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Surgery Extra Questions > Breast > Flashcards

Breast Flashcards

1
Q

What medication is recommended for oestrogen-receptor positive breast cancer in post-menopausal women ONLY?

A

Anastrozole

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2
Q

How does Anastrozole work?

A

Aromatase inhibitor

It inhibits the enzyme aromatase and hence reducing the conversion of androgens into oestrogens in peripheral tissues. This is the main source of oestrogen production in postmenopausal women, compared to pre-menopausal women, where the main source of oestrogen is the ovaries.

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3
Q

What medication is used for women with oestrogen positive Breast Cancer who are premenopausal or post menopausal?

A

Tamoxifen

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4
Q

How does Tamoxifen work?

A

Its a selective oestrogen receptor modulator, meaning it antagonises oestrogen receptors on the breast cancer cells and blocks the anabolic effects of oestrogen.

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5
Q

What is the treatment for lactational mastitis?

A

1st - Continue breastfeeding

2nd - PO Flucloxacillin for 10 days

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6
Q

What is the most common organism in Lactational Mastitis?

A

Staph Aureus

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7
Q

How does Mastitis present?

A

Redness
Tender
Warm to the touch
Swelling

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8
Q

What are the sentinel lymph nodes?

A

The first few lymph nodes a cancer can spread to

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9
Q

What is the purpose of a sentinel lymph node biopsy?

A

To see if the cancer has spread from the initial location

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10
Q

How do you do a sentinel lymph node biopsy?

A

A radioactive substance and/or blue dye is injected near the tumour. During the surgery a probe is used to locate the lymph nodes containing the radioactive substance so they can be excised.

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11
Q

What is an intra-ductal papilloma?

A

A benign tumour of fibrovascular tissue that develops within the lactic ducts.

Can grow to become painful and leak blood-stained discharge

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12
Q

Above what age does a patient with a breast lump require urgent cancer referral to the breast team?

A

All women > 30 with unexplained breast lump

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13
Q

What is duct ectasia?

A

Shortening and widening of the terminal breast ducts around the nipple.

Presents as a benign breast lump with thick- green nipple discharge

Occurs after breast involution (around the time of menopause)

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14
Q

What is breast involution?

A

Process by which the breast epithelial tissue is gradually lost with aging of the mammary gland.

Mammary glands are lost as they are now redundant

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15
Q

What specific risk should patients undergoing a axillary node clearance be aware of?

A

Lymphedema causing functional arm impairment

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16
Q

What are the types of breast malignancy?

A

Ductal carcinoma in situ
Invasive ductal carcinoma

Lobular carcinoma in situ
Invasive lobular carcinoma

Mucinous carcinoma

Paget’s disease of the nipple

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17
Q

How do you distinguish between ductal and lobular carcinoma on a mammogram?

A

Calcification is seen more in ductal than lobular - hence it is more visible on mammogram

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18
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinomas

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19
Q

What are the typical treatments for breast cancer?

A

Wide local excision
Mastectomy

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20
Q

What are the indications for a Mastectomy?

A

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
Patient Choice

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21
Q

What are indications for a Wide Local Excision?

A

Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
Patient Choice

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22
Q

What drug is used for patients who are HER2 postive?

A

Herceptin

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23
Q

What type of chemotherapy is used in patients who are node negative that require it?

A

FEC chemotherapy

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24
Q

What type of chemotherapy is used for patients who are node positive?

A

FEC-D chemotherapy

25
Q

What are the treatments available for duct ectasia?

A

None needed - reassurance

Microdochectomy - if condition is bothering patient and they are younger

Total duct excision - if symptomatic and bothering the patient and they are older

26
Q

What is a microdochectomy?

A

A procedure to remove one or more of the milk ducts from your breast

27
Q

What is Total Duct excision?

A

Removal of a disc of duct tissue from behind the nipple

28
Q

What is a side effect of Aromatase inhibitors?

A

Osteoporosis

29
Q

What are side effects of SERMs ( Selective Oestrogen Receptor Modulators) i.e Tamoxifen?

A

Amenorrhoea
Endometrial cancer
Vaginal bleeding
VTE

30
Q

What is another name for Herceptin?

A

Trastuzumab

31
Q

What is the appropriate management for fibroadenomas that are >3cm?

A

Surgical excision biopsy

32
Q

What would be a reasonable indication for surgical excision if a fibroadenoma was <3cm ?

