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CP3 SURGERY > BREAST > Flashcards

BREAST Flashcards

1
Q

When is a fibroadenoma?

A

Common benign breast lump

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2
Q

Who gets fibroadenoma’s

A

Young F (<30)

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3
Q

Features of fibroadenoma

A 
Not fixed to Chx wall
Smooth/rubbery 
Solid 
Painless 
Well-circumscribed 
Painless
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4
Q

When may a fibroadenoma want to be removed for cosmetic purposes?

A

If the woman has small breasts

b/c can cause a large deviation

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5
Q

Why do fibroadenosis + cysts occur

A

Menstrual cycle

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6
Q

What age group gets fibroadenosis + cysts

A

30-50 y/o

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7
Q

What may cysts + fibrous nodules feel like o/e

A

Bubble wrwap

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8
Q

If cysts are multiple, what are they related to?

A

Homones

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9
Q

Which quadrant of the breast has the highest % of carcinoma?

A

Upper outer quadrant

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10
Q

What is the most common cancer in females?

A

Breast cancer

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11
Q

What are the 2 main cell types in breast cance r

A

Ductal

Lobar

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12
Q

Can you usually palpate breast carcinoma in situ

A

No

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13
Q

PS breast carcinoma (5)

A 
Breast mass 
Pain 
Nipple changes 
Dimpling breast tissue 
Local oedema
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14
Q

Non specific Sx breast carcinoma

A

W loss
Loss appetitie
Fatigue

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15
Q

Features of lump - breast carcinoma (4)

A

Hard
Spiky
Not well circumscribed
Fixed to chest wall

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16
Q

How does breast carcinoma spread

A

Via direct extension
Lymphatics + bloods
Pleura + peritoneum

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17
Q

Symptom + related mets: SOB

A

Lung mets + pleural effusion

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18
Q

Symptom + related mets:

Headache/vision change/seizure

A

Brain mets

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19
Q

Symptom + related mets: abdo pain

A

Liver mets

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20
Q

Symptom + related mets: abdo distention

A

Ascites

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21
Q

Symptom + related mets: bone pain, weakness, numbness

A

SC compression

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22
Q

RF breast carcinoma (10)

A 
= ALL TO DO W/ HIGH CIRCULATING OESTROGEN
Female 
Late menopause/early menarche 
OCP
HRT
FHx
Age 
Nulliparity 
< time breast feeding 
'Western lifestyle'
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23
Q

What % breast cancers are familial

A

5-10%

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24
Q

What assessment are most breast lumps referred for?

A

Triple assessment

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25
Q

What is ‘triple assessment’

A

Combo of 3 tests

Clinical exam, radiology + pathology

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26
Q

How are biopsies of the breast performed

A

Either Freehand if not palpable

Stereotactic if cant be seen on mammogram

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27
Q

What is the sensitivity of triple assessment?

A

99%

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28
Q

Why are mammograms not useful on young patients

A

Because their breast tissue is very dense

So all comes up as white hence = difficult to see anything

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29
Q

USS - black circle w/ well defined margin =

A

cyst

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30
Q

USS - grey/black circle w/ well defined margin =

A

Something capsulated :)

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31
Q

USS - grey/black circle w/ ill-defined margin =

A

Cancer

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32
Q

Nipple discharge - what does clear mean

A

Physiological

33
Q

Nipple discharge - what does milky mean (2)

A

Pregnancy

Hyperprolactinaemia

34
Q

Nipple discharge - what does green discharge mean

A

Duct ectasia around menopause

Fibroadenotic cyst

35
Q

Nipple discharge - what does single blood stained duct discharge mean

A

V worrying

36
Q

What to do if pt has Single blood stained duct discharge

A

Microducetomy

37
Q

What is most suspicious, single or multiduct discharge

A

Single duct

38
Q

What is periductal mastitis

A

Infection of ducts beneath the nipple

39
Q

Who is more likely to suffer from periductal mastitis (2)

A

Smokers

Those w/ nipple piercings

40
Q

Mx periductal mastitis

A

Flucloxacillin

41
Q

What is the most common cause of breast pain?

A

MSK

42
Q

Mx cyclical breast pain

A

Tamoxifen/danzol

43
Q

Mx all breast pain

A

Evening primrose oil

44
Q

Breast TNM: T1

A

<2cm

45
Q

Breast TNM: T2

A

2-5cm

46
Q

Breast TNM: T3

A

> 5cm

47
Q

Breast TNM: T4

A

Fixed to chest wall

Or Peau d’orange

48
Q

Breast TNM: N0

A

No nodes

49
Q

Breast TNM: N1

A

Mobile ipsilateral nodes

50
Q

Breast TNM: N2

A

Fixed nodes

51
Q

Breast TNM: M0

A

No distant mets

52
Q

Breast TNM: M1

A

Distant mets

53
Q

Further Ix if you suspect a patient of having mets

A

Liver USS
CXR
Bone scan

54
Q

What is another name for breast conserving surgery?

A

WLE - Wide local excision

55
Q

What does WLE involve

A

Excising tumour w/ 1cm margin

Making sure microscopically margins are clear

56
Q

When is a mastectomy used? (4)

A

Multifocal disease
High tumour:breast
Disease recurrence
Pt choice

57
Q

What are the 2 types of axillary surgery

A

Sentinel node biopsy

Axillary node clearance

58
Q

What is sentinel node biopsy

A

Remove the 1st LN into which tumour drains
This involves using a blue dye
Node is removed + sent for histological analysis

59
Q

What is Axillary node clearance

A

Remove all nodes in axilla

60
Q

What treatment is most surgery combined with?

A

Radiotherapy

61
Q

When to consider using chemo for Tx breast cancer

A

If nodal disease

High grade tumours

62
Q

Chemotherapeutic agents used in breast cancer (3)

A

Anthracyclines
Cyclophosphamides
methotrexate

63
Q

What additional Tx is given to pt who are either HER2 or ER +ve - pre-menopausal

A

5 y of tamoixfen

64
Q

What additional Tx is given to pt who are either HER2 or ER +ve - post menopausal

A

Aromastase inhibitors e.g. letrazole, aromisin

65
Q

What additional Tx is given to pt who are HER2 +ve

A

Herceptin

66
Q

If there are mets, what Tx is recommended

A

Surgery for Sx relief

Radiotherapy for palliation

67
Q

What is the NPI

A

Nottingham porgnostic index which assesses survival and risk relapse

68
Q

How is the NPI calculated?

A

Size (cm x 0.2) + grade (1-3) + nodes (0 = 1point, 1-3 = 2 points, >3 = 3 points)

69
Q

10 y survival rate (after surgery) NPI <2.4

A

95%

70
Q

10 y survival rate (after surgery) NPI 2.4-3.4

A

85%

71
Q

10 y survival rate (after surgery) NPI 3.4-4.4

A

70%

72
Q

10 y survival rate (after surgery) NPI 4.4-5.4

A

50%

73
Q

10 y survival rate (after surgery) NPI >5.4

A

20%

74
Q

Age at which breast cancer screening starts

A

47-50

75
Q

How often are women screen for breast cancer?

A

Every 3 years

76
Q

When does breast screening end

A

After 73 y/o

77
Q

If a women is older than 73 can she been screened?

A

No but she can request a scan

78
Q

Which type of breast cancer has the poorest prognosis?

A

HER2+

CP3 SURGERY (19 decks)

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