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Yr3 - General Surgery > Breast > Flashcards

Breast Flashcards

1
Q

Define galactorrhoea

A

Copious, bilateral, multi-ductal milky discharge - not associated with pregnancy or lactation

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2
Q

How is lactation regulated?

A

Prolactin - produced and secreted by the anterior pituitary gland
Secretion controlled by
- inhibited by dopamine - released by hypothalamus
- stimulated by TRH and oestrogen - released by pituitary

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3
Q

Causes of hyperprolactinaemic galactorrhoea

A 
Idiopathic
Pituitary adenoma
Drug-induced - SSRIs, anti-psychotics and H2-antagonists
Neurological
Hypothyroidism
Renal or liver failure
Damage to pituitary stalk
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4
Q

Investigation for galactorrhoea

A

Exclude pregnancy
Serum prolactin levels
MRI head with contrast - suspected pituitary tumour

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5
Q

Management of galactorrhoea

A 
Pituitary tumour
- dopamine agonist therapy
- trans-sphenoidal surgery
Idiopathic
- resolves spontaneously
- bilateral total duct excision
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6
Q

Define mastalgia

A

Breast pain

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7
Q

Describe the classifications of breast pain

A

Cyclical pain - associated with the menstrual cycle and affects both breasts
Non-cyclical - can be caused by medication
Extramammary - chest wall or shoulder pain

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8
Q

Investigations of breast pain

A

Breast pain in isolation with no further relevant features is not an indication for imaging
Pregnancy test

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9
Q

Management of mastalgia

A

Reassurance and pain control
Oral ibuprofen or paracetamol or topical NSAIDs
Referral to specialist

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10
Q

Define mastitis

A

Inflammation of the breast tissue

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11
Q

What is the most common cause of mastitis?

A

Infection - S.Aureus

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12
Q

Types of mastitis

A

Lactational
- first 3 months of breastfeeding or weening
- cracked nipples and milk stasis
Non-lactational
- Duct ectasia
- tobacco smoking causes damage to sub-areolar duct walls

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13
Q

Clinical features of mastitis

A

Tenderness
Swelling
Erythema

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14
Q

Management of mastitis

A

Systemic antibiotic therapy
Simple analgesics
Continued milk drainage or feeding

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15
Q

Define a breast abcess

A

Collection of pus within the breast lined with granulation tissue

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16
Q

Presentation of a breast abscess

A

Tender, fluctuant and erythematous mass
Associated fever and lethargy
Confirmed via ultrasound if needed

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17
Q

Treatment of a breast abscess

A

Empirical antibiotics
US-guided needle therapeutic aspiration
Advanced abscesses may need incision and drainage under local anaesthetic

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18
Q

Complications of a breast abscess

A

Mammary duct fistula

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19
Q

Define a breast cyst

A

Epithelial lined fluid-filled cavities

Form when lobules become distended due to blockage

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20
Q

Clinical presentation of breast cysts

A

Singular or multiple lumps
One or both breasts
Distinct smooth masses on palpation
May be tender

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21
Q

Investigations for breast cysts

A

Halo shape on mammography

Definitively diagnosed using ultrasound

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22
Q

Management of breast cysts

A

Usually no further management and self-resolve
Persisting, symptomatic or undeterminable cystic masses may be aspirated
Cancer excluded if free of blood or lump disappears

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23
Q

Complications of breast cysts

A

Risk of developing breast cancer

Fibroadenosis (fibrocystic change)

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24
Q

Define mammary duct ectasia

A

Dilation and shortening of major lactiferous ducts

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25
Q

Presentation of duct ectasia

A

Coloured green/yellow nipple discharge
Palpable mass
Nipple retraction

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26
Q

Investigations for duct ectasia

A

Mammorgraophy - dilated calcified ducts

Biopsy - multiple plasma cells

27
Q

Management of duct ectasia

A

Conservatively

Duct excision

28
Q

Define fat necrosis

A

Ischaemic necrosis of fat lobules to due acute inflammatory response

29
Q

Causes of fat necrosis in the breast

A

Blunt trauma to breast

Previous surgical or radiological intervention

30
Q

Presentation of fat necrosis

A

Usually asymptomatic
Lump
Acute inflammatory response can persist -> chronic fibrotic change -> solid irregular lump

31
Q

Investigations of fat necrosis

A

Positive traumatic history

Hyperechoic mass on ultrasound

32
Q

Management of fat necrosis

A

Self-limiting

Analgesic management and reassurance

33
Q

Describe a fibroadenoma

A

Proliferation of stromal and epithelial tissue
Most common benign growth
Occur in women of reproductive age

