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Year 3 - Surgery > Breast > Flashcards

Breast Flashcards

1
Q

State what is involved in a triple assessment of a breast lump

A
  1. Clinical assessment (history and examination)
  2. Imaging
    - Ultrasound <35yrs
    - Mammogram >35yrs
  3. Histology
    - Fine needle aspiration
    - Core biopsy
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2
Q

List all the differentials for a breast lump

A
  • Breast cancer
  • Fibroadenoma
  • Breast cyst
  • Fibrocystic breast changes
  • Fat necrosis
  • Lipoma
  • Galactocele
  • Phyllodes tumour
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3
Q

Breast cancer - state the following:
- Pain?
- Shape/texture?
- Mobile?
- Well circumscribed?
- Common age groups?
- Additional features?

A

Pain?
- No

Shape/texture?
- Firm
- Irregular

Mobile?
- Fixed

Well circumscribed?
- No

Common age groups?
- Over age 30

Additional features?
- Nipple retraction
- Skin changes including skin dimpling

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4
Q

Fibroadenoma - state the following:
- Pain?
- Size?
- Shape/texture?
- Mobile?
- Common age groups?
- Increased risk of developing cancer?

A

Pain?
- No

Size?
- Generally < 3cm

Shape/texture?
- Smooth
- Round
- Fluctuant

Mobile?
- Yes

Common age groups?
- 20-40 years

Increased risk of developing cancer?
- Not usually, unless family history or complex fibroadenoma

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5
Q

Lipoma - state the following:
- Pain?
- Shape/texture?
- Mobile?
- Management

A

Pain?
- No

Shape/texture?
- Soft

Mobile?
- Yes

Management:
- Conservatively, with reassurance
- Can be removed surgically

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6
Q

Fibrocystic breast changes - state the following:
- Pain?
- Size?
- Shape/texture?
- Mobile?
- Well circumscribed?
- Common age groups?
- Increased risk of developing cancer?
- Additional features?

A

Pain?
- Yes

Size?
- Fluctuating breast size overall

Shape/texture?
- Generalised lumpiness

Common age groups?
- Menstruating ages

Increased risk of developing cancer?
- Yes

Additional features?
- Features change with menstrual cycle, worst 2 weeks before and resolve during period

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7
Q

Breast cysts - state the following:
- Pain?
- Size?
- Shape/texture?
- Mobile?
- Well circumscribed?
- Common age groups?
- Increased risk of developing cancer?

A

Pain?
- Yes

Size?
- Fluctuate with menstrual cycle

Shape/texture?
- Smooth
- Fluctuant

Mobile?
- Yes

Common age groups?
- 30-50 years

Increased risk of developing cancer?
- Yes

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8
Q

Fat necrosis - state the following:
- Pain?
- Shape/texture?
- Mobile?
- Increased risk of developing cancer?
- Additional features?
- Management

A

Pain?
- Yes

Shape/texture?
- Firm
- Irregular

Mobile?
- No

Increased risk of developing cancer?
- No

Additional features?
- May have bruising and erythema
- May have nipple retraction
- May have skin dimpling

Management:
- Needs further investigation for cancer
- May resolve spontaneously over few months
- May require surgical excision

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9
Q

Galactocele - state the following:
- Pain?
- Shape/texture?
- Mobile?
- Common age groups?
- Management

A

Pain?
- Yes

Shape/texture?
- Firm

Mobile?
- Yes

Common age groups?
- Lactating women

Management:
- May resolve spontaneously
- Can drain with needles
- May require antibiotics if they become infected

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10
Q

Outline the management options for fibrocystic breast changes

A
  • Supportive bra
  • NSAIDs for analgesia
  • Avoid caffeine
  • Apply heat
  • Some hormonal treatments
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11
Q

Gynaecomastia - state the following:
- Pathophysiology
- Causes
- Investigations

A

Pathophysiology:
- Enlargement of glandular breast tissue in males
- Particularly common in adolescents and older men
- May be present transiently in newborns

Causes:
- Generally from imbalance between oestrogens and androgens
- Raised prolactin (including dopamine antagonists)
- Conditions that increase oestrogen
- Conditions that decrease androgens
- Medications e.g. Spironolactone

Investigations:
- Blood tests (depends on suspected cause)
- Imaging e.g. ultrasound, mammogram

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12
Q

Galactorrhoea - state the following:
- Pathophysiology (vague definition)
- Causes
- Investigations
- Management

A

Pathophysiology:
- Breast milk production, not associated with pregnancy or breastfeeding

Causes:
Hyperprolactinaemia
- Idiopathic
- Prolactinomas
- Endocrine disorders e.g. hypothyroidism, PCOS
- Medications e.g. Dopamine antagonists
- PREGNANCY!

