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taz year 3 surgery > Breast > Flashcards

Breast Flashcards

1
Q

What is Mastitis?

A

Inflammation of breast tissue

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2
Q

What are the two types of Mastitis

A

Lactational Mastitis - usually presents during the first 3 months of breast feeding or during weaning

Non Lactational Mastitis - occurring in Women with other conditions such as duct ectasia

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3
Q

What is the link between Tobacco and Breast disease?

A

Tobacco causes damage to sub-areolar duct walls predisposing to bacterial infection

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4
Q

Give three clinical features of Mastitis

A

Tenderness
Swelling
Erythema

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5
Q

How is Mastitis managed?

A

Simple Analgesia
Antibiotics
If breast feeding - encouraged to continue

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6
Q

Name a complication of Mastitis

A

Breast Abscess

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7
Q

What is a Breast Abscess?

A

Collection of pus within the breast lined with granulation tissue
Presents with systemic symptoms of fever and lethargy

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8
Q

What are Breast Cysts?

A

Epithelial lined fluid filled cavities, formed when lobules become distended due to blockage
Normally affects peri-menopausal age group
Can be single/multiple distinct smooth masses

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9
Q

Describe two investigations for Breast Cysts

A 
Mammography (classic halo shape)
Needle Aspiration (sent for cytology)
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10
Q

How are Breast Cysts managed?

A

Generally self resolving
Can be aspirated for aesthetic reasons

Advise patient to monitor as they do have a higher risk of Breast Cancer

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11
Q

What is Mammary Duct Ectasia?

A

Dilation and shortening of lactiferous ducts common in the peri-menopausal age group

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12
Q

Give 3 clinical features of Mammary Duct Ectasia

A
  • Green/Yellow nipple discharge
  • Palpable Mass
  • Retracted Nipple
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13
Q

Describe two investigations for Mammary Duct Ectasia

A

Mammography (dilated calcified ducts with no other features of malignancy)
Biopsy (multiple plasma cells)

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14
Q

How would you manage Mammary Duct Ectasia?

A

Conservative unless persistent discharge (duct excision)

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15
Q

What is Fat Necrosis of the breast?

A

Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules

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16
Q

Name 3 causes of Fat Necrosis

A

Trauma
Previous Surgery
Previous Radiation

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17
Q

How does Fat Necrosis present?

A

Normally presents asymptomatically/as a lump

Less commonly can present with fluid discharge/skin dimpling/pain/nipple inversion

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18
Q

Fat Necrosis may mimic malignancies on mammograms, so what investigations coud you do?

A

Core Biopsy

Ulstrasound (Hyperechoic mass)

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19
Q

Name five types of benign breast lumps

A 
Fibroadenoma
Adenoma
Papilloma
Lipoma
Phyllodes Tumour
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20
Q

How does a Fibroadenoma present?

A

Highly mobile, well defined and rubbery mass (breast mouse)

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21
Q

Where do Papillomas present?

A

Typically in sub-areolar region

Often with bloody/clear nipple discharge

22
Q

What are Phyllodes Tumours?

A

Rare fibroepithelial tumours that grow rapidly

Should be excised as 1/3 have malignant potential

23
Q

What is Gynaecomastia?

A

When males develop breast tissue due to imbalanced ratio of oestrogen and androgen
Usually benign but breast cancer can develop in 1%

24
Q

Describe the physiological causes of Gynaecomastia

A

Adolescent - delayed testosterone surge in response to Oestrogen
Elderly - Decreasing testosterone levels

