breast Flashcards
pagets disease of the nipple what is it how des it present
eczematid change of the nippe associated w underlying breast malignancy
ezcema involving nipple (first then laterally spreads to areolar
(opposite in ezcema)
erthythematous and may have nipple blood/discharge
pagets disease of nipple diagnosis
punch biospy
mammography
US of breast
1st lin mx lactational mastitis
continue breastfeeding
analgesia
warm compress
reasons to give oral fluclox(10-14days) in mastitis
breastfeed ?
organism
systemically unwell
nipple fissure present
no improve sx 12-24hr of effective milk removal
culture indicates infection
mc staph aureus
continue breastfeeding or expressing during abx tx
biologic tx for HER2 +ve
CI
trastuzumab (herceptin)
Ci hx heart disorder
hormonal therapy for oestrogen receptor +ve
pre or peri menopausal = tamoxifen
post menopausal = aromatase inhibitor ie letrozole anastrazole
breast cancer referal
refer 2 weeks
30+ unexplained breast lump +/- pain
50+ one nipple w any: discharge, retraction, other changes of concern
consider 2 weeks
skin changes that suggest ca
30+ unexplained lump in axillla
consider non urgent refer
<30 unexplained lump +/-pain
cytoxic chemo example
when
FEC -D
b4 surg to shrink lesion
after surg based on stage ie axilla node disease
SE of aromatase inhibitors
osteoporosis and fractures
hot flushes
arthralgia myalgia
insomnia
breast cancer screening
women 50-70yo
mammogram every 3 years
make own appointments after 70
refer for further assesment if one first degree relative
female diagnosed breast Ca<40yo
male diagnosed w breast any age
bilateral breast cancer where first primary diagnosed<50yo
refer for further assesment if two first degree
(or one 2nd) breast ca any age
refer further assesment two relatives
1st or 2nd dgree w breast anyage
and
1st ir 2nd w ovarian ca any age
(one must be 1st degree)
duct ectasia presentation why
usually age >50
nipple d/c from one or many ducts
thick and green
subareolar
mc smokers
normal variant due to breast involution during menopause -> ducts shorten and many contain insipiated material
periductal mastitis presentation RF and tx
younger than duct ectasia
pt may fx of inflammation, abscess of mammary duct fistula
periareolar
recurrent infections
RF
breastfeeding
associated w smoking
duct ectasia
(build up of keratin in milk ducts = inflam and infxn)
tx coamox , abscess = drainage
intraductal papilloma
papilloma in a single duct = single duct discharge
clear fluid labstix = small blood
no malignnacy risk
breast abscess presentation n tx
tender fluctuant mass
system unwell
tx abx n US guided aspirration
breast abcess complication
common cause
overlying skin necrosis = need surgical debridement
this may be complicated by development of subsequent mammary duct fistular
lactational mastitis (staph aureas)
Pt breast Ca n no palpable lymphadenopathy
pre op axillary USS negative
next step
sentinal node biopsy to asses nodal burden
fibroadenoma
develop from whole lobule
mobile firm smooth breast lump
‘breast mouse’
> 3cm surgical excision
breast cyst
smooth discrete lump
small inc risk of breast Ca (esp younger women)b
breast cyst tx
aspirated
blood stained or persistently refill
= biospy or excise
fat necrosis
obese post menopausal women
hx of trauma
-> mammography
side effects of tamoxifen
increased risk of endometrial cancer
VTE
menopausal sx
factors for mastectomy
multifocal tumor
central tumor
large lesion in small breast
DCIS >4cm
factors for wide local excision
solitary lesion
peripheral tumor
small lesion large breast
DCIS<4cm
breast Ca management
surgery (mast or excision)
oest receptor +ve = adjuvent hormonal ie tamox letro
her2 +ve = herceptin (traztsumab)
in nodes
either remove with surgery
or radiotherapy
how does tamox work
oestrogen receptor antagonsim
primarily in breast tissue (selective)
ie selective oestrogen receptor modulater (SERM)
how do aromatase inhibitors worK?
aromatase enzyme = androgen–>oestrogen
therefore inhib = reduces peripheral oestrogen sythesis
why dont use tamoxifen in pot menopause
post menopausal bleeding
endoetrial hyperplasia
endometrial ca
snowstorm sign on axillary lymph noedes
extracapsular breast implant rupture
its due to leakage of silicone which then drains into the lymphatic draining = snowstorm in breast and lymph nodes
breast cancer lump features
lump typically painless, fixed hard
breast skin changes
blood nipple discharge
inverted nipple
axillary mass
nipple candidiasis while breastfeeding tx
miconazole cream for mum
nystatin suspension for baby
breast cancer risk factors
oestrogen - obesity, nulliparity (1stpreg>30), early menarche, late menopause, HRT, COCP
never breastfed
genes - BRCA 1/2, ionising radiation
triple assessment
clinical exam
imaging (US or mammography)
biopsy fine needle or core
mc type breast ca
invasive ductal carcinoma
prostate cancer radiotherapy = inc risk of what
blader colon and rectal cancer