Investigations:
- Pregnancy test!!
- Blood tests inclu. serum prolactin, renal, liver and thyroid tests
- MRI scan (first line for pituitary tumours)

Management:
Target underlying cause
- Dopamine agonists e.g. Bromocriptine
- Transsphenoidal removal of pituitary tumour

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13
Q

List 3 hormones that inhibit the production of prolactin (for lactation)

A
  • High oestrogen (high during pregnancy)
  • High progesterone (high during pregnancy)
  • Dopamine (some medications block this)
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14
Q

State the presentation of galactorrhoea plus additional symptoms they may present with as a result of LH / FSH suppression

A

Presentation:
- Breast milk production, in the absence of pregnancy or breastfeeding

Additional symptoms:
- Menstrual disturbances
- Low libido
- Erectile dysfunction (males)
- Gynecomastia (males)

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15
Q

Mammary duct ectasia - state the following:
- Pathophysiology
- Main risk factor?
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Dilation of the large ducts of the beast, with inflammation
- Intermittent discharge from the nipple (white, grey or green)
- Benign condition

Main risk factor:
- Smoking!
- Also common in peri-menopausal women

Presentation:
- Nipple discharge (white, grey or green)
- Pain
- Nipple retraction/inversion
- Breast lump

Investigations:
- First, triple assessment to rule out breast cancer (examination, imaging and biopsy)
- Ductography (contrast mammogram)
- Ductoscopy (small camera into duct)
- Discharge cytology

Management:
- Reassurance (exclude cancer)
- Symptomatic management e.g. warm compress
- Antibiotics if infection
- Surgical excision

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16
Q

Intraductal papilloma - state the following:
- Pathophysiology and common age group
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Warty lesion within duct of the breast
- Caused by proliferation of epithelial cells
- Commonly occur at 35-55 yrs

Presentation:
- Can be asymptomatic (picked up incidentally)
- Blood stained or clear nipple discharge
- Pain
- Breast lump

Investigations:
- First, triple assessment to rule out breast cancer (examination, imaging and biopsy)
- Ductography (contrast mammogram)

Management:
- Complete surgical excision (check for cancer)

17
Q

Lactational mastitis - state the following:
- Pathophysiology
- Common organism (if infected)
- Presentation
- Management

A

Pathophysiology:
- Inflammation of breast tissue
- Complication of breast feeding (with or without infection)
- Either caused by an obstruction in the ducts, or bacteria getting in through the nipple

Common organism (if infected):
- Staphylococcus aureus

Presentation:
- Unilateral breast pain
- Erythema
- Warmth
- Nipple discharge
- Fever

Management:
- Advise to continue breastfeeding
- Conservative e.g. warm compress, analgesia
- Antibiotics if infected

18
Q

Suggest which antibiotics should be used in lactational mastitis

A

Flucloxacillin (Erythromycin if penicillin allergy)

19
Q

Suggest which antibiotic should be used in lactational mastitis if candidal infection is suspected

A

Fluconazole - but needs to be given to both the baby and mother (otherwise infection will reoccur)

20
Q

Breast abscess - state the following:
- Pathophysiology
- Risk factors
- Common organism
- Presentation
- Management

A

Pathophysiology:
- Collection of pus within an area of the breast, commonly a bacterial infection
- Either a lactational (associated with breastfeeding) or non-lactational abscess (unrelated to breastfeeding)

Risk factors:
- Smoking
- Breastfeeding
- Damaged nipple surface
- Underlying breast disease

Common organism:
- Staphylococcus aureus (most common)

Presentation:
- Acute presentation of a swollen, fluctuant tender lump (fluid filled)
- Generalised symptoms of infection e.g. fever