A

Cosmesis ( Aesthetic/ Body image issues)

33
Q

What is a Phyllodes tumour?

A

Rare breast tumour that starts in the connective tissue ( fatty tissue, ligaments around area) rather that the ducts or lobules. Most are benign

A fibroepithelial lesion ( stroma and epithelial components )

34
Q

What is Paget’s disease of the nipple?

A

Reddening
Thickening
May resemble eczema ( itchy, crusty)
Inverted nipple
Affects nipple first then areola

It is associated with underlying breast malignancy

35
Q

How does eczema spread on the nipple?

A

Areolar then to the nipple

36
Q

What is FIbroadenosis?

A

Fibrocystic breast disease
Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

37
Q

What is Duct Papilloma?

A

Local areas of epithelial proliferation in large mammary ducts

May present with blood stained discharge

38
Q

What is Fat necrosis?

A

More common in obese women with large breasts

May follow trivial or unnoticed trauma

Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump

39
Q

What is a breast abscess?

A

More common in lactating women
Red, hot tender swelling

Can result from mastitis

40
Q

What is a key reason for Neo-Adjuvant Chemotherapy?

A

Try to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy.

Reduce peri-operative risks
Better cosmetic outcome

41
Q

What do Breast Cysts show on mammogram?

A

Halo appearance

42
Q

What treatment is required following a wide local excision?

A

Whole breast radiotherapy

Then Anastrozole, Tamoxifen or Herceptin can be used as maintenance therapy following the radiotherapy

43
Q

What sign on ultrasound indicates extracapsular breast implant rupture?

A

Snowstorm sign of axillary lymph nodes

Leakage of silicone is drained by lymphatic system

44
Q

Who is breast cancer screening offered to?

A

All women age 50-70 every 3 years

45
Q

A 52-year-old woman with early-stage breast cancer is undergoing breast-conserving surgery. During the procedure, the sentinel lymph node biopsy reveals two nodes with micrometastatic involvement. There are no clinical signs of further axillary disease, and the patient is scheduled for adjuvant radiotherapy.

Considering these findings, what is the most appropriate next step?

A

Close without additional axillary surgery

Micrometastases or 2 micrometastases on sentinel lymph node

46
Q

What is Triple Negative breast cancer?

A

A type of breast cancer that does not have any of the receptors ( Oestrogen, Progesterone, HER2 )

47
Q

Who is Periductal Mastitis common in?

A

Smokers

48
Q

What age is screening with a mammogram as opposed to an US used?

A

Over 35 - more dense breast tissue

49
Q

What nerve injury can be a complication of axillary node clearance?

A

Brachial Plexus injury

50
Q

What treatment is recommended for Triple Negative breast cancer?

A

Aggressive

Neoadjuvant chemo
Lumpectomy/Mastectomy
Adjuvant chemo/radiation

51
Q

What is cyclical mastalgia?

A

Breast pain associated with menstrual cycle

52
Q

What is the treatment for Fat Necrosis?

A

Conservative as in most cases the body will break it down over time

Safety net - gets bigger or other breast changes come back

53
Q

What is a radial scar?

A

A radial scar is a benign breast condition which can mimic a breast carcinoma. It describes idiopathic sclerosing hyperplasia of the breast ducts. Patients are typically asymptomatic, and it is usually picked up incidentally. A mammogram typically shows a star or rosette-shaped lesion with a translucent centre.

54
Q

What should be monitored before and during usage of Herceptin?

A

Cardiac function - causes cardiotoxicity

55
Q

What is a Galactocele?

A

A breast lesion most commonly occurring in women who have recently ceased breastfeeding. Milk builds up and stagnates within the lactiferous ducts, leading to the formation of a mobile, cyst-like lesion which can be tender.

56
Q

What are risk factors for breast cancer?

A

Increased hormone exposure (Early menarche or late menopause
Nulliparity or late first pregnancy
Oral contraceptives or Hormonal Replacement Therapy)

BRCA1/BRCA2

Older
White
Obesity
Alcohol/Smoking
Family Hx

57
Q

What is a Seroma?

A

A localised accumulation of fluid beneath the skin surface

58
Q

What is recommended in any woman who undergoes a WLE?

A

Adjuvant radiotherapy
If ER+ , Tamoxifen or Anastrozole (Post-Menopasual) would also be given
If HER2 + , Herceptin would also be given

59
Q
A

Surgery Extra Questions (9 decks)

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