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Surgery > Breast > Flashcards

Breast Flashcards

1
Q

Until what age is the breast classified as undergoing development?

A

25

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2
Q

How do fibroadenomas develop and appear?

A
  • as lobular units and dense stroma are being formed within the breast tissue
  • mobile, firm breast lumps
  • 12% of masses
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3
Q

Classifications of fibroadenomas?

A
  • juvenile
  • common
  • giant (>4cm)
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4
Q

Investigations of fibroadenomas?

A
  • young and small <3cm on imaging - watchful waiting
  • > 4cm - core biopsy to exclude phyllodes tumour
  • very large - mastectomy
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5
Q

How do fibroadenomas change?

A
  • 10% increase in size
  • 30% regress
  • rest remain same
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6
Q

How can fibroadenomas be excised?

A
  • shelled out through circumareolar incision

- smaller lesions - mammotome

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7
Q

In whom are breast cysts most common?

A

perimenopausal women caused by distended and involuted lobules

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8
Q

How do breast cysts appear?

A
  • soft, fluctuant swellings
  • halo appearance on mammography
  • US: fluid filled
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9
Q

Management of breast cysts:

A

symptomatic may be aspirated

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10
Q

What is duct ectasia?

A
  • as women progress through menopause
  • ducts shorten and dilate
  • cheese like nipple discharge
  • slit like retraction of nipple
  • no treatment
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11
Q

Selective Oestrogen Receptor Modulators (SERM) - MOA, ADR

A
  • Tamoxifen
  • oestrogen receptor antagonist and partial agonist
  • management of oestrogen receptor positive breast cancer
  • ADR: menstrual disturbance, hot flushes, VTE, endometrial cancer
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12
Q

Aromatase inhibitors - examples, MOA, ADR

A
  • anastrozole, letrozole
  • reduce peripheral oestrogen synthesis
  • ER positive breast cancer
  • ADR: osteoporosis (DEXA scan when initiating), hot flushes, arthralgia, myalgia, insomnia
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13
Q

Is there increased risk of malignancy with fibroadenomas?

A

no

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14
Q

Is there increased risk of breast cancer with breast cysts?

A

small , especially if younger

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15
Q

Management of breast cysts:

A
  • aspiration

- if blood stained or persistently refill - biopsy or excision

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16
Q

What are sclerosing adenosis, radial scars and complex sclerosing lesions?

A
  • breast lump or pain
  • mammographic changes which mimic carcinoma
  • distortion of distal lobular unit without hyperplasia
  • disorder of involution
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17
Q

Is there increased risk of malignancy with sclerosis adenosis?

A

no

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18
Q

Management of sclerosing adenosis:

A

biopsy, excision not mandatory

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19
Q

What is epithelial hyperplasia?

A
  • ranges from generalised lumpiness to discrete lump
  • increased cellularity of terminal lobular unit
  • atypical features and family history of breast cancer - greatly increased risk of malignancy
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20
Q

Management of epithelial hyperplasia:

A

no atypical features - conservative

atypical features - close monitoring or surgical resection

21
Q

What is fat necrosis?

A
  • 40% traumatic
  • physical features mimic carcinoma
  • mass may increase in size initially
22
Q

Management of fat necrosis:

A

imaging and core biopsy

23
Q

What is a duct papilloma?

A
  • present with nipple discharge
  • large papillomas - mass
  • discharge from single duct
24
Q

Is there increased risk of malignancy with duct papillomas?

A

no

25
Q

Management of duct papillomas:

A

microdochectomy

26
Q

Most common type of breast cancer:

A

invasive ductal carcinomas

some arise as result of ductal carcinoma in situ

27
Q

Pathological assessment of breast cancer:

A
  • assessment of tumour and lymph nodes

- sentinel lymph node biopsy to minimise morbidity of axillary dissection

28
Q

Main breast cancer reconstruction type:

A

latissimus dorsi myocutaneous flap and sub pectoral implants

29
Q

Indications for mastectomy:

A
  • multifocal tumour
  • central tumour
  • large lesion in small breasts
  • DCIS >4cm
  • patient choice
30
Q

Indications for wide local excision of breast cancer:

A
  • solitary lesion
  • peripheral tumour
  • small lesion in large breast
  • DCIS <4cm
  • patient choice
31
Q

What scoring system is used for breast cancer prognosis?

