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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
Q

Describe the pathological causes of Gynaecomastia

A

Lack of testosterone (Klinefelters, Androgen Insensitivity)
Increased Oestrogen (Liver Disease)
Medication (Digoxin, Metronidazole, Spironolactone)

26
Q

How is Gynaecomastia managed?

A

Treat underlying cause

Tamoxifen can alleviate symptoms

27
Q

What is Carcinoma In-Situ?

A

Tumour contained within basement membrane so seen as a pre-malignant condition

28
Q

What are the two types of Carcinoma In-Situ?

A

Ductal (more common, lower chance of invasive disease)

Lobular (rarer, higher chance of invasive disease)

29
Q

What is the most common type of Invasive Breast Cancer?

A

Over 75% ductal carcinoma

Almost all subtypes arise in the terminal lobular duct

30
Q

Give 5 risk factors for Breast Cancer

A
  • 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
Q

Give 5 features of Breast Cancer

A 
Breast Lump/Asymmetry
Nipple Discharge (may be bloody)
Nipple retraction
Peau D'Orange
Axillary Lump
32
Q

What is a Triple Assessment?

A

Methods of investigation for concerning breast lumps

Examination, Imaging, Histology/Cytology

33
Q

How is the prognosis of Breast Cancer calculated?

A

Nottingham Prognostic Index

Receptors (ER,PR,HER2)

34
Q

Who is screened for Breast Cancer?

A

Women aged 50-70 every 3 years

35
Q

What is Paget’s Disease of the Nipple?

A

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
Q

What is Sentinel Node Biopsy?

A

Removing first lymph node that the breast tissue drains to, found by injecting blue radioactive dye

37
Q

For Oestrogen receptor positive cancers, name two hormonal treatments

A

Tamoxifen (SERM) - Premenopausal

Letrozole (Aromatase Inhibitors) - Postmenopausal

38
Q

For HER2 receptor positive cancers, name a hormonal treatments

A

Herceptin

39
Q

Describe three oncoplastic reconstruction techniques for Breast Cancer

A

Lat Dorsi - for smaller breasts, can be free or pedicled
TRAM - Transverse Rectus Abdominal Muscle
DIEP - Deep Inferior Epigastric Perforator

40
Q

How is breast cancer diagnosed?

A
  • 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
Q

What is the most common type of breast cancer? How are they subdivided?

A

adenocarcinoma- may be invasive (usually invasive ductal carcinoma no special type (IDC NST)) or ductal carcinoma in situ (DCIS)

42
Q

Are DCIS removed?

A

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
Q

Where does invasive breast cancer (IDC NST) most commonly metastasise to?

A

The axillary lymph nodes.

Bone is the most common distant site, followed by lung, liver and brain.

44
Q

Where does invasive lobular carcinoma spread to?

A

odd places- peritoneum, meninges, GI tract, ovaries, uterus

45
Q

What are the NICE indications for 2WW breast cancer referal?

A
  • 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
Q

what grading system is used for breast cancer

A

bloom richardson
Tnm staging used
Bcrisk score used to asses risk of the cancer

47
Q

What surgical options are available for DCIS and IDC NST?

A
  • 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
Q

What is cyclical mastalgia?

A

normal tenderness of breasts just before mensturation

49
Q

state one benign cause of nipple discharge which may be bloody

A

intraductal papilloma

50
Q

How is non lactational mastitis managed?

A
  • 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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