large lesion in small breast
DCIS >4 cm

65
Q

Drugs that can cause gynaecomastia?

A 
DISCO
Digoxin
Isoniazid
Cimetidine (H2RA)
Spironolactone
Oestrogens

Year 3 Surgery (6 decks)

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