Management:
- Depends on whether lactational or non-lactational mastitis
- Lactational mastitis = conversative management, may need antibiotics (Flucloxacillin)
- Non-lactational mastitis = conversative management, may need broad-spectrum antibiotics (Co-Amoxiclav)
Abscess:
- Ultrasound
- Drainage
- Antibiotics / MCS

21
Q

Outline some risk factors for breast cancer

A
  • Female gender
  • Smoking
  • Family history
  • Obesity
  • HRT
  • Oral contraceptive
  • Prolonged lifetime oestrogen exposure
  • Previous breast cancer
  • More dense breast tissue (more glandular)
22
Q

Outline the main gene mutations associated with breast cancer

A

BRCA - tumour supressor genes:

BRCA-1 on chromosome 17
BRCA-2 on chromosome 13

23
Q

Outline the 6 main types of breast cancer

A

Ductal carcinoma in-situ
Lobular carcinoma in-situ
Invasive ductal carcinoma
Invasive lobular carcinoma
Inflammatory breast cancer
Paget’s disease

24
Q

Ductal carcinoma in-situ - state the following:
- Type of cell affected
- Localised or widespread?
- Presentation?
- Detectable on mammogram?
- Potential to spread?
- Prognosis?

A

Type of cell affected?
- Epithelial cells of the breast ducts

Localised or widespread?
- Localised to single area

Presentation?
- Often picked up incidentally on mammogram

Detectable on mammogram?
- Yes

Potential to spread?
- May spread, around 30%

Prognosis?
- Good, if fully excised with adjuvant treatment

25
Q

Lobular carcinoma in-situ - state the following:
- Outline?
- Presentation?
- Detectable on mammogram?
- Potential to spread?
- Management?

A

Outline?
- Precancerous condition typically in pre-menopausal women

Presentation?
- Often asymptomatic, usually diagnosed incidentally during a breast biopsy

Detectable on mammogram?
- No

Potential to spread?
- May spread, around 30%

Management?
- Close monitoring

26
Q

Invasive ductal carcinoma - state the following:
- Type of cell affected?
- Detectable on mammogram?

A

Type of cell affected?
- Cells of the breast ducts

Detectable on mammogram?
- Yes

27
Q

Invasive lobular carcinoma - state the following:
- Type of cell affected?
- Detectable on mammogram?

A

Type of cell affected?
- Cells of the breast lobules

Detectable on mammogram?
- Not always

28
Q

Inflammatory breast cancer - state the following:
- Presentation?
- Prognosis?

A

Presentation?
- Presents similarly to mastitis or breast abscess
- However, does not respond to antibiotics

Prognosis?
- Often worse than other types of breast cancer

29
Q

Describe the presentation of Paget’s disease of the nipple

A
  • Eczema appearance
  • Erythematous, scaly rash
30
Q

State the current breast cancer screening programme

A

3 yearly mammograms for women ages 50-70 years

31
Q

Outline the negatives of the breast cancer screening programme

A
  • Unnecessary stress and anxiety and additional testing
  • Missing cancer, leading to false reassurance
  • Exposure to radiation (mammogram is x-ray)
32
Q

Outline some presenting features of breast cancer

A
  • Lump
  • Lymphadenopathy (especially in axilla)
  • Skin changes e.g. dimpling
  • Nipple changes e.g. retraction or discharge
33
Q

Outline the triple assessment for breast cancer investigation

A
  1. History and examination
  2. Imaging
    - Ultrasound if <35 years
    - Mammogram if >35 years
  3. Biopsy
    - Fine needle aspiration
    - Core biopsy
34
Q

State the 3 receptors that can be targeted in breast cancer hormonal treatment

A
  1. Oestrogen receptor
  2. Progesterone receptor
  3. HER2 (human epidermal growth factor) receptor
35
Q

State the common sites of metastasis for breast cancer

A

LLBB

Lungs
Liver
Brain
Bones

36
Q

Suggest some indications for when to prescribe antibiotics in mastitis

A
  • Patient is systemically unwell
  • Not improving on breastfeeding alone (within 12-24 hours)
  • Nipple fissures are present
  • Positive culture

Year 3 - Surgery (10 decks)

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