breast diseases Flashcards
how do breast diseases commonly present
50% asymptomatic via screening
50% symptomatic (half with a with a lump)
symptoms of breast disease
dimpled/depressed skin visible lump nipple changes eg inversion bloody discharge texture change colour change
what is triple assessment
clinical assessment
imaging
histology
what type of imaging is used
mammogram in older women
USS in younger
why is mammogram less effective in younger women
denser breast tissue
how do DCIS calcifications appear on mammography
pleomorphic casting
how is definitive diagnosis of DCIS established
vacuum-assisted core biopsy
LCIS most commonly progresses into which type of cancer
ductal
what is the preferred surgical treatment of breast ca
breast conserving surgery
what is the normal form of breast conserving surgery
wide local excision with or without an oncoplastic procedure to shape breast
what is an essential non-surgical component of breast conserving surgery
radiation therapy
what is removed in modified radical mastectomy
entire breast including overlying skin and axillary lymph nodes
preservation of pec major
what types of breast reconstruction are possible
immediate (during the same operation as mastectomy)
delayed (performed at a later date)
how is the result of non-skin sparing mastectomy reconstruction aesthetically poor
often results in prominent scars on new breast and a paddle of skin of a different colour/texture
what are indications for post-mastectomy radiation
involvement of three or more nodes
positive surgical margins
tumours larger than 5 cm
what is the most commonly used hormonal therapy
tamoxifen (oestrogen receptors)
what is trastuzamab
recombinant monoclonal antibody which targets HER-2 receptors
how do phyllodes tumour differ from fibroadenoma
tend to be larger (3-6 cm)
occur in older women (35-35 years)
management of phyllodes tumour
excision with 1 cm margin
follow up
how are cysts diagnosed
FNA
when should fluid from a cyst be sent for cytology
if bloody
what is the most common aetiology of spontaneous nipple discharge
intraductal papilloma
investigations for pathological nipple discharge
mammography
ultrasonography
surgical excision of the discharging ducts
dry, scaly, eczematous nipple
paget’s
management of mastitis (lactational)
fluclox
examination every 3 days
pump infected breast until mastitis clears
wen should antibiotics be started for mastitis
signs of fever, erythema, induration, tenderness, swelling
management of breast abscess
aspiration (diagnostic and therapeutic)
surgical drainage under anaesthesia if not responding to aspiration
antibiotics
mastitis that doesn’t respond the antibiotics and seems to be diffuse over the breast is suggestive of
inflammatory carcinoma
