breast Flashcards
Mx. mastitis
mastitis: encourage breast feeding from other unaffected breast, use analgesia, antibiotics usually not needed
Antibiotics: flucloxacillin (lactational) with metronidazole (non-lactational)
breast abscess: US guided FNA or surgical incision/drainage
breast screening:
mammography 47-73 y/o every 3 years
most common breast cancer
invasive ductal carcinoma
concerned about familial breast cancer. when to refer
first degree/ second degree relative and one of:
- age of diagnosis < 40
- bilateral breast cancer
- male breast cancer
- ovarian cancer
- Jewish ancestory
- family history of multiple cancers at a young age
- two or more relatives on the father’s side
symptoms of fibroadenosis
aka. fibrocystic disease middle aged women lumpy breasts \+/- pain symptoms worsen prior to menstruation
Breast hormonal therapy options
ER+ cancer
tamoxifen ER antagonist blocks oestrogen effect – pre/peri menopausal
post menopausal
aromatase inhibitors eg. letrozole, anastrozole
reduce conversion of testosterones into oestrogens
HER2+ breast cancer
HER2+ cancer
trastuzumab (herceptin)
plan for lymph nodes in breast cancer
no lymphadenopathy:
do a pre-op USS and if positive do a sentinel node biopsy
present with lymphadenopathy:
axillary node clearance
consequences of axillary lymph node clearance
arm lymphoedema
functional arm impairment
surgical options for breast cancer
wide local excision
masectomy
followed by breast reconstruction for cosmesis if the patient wants - either at the initial operation or at a later date
DCIS size cut off for wide local excision vs masectomy
4cm
below = wide local excision
above 4cm = masectomy
masectomy indications
multifocal tumour (several lobes)
central tumour
large lesion in small breast
DCIS>4cm
wide local excision
solitary lesion
peripheral tumour
small lesion in large breast
DCIS<4cm
adjuvant radiotherapy indications breast cancer
following wide local excision
following masectomy for T3/4 tumours, >4 positive axillary nodes
side effects of tamoxifen (selective oestrogen receptor modulator SERM)
menstrual disturbance: bleeding/ amenorrhoea
menopausal symptoms
endometrial cancer
venous thromboembolism
broad management options for breast cancer
hormone therapy - ER antagonists eg. tamoxifen, aromatase inhibitors eg. anastrazole, letrozole
biologics eg. herceptin (trastuzumab) in HER2+ cancer
chemo prior or after surgery
surgery: wide local excision or masectomy, with breast reconstruction
radiotherapy after
when to start abx in breast feeding mastitis
symptoms do not improve after 12-24 hours of effective milk removal
nipple fissure
systemically unwell
culture indicates infection
- continue breast feeding with abx (fluclox 14 days)
receptors to check for on breast cancer biopsy
oestrogen
progesterone
HER-2
when can you surgically excise fibroadenoma
> 3cm + causing discomfort
prognostication in breast cancer
nottingham prognostic index
score based on tumour size, number of lymph nodes, grade
the score matches to a percentage 5 year survival
signs of inflammatory breast cancer
rapidly progressive
obstruction of lymph drainage –> erythema, oedema of the breast
major side effect of aromatase inhibitors
osteoporosis
so need to check bone mineral density prior and during treatment
hot flush, arthralgia, myalgia
duct ectasia mx
self limiting
stop smoking
total duct excision for severe symptoms
BRCA gene mutations inheritance pattern
people are usually heterozygous
autosomal dominant
so having a parent with the mutation gives child a 50% chance of getting it
lifetime risk of getting breast or ovarian cancer with BRCA1 or 2
40%
risk factors for breast cancer
early menarche, late menopause COCP not breastfeeding nulliparity having children after 30 doubles the risk past breast cancer obesity smoking
what is the first line treatment for breast cancer
surgery (routinely followed by radiotherapy to reduce recurrence)
axillary radiotherapy vs surgical axillary node clearance
AMAROS trial found axillary radiotherapy = axillary node clearance with fewer side effects in radiotherapy
snowstorm sign on USS axillary lymph nodes
extracapsular breast implant rupture
the silicone drains via the lymphatics giving a snowstorn appearance in the breast and lymph nodes
periductal mastitis
recurrent infections
smokers
Mx. co-amoxiclav
intraductal papilloma mammography findings
no findings on mammography
so do a USS +/- galactogram