25
Describe the pathological causes of Gynaecomastia
Lack of testosterone (Klinefelters, Androgen Insensitivity) Increased Oestrogen (Liver Disease) Medication (Digoxin, Metronidazole, Spironolactone)
26
How is Gynaecomastia managed?
Treat underlying cause | Tamoxifen can alleviate symptoms
27
What is Carcinoma In-Situ?
Tumour contained within basement membrane so seen as a pre-malignant condition
28
What are the two types of Carcinoma In-Situ?
Ductal (more common, lower chance of invasive disease) | Lobular (rarer, higher chance of invasive disease)
29
What is the most common type of Invasive Breast Cancer?
Over 75% ductal carcinoma | Almost all subtypes arise in the terminal lobular duct
30
Give 5 risk factors for Breast Cancer
- being female - BRCA1/2 mutations - uninterrupted menses - late age of first pregnancy - obesity and high fat diet - never breast feeding - late menopause - HRT and ?long term COCP use - radiation exposure
31
Give 5 features of Breast Cancer
``` Breast Lump/Asymmetry Nipple Discharge (may be bloody) Nipple retraction Peau D'Orange Axillary Lump ```
32
What is a Triple Assessment?
Methods of investigation for concerning breast lumps | Examination, Imaging, Histology/Cytology
33
How is the prognosis of Breast Cancer calculated?
Nottingham Prognostic Index | Receptors (ER,PR,HER2)
34
Who is screened for Breast Cancer?
Women aged 50-70 every 3 years
35
What is Paget's Disease of the Nipple?
Malignant cells migrate from ducts to nipple's surface causing roughening/reddening and ulceration of the nipple Where DCIS extends to the nipple without crossing the basement membrane and so you get eczema like changes around the affected nipple. 97% associated with breast cancer. Needs skin biopsy, breast and axilla examination and USS + mammogram
36
What is Sentinel Node Biopsy?
Removing first lymph node that the breast tissue drains to, found by injecting blue radioactive dye
37
For Oestrogen receptor positive cancers, name two hormonal treatments
Tamoxifen (SERM) - Premenopausal | Letrozole (Aromatase Inhibitors) - Postmenopausal
38
For HER2 receptor positive cancers, name a hormonal treatments
Herceptin
39
Describe three oncoplastic reconstruction techniques for Breast Cancer
Lat Dorsi - for smaller breasts, can be free or pedicled TRAM - Transverse Rectus Abdominal Muscle DIEP - Deep Inferior Epigastric Perforator
40
How is breast cancer diagnosed?
- Mammogram to screen - USS and core needle biopsy (for very large lesions) or fine needle aspiration cytology - excision biopsy or incisional biopsy (lesion >4cm)
41
What is the most common type of breast cancer? How are they subdivided?
adenocarcinoma- may be invasive (usually invasive ductal carcinoma no special type (IDC NST)) or ductal carcinoma in situ (DCIS)
42
Are DCIS removed?
yes- although they do not cross the basement membrane and so cannot metastasise, they may go to become invasive carcinoma, especially if high grade
43
Where does invasive breast cancer (IDC NST) most commonly metastasise to?
The axillary lymph nodes. | Bone is the most common distant site, followed by lung, liver and brain.
44
Where does invasive lobular carcinoma spread to?
odd places- peritoneum, meninges, GI tract, ovaries, uterus
45
What are the NICE indications for 2WW breast cancer referal?
- age >30 and unexplained breast lump - age >50 and unilateral discharge, retraction or other nipple changes - consider if >30 and unexplained axilla lump or skin changes - non urgent referal if age <30
46
what grading system is used for breast cancer
bloom richardson Tnm staging used Bcrisk score used to asses risk of the cancer
47
What surgical options are available for DCIS and IDC NST?
- mastectomy (removal of all breast tissue) - wide local excision (breast conserving) - Many will also get axillary lymph node clearance or at least sentinal node biopsy (inject blue dye and remove first nodes for biopsy)
48
What is cyclical mastalgia?
normal tenderness of breasts just before mensturation
49
state one benign cause of nipple discharge which may be bloody
intraductal papilloma
50
How is non lactational mastitis managed?
- admit if septic, immunocompromised or abscess - warm compress, NSAIDS - oral abx for all pts (coamox or erythro + metronidazole) - tell them to stop smoking and removal nipple rings as appropriate to stop recurrence

taz year 3 surgery (10 decks)

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