A

Nottingham Prognostic Index

32
Q

Calculation of NPI:

A

tumour size x 0.2 + lymph node score + grade score

33
Q

How does axillary lymphadenopathy determine surgical management of breast cancer?

A
  • no palpable axillary lymphadenopathy: pre-operative axillary ultrasound before primary surgery (if positive - sentinel node biopsy to asses burden)
  • palpable lymphadenopathy: axillary node clearance indicated at primary surgery (may lead to arm lymphedema and functional arm impairment)
34
Q

When is radiotherapy used in breast cancer?

A
  • whole radiotherapy recommended after wide local excision (reduce risk of recurrence in 2/3)
  • mastectomy for T3-4 tumours or >=4 positive axillary nodes
35
Q

When is hormonal therapy indicated for breast cancer?

A
  • if positive for hormone receptors
  • tamoxifen pre- and peri-menopausal women
  • post-menopausal: aromatase inhibitors
36
Q

How is biological therapy used in breast cancer management:

A
  • most common: trastuzumab (Herceptin)
  • only in HER2 positive
  • not if history of heart disorders
37
Q

How is chemotherapy used in breast cancer?

A
  • prior to surgery to downstage primary lesion

- or after surgery e.g. axillary node disease (FEC-D used)

38
Q

When should you refer people using suspected cancer pathway referral for an appointment within 2 weeks for breast cancer?

A
  • > =30yo with unexplained breast lump with or without pain

- >=50yo with symptoms in one nipple of: discharge, retraction or other changes

39
Q

When should referral for appointment in 2 weeks be considered for breast cancer?

A
  • skin changes that suggest breast cancer

- or aged 30 and over with an unexplained lump in axilla

40
Q

What qualifies as a non-urgent referral for breast cancer?

A

under 30 with unexplained breast lump with or without pain

41
Q

Predisposing factors breast cancer:

A
  • BRCA1 and 2 (40% lifetime risk)
  • 1st degree relative premenopausal breast cnacer
  • nulliparity (1st pregnancy >30yo)
  • early menarche, late menopause
  • combined hormone replacement therapy, COCP
  • past breast cancer
  • ionising radiation
  • p53 gene mutations
  • obesity
  • previous surgery for benign disease
42
Q

NHS breast screening programme:

A
  • 47-73 yo

- mammogram every 3 years

43
Q

Who is offered breast cancer screening:

A

one first or second degree relative WITH:

  • age of diagnosis <40yo
  • bilateral breast cancer
  • male breast cancer
  • ovarian cancer
  • Jewish
  • sarcoma in relative younger than 45yo
  • glioma or childhood adrenal cortical carcinomas
  • complicated patterns of multiple cancers at young age
  • paternal history of breast cancer
44
Q

Go study the anatomy of the breast

A

on google images

45
Q

Most breast cancers arise from what tissue?

A
  • duct tissue

- lobular tissue

46
Q

All the most common types of breast cancer:

A
  • invasive ductal carcinoma (most common)
  • invasive lobular carcinoma
  • ductal carcinoma in situ
  • lobular carcinoma in situ
47
Q

Rare types of breast cancer:

A
  • medullary
  • mucinous
  • tubular
  • adenoid cystic carcinoma
  • metaplastic
  • lymphoma
  • basal type
  • phyllodes or cyst-sarcoma phyllodes
  • papillary
48
Q

What is paget’s disease of the nipple:

A
  • eczematoid change of nipple
  • underlying breast malignancy
  • 1-2% patients with breast cnacer
  • mostly with invasive carcinoma
49
Q

What is inflammatory breast cancer?

A
  • cancerous cells block lymph drainage

- inflamed appearance of breast

Surgery (10 decks)

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