34
Q

Examination of fibroadenoma

A

Highly mobile lesions
Well-defined
Rubbery
Can be multiple and bilateral

35
Q

Malignancy potential of fibroadenoma

A

Very low

36
Q

Describe a adenoma

A

Benign glandular tumour

Occur in older population

37
Q

Examination of adenoma

A

Nodular

Easily mimic malignancy - undergo escalation for triple assessment

38
Q

Describe a papilloma

A

Benign breast lesion
Occur in subareolar region
40-50 years

39
Q

Presentation of papilloma

A

Nipple discharge

Similar to ductal carcionmas

40
Q

Malignancy potential of papilloma

A

High if multi-ductal -> microdochectomy

41
Q

Define a lipoma

A

Benign adipose tumour
Asymptomatic
Soft and mobile
Low malignant potential

42
Q

Define phyllodes tumour

A

Rare fibroepithelial tumour - comprised of epithelial and stomral tissue
Older age group

43
Q

Management of phyllodes tumour

A

Wide excision or mastectomy - malignant potential

44
Q

Triple assessment stages

A

Examination
Imaging
Histology

45
Q

Define gynaecomastia

A

Development of breast tissue in males

Due to an imbalance of oestrogen and androgens

46
Q

Causes of gynaecomastia

A 
Lack of testosterone
- androgen insensitivy
- testicular atrophy
- renal disease
Increased oestrogen levels
- liver disease
- hyperthyroidism
- obesity
- adrenal tumours
Medication
- digoxin
- metronidazole
- spironolactone
Idiopathic
47
Q

Examination of gynaecomastia

A

Rubbery or firm mass

Starts from underneath nipple and spreads outwards

48
Q

Management of gynaecomastia

A

Reverse underlying cause
Reassurance
Tamoxifen
Surgery

49
Q

Define carcinoma in situ

A

Malignancies are contained within the basement membrane

Pre-malignancy condition

50
Q

Types of carcinoma in situ

A

Ductal carcinoma in Situ - most common

Lobular carcinoma in Situ

51
Q

Management of carcinomas in situ

A 
DCIS 
- complete wide excision
- complete mastectomy
LCIS
- monitoring
- bilateral prophylactic mastectomy
52
Q

Types of invasive carcinoma of the breast

A

Ductal carcinoma - 85%
Lobular carcinoma - 10 % - older women
Medullary carcinoma
Colloid carcinoma

53
Q

Risk factors for breast cancer

A 
Female sex
Increased age
Mutations to certain genes - BRCA1 and BRCA2
Family hisotry in first degree relative
Previous benign disease
Obesity
Alcohol consumption 
Exposure to unopposed oestrogen
- early menarche
- late menopause
- nulliparous women
54
Q

Clinical features of breast cancer

A 
Symptomatically or asymptomatically via screening
Breast lumps
Asymetry
Swelling
Abnormal nipple discharge
Nipple retraction
Skin changes
Mastalgia
Palpable lump in axilla
55
Q

Diagnosis of breast cancer

A

Triple assessment
Examination
Imaging
Histology/cytology

56
Q

Criteria for UK breast screening

A

50-70 years old

Mammogram every 3 years

57
Q

Define Paget’s disease of the nipple

A

Involvement of epidermis by malignant ductal carcinoma cells

58
Q

Presentation of Paget’s disease of the nipple

A

Itching or redness of nipple/areola
Flaking and thickened skin
Painful and sensitive

59
Q

Investigations for Paget’s disease of the nipple

A

Biopsy

Complete breast and axilla examination

60
Q

Management of Paget’s disease of the nipple

A

Surgical

Radiotherapy

61
Q

Surgical treatment of breast cancer

A

Breast conserving - wide local excision
Mastectomy
Axillary surgery
- identify sentinel node by injecting blue dye

62
Q

Hormone treatments of breast cancer

A

Tamoxifen
- blockade of oestrogen receptors
- increased risk of thromboembolism and uterine carcinoma
Aromatase inhibitors
- binding to oestrogen receptors to inhibit further malignant growth
- post-menopausal patients
Immunotherapy
- Herceptin for human epidermal growth factor receptor (HER-2 positive)
- can cause cardiotoxicity

63
Q

Oncoplastic management of breast cancer

A

Therapeutic mammoplasty
- WLE with breast reduction
- nipple and areola preserved
Flap formation
- latissimus dorsi flap
- transverse rectus abdominal muscle flap
- deep inferior epigastric perforator flap

Yr3 - General Surgery (17 decks)

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