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General Surgery > Breast > Flashcards

Breast Flashcards

1
Q

3 tissue types in breast

A

fat, fibrous tissue, glandular tissue

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2
Q

Breast lobules are divided into segments by ___

A

suspensory ligaments of Astley Cooper

dimpling of skin in advanced breast CA due to malignant infiltration & contraction of Cooper’s ligament

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3
Q

Structure of the breast duct

A

1) Opening at nipple
2) Lactiferous sinus
3) Major duct
4) Terminal duct lobular unit
5) Stroma (surrounds lobular units)

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4
Q

Major lymphatic drainage of breast

A

75% - axillary nodes (anterior, posterior, lateral, medial, apical) that drain into supraclavicular & jugular nodes

20% drain into internal mammary nodes

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5
Q

Division of axillary lymph nodes

A

Divided by pectoralis minor

Level I: lateral to PM
Level II: behind PM
Level III: medial to PM

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6
Q

More likely pathological characteristics of nipple discharge

A

1) unilateral
2) bloody
3) uni-ductal
4) spontaneous (no need press)
5) persistent (>2x/week)

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7
Q

Characteristics of paget’s disease

A

unilateral
distinct edges
no itching, no vesicles
nipple destroyed
underlying lump present

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8
Q

Characteristics of nipple eczema

A

bilateral
indistinct edges
itching, vesicles
nipple not destroyed
no underlying lump

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9
Q

Differentials for nipple discharge causes can be classified by

A

discharge colour

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10
Q

Ddx blood discharge

A

intraductal papilloma
mammary ductal CA (DCIS or invasive)
fibrocystic change

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11
Q

Ddx clear (serous) or straw-coloured discharge

A

ductal papilloma/CA
mammary ductal ectasia (benign condition - ducts dilated + inflamed + fibrosed)

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12
Q

Ddx purulent, foul smelling discharge

A

1) lactational mastitis
- usually staph aureus
2) breast abscess

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13
Q

Ddx white, milky discharge

A

1) drug related galactorrhea - dopamine antagonists (usually inhibit prolactin), estrogenic effect

2) spontaneous galactorrhea - prolactinoma

3) lactation

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14
Q

Triple assessment in breast CA

A

History + clinical exam
Imaging (mammogram/US)
Histopathological

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15
Q

Risk factors for breast CA

A

1) Personal malignancy Hx
2) Family Hx - 1st deg relative with cancer, BRCA carrier
3) Previous chest wall irradiation
4) Estrogen exposure - menarche, menopause, OC, hormone replacement therapy, nulliparity, late first live birth
5) Pre-malignant breast conditions: atypical ductal/lobular hyperplasia

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16
Q

BRCA1 tumours tend to be ___, ___, ___

BRCA2 tumours tend to be ___, ___

A

hormone receptor negative (triple -ve), high grade, poorly differentiated

hormone receptor positive, well-differentiated

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17
Q

Premenopausal women in early reproductive period (<25), breast lumps are usually ___

A

fibroadenoma

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18
Q

Ddx for benign breast neoplasms

A

1) Atypical: atypical lobular/ductal hyperplasia
2) Typical: intraductal papilloma
3) Non-proliferative epithelial alterations: cysts, apocrine metaplasia
4) others: Phyllodes tumour, lipoma

breast infection

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19
Q

Ddx of malignant breast neoplasms

A

Carcinoma in situ: DCIS, LCIS
Invasive CA: ductal/lobular, inflammatory, other subtypes

20
Q

Fibroadenoma arise from ___. Presents as a ____. Commonly occurs in those under ___.

A

terminal duct lobular units

well-circumscribed, mobile lump with rubbery consistency

30

21
Q

Phyllodes tumour is a ___ tumour. Can be ___, spreads via ___. Local recurrence ___, distant metastasis is ___.

A

fibroepithelial
benign, borderline, malignant
blood
common, rare

22
Q

Fibrocystic breast change occurs in women aged ___. Presents with ___. Patients should be re-examined on ____.

A

20-55
premenstrual breast pain or lump

day 10 of menstrual cycle (hormonal influence is lowest, lump should diminish in size)

23
Q

Two views of mammography

A

cranio-caudal (CC)
mediolateral oblique (MLO)

24
Q

On mammogram, breast pointing to the right means its the ___ breast

A

left

25
Q

MLO view allows you to see ___, capture ___

A

axillary tail
enlarged lymph nodes

26
Q

Recommendation for mammogram

A

1x yearly 40-49yrs old
1x every 2 years 50-69 yrs old

27
Q

For breast biopsy, ___ is preferred over ___ as it is able to view ___

A

core biopsy
FNAC
tissue architecture/invasion

28
Q

Biggest risk factors for breast cancer

A

Genes: BRCA, TP53 mutation (56-87% higher risk)

Oral contraceptives (24%)

Previous breast disease (atypical hyperplasia) - 20%

Family history

29
Q

DCIS pathophysiology. How many tumours usually?

A

proliferation of malignant ductal cells from terminal duct lobular unit, confined by basement membrane with preserved myoepithelial layer

usually unicentric

*positive for E cadherin

30
Q

Lobular intraepithelial neoplasia pathophysiology

How many tumours usually?

A

LIN combines LCIS and atypical lobular hyperplasia. Arises from terminal duct lobular unit.

Not pre-malignant lesion, but marker of increased risk for cancer.

usually multicentric, bilateral

*negative for e-cadherin

31
Q

What is invasive carcinoma of no special type

A

Unclear origin of tumour. Not ductal nor lobular

32
Q

Invasive lobular carcinoma tends to metastasise to

A

GIT, gynae organs, peritoneum

33
Q

Inflammatory breast CA presentation

A

rapid swelling, +/- skin changes, nipple retraction, erythematous swollen breast w/o palpable mass

34
Q

Triple negative breast cancer means ___, has a ___ prognosis

A

ER, PR, HER2 negative

poor prognosis - lack of treatment target

35
Q

Stage 4 breast tumour occurs when tumour has ___

A

invaded chest wall, skin

inflammatory breast CA is stage 4

36
Q

Breast-conserving surgery MUST be accompanied with ___

A

post-operative radiotherapy

37
Q

Current recommendation for mastectomy

A

Simple mastectomy + sentinal lymph node biopsy KIV axillary clearance

*if SLNB positive, then axillary clearance performed

38
Q

Autologous breast reconstruction uses muscle from ___ or ___

A

latissimus dorsi
rectus abdominis

39
Q

What is a sentinal lymph node?

A

First draining lymph node. If negative then other lymph nodes unlikely to have tumour cells

40
Q

Neoadjuvant chemo increases possibility of ___, reduces ___ to improve ___

A

breast conserving surgery
tumour size, improve cosmesis

41
Q

Treatment drugs for ER/PR positive cancer

A

pre-menopausal: tamoxifen
post-menopausal: aromatase inhibitors

42
Q

Treatment for HER2 positive cancers

A

Herceptin (trastuzumab)

43
Q

Paget’s disease is associated with ___

A

underlying DCIS/invasive carcinoma

44
Q

Unlike eczema, paget’s disease ___

A

destroys the nipple
usually unilateral

45
Q

Causes of gynaecomastia

A

DOPING N Others

drugs - oestrogens, spironolactone, tricyclic antidepressants, cannabis

organ failure - liver, kidney, testicle, hyperthyroid

physiological

idiopathic

nutrition - malnutrition

hypoGonadism

Neoplasm - carcinoma, prolactinoma

General Surgery (13 decks)

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