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RCSI SURGERY > Breast Disorders > Flashcards

Breast Disorders Flashcards

1
Q

4 risk factors for Breast cancer

A
  1. increase age
  2. genetics (BRAC 1 and 2 gene, fam Hx, ovarian or breast Ca
  3. HIGH ESTROGEN states
  4. Beast condition statues (SCIS or LCIS
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2
Q

types of breast cancer

A
  1. ADENOCARCINOMA!!
T  II MM  
Tubular carcinoma 
invasive lobular cancerima 
inflammatory carcinoma 
Medullary carcinoma 
Mutinous carcinoma
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3
Q

invasive ductal carcinoma histology

A

recall this is the number one commonest histological subtype (75%)

  • malignant ductal cells deposed in cords
  • solid nest
  • tubules and anastomosing sheets
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4
Q

histology of ILC

A

small uniform cells forming strands of infiltrating tour cells concentrically around ducts

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5
Q

what does mammogram show on DCIS

A

MICROCALCIFICATIONS

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6
Q

bowen’s disease of the breast

A

eczema like change of the nipple

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7
Q

late presentation of breast cancer

A
  1. ulceration

2. tumour function

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8
Q

define peau d’orange

A

sensation of texture of an orange peel arises as a result of tumour invasion of dermal lymphatics causing dermal edema

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9
Q

suspicious finding on mammogram

A 
MM SS 
mass 
microcalcifciation 
stellate 
Spiculated mass
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10
Q

when do you use US for breast cancer

A
  1. detect LN

2. assess lumps on mammograms or clinical exam

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11
Q

FNAC use and disadvantage

A

sued for aspiration of beign cyst

- NOT GOOD TO DIFFERENTIATE b/w invasive and non invasive (therefore use CORE Bx)

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12
Q

when do you use Open wide guided bx

A

when all else fails (core Bx)

- under GA

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13
Q

when do you do an MRI when investigating breast cancer

A
  1. lobular cancer to determine the extent of disease , multifocality and the opposite breast
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14
Q

Breast cancer t staging

A 
Tis - carcinoma in situ 
T0- no primary tumour located 
T1 - no primary tumour located 
T2 - <2cm 
T3 - 2-5cm 
T4 - extension to chest wall
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15
Q

Breast cancer n staging

A

No- no nodal involvement
N1 - mobile ipsilateral axillary nodes
N2 - fixed ipsilateral axillary node
N3 - ipsilateral supraclavicular node

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16
Q

what investigations must be done to stage breast cancer

A
  • staging Ct - chest , abdomen and pelvis
  • liver US
  • bone scan
  • LFT and serum calcium
17
Q

when would you NOT do a wide local excision

A
  • the tumour is located central / retroareolar

- small brest

18
Q

indications for mastectomy

A
  • widespread disease
  • central located
  • late presentation
  • large tomour
  • multifocal
  • small breast

WCS LLM

19
Q

types of reconstruction

A

implant reconstruction - tissue expanders , saline/ silicone implants

Autologues

  • pedicle flap - latissimus dorsi (LD ) flap
  • free flap
    - deep inferior epigastric perforator (DIEP) flap
    • transverse upper gracious (TUG) flap
20
Q

complication of reconstruction

A
  1. infection
  2. hematoma
  3. serum
  4. skin flap necrosis
21
Q

axillary node clearance

A

involves 3 levels - lateral to , behind to and medial to the pectoral muscles

22
Q

risk of axillary clearance

A
  1. lymphadoema

2. axillary numbness

23
Q

when do you perform surgery if mets are present from breast cancer

A

only do if there is a fungating tumour

24
Q

risk factor for anastrozole

A

recall: aromatase inhibitor used in ER positive postmenopausal women

RISK OF OSTEOPOROSIS

25
Q

lapatinib

A

tyrosine kinase inhibitor binds to tyrosine kinase domains of EGFR and Her-2 new receptors inhibiting single transduction

26
Q

WHEN IS CHEMO OFFERED IN breast cancer

A
  1. positive nodes
  2. poor grade
  3. large tumour
  4. young patients
  5. oncogene Dx
  6. high recurrence rate
27
Q

types of chemo regime used in breast cancer

A
  1. CMF - cyclophosphamide, MTX and 5FU
  2. CA - cyclophosphamide, anthracycline
  3. Taxane based (paritaxel, docetaxel)
28
Q

who is RTX offered to in breast cancer

A
  1. breast conservative sx
  2. high grade
  3. large tumour
  4. 4> LN
  5. postive surgical margines
29
Q

what is oncogene testing for breast cancer

A

genomic testing which activates 21 genes that can affect how the cancer is likely to behave and respond to treatment

30
Q

Treatment for mets

A
  1. Endocrine
  2. CTX
  3. RTX

Site:s: - bone, lung , liver, brain , LN

31
Q

age of screening in irealndd

A

50-64 every 2 years

32
Q

fibroadenoma

A

being overgrowth due to one lobe of the breast, epithelium and fibrous components
- common < 30 but may occur in any age

33
Q

when do you excise a fibroadenoma

A
  1. if >3cm
  2. cosmetic
  3. symptoms
34
Q

dx of fibroadenoma

A

US and core Bx

35
Q

Breast cyst

A

always benign , green yellow filled cyst

- FNA and triple assessment to exclude cancer

36
Q

FCC breast disease

A

related to hormonal influences - 15-55years of age
- swelling lumpy beast multiple breast cyst
Triple assessment and reassurance

37
Q

recurrent mastitis or ductal ectasia

A

chronic inflammation of subareolar mammary ducts ass/ w/ smoking

  • yellow nipple discharge or breast abscess
  • broad spectrum antibiotics and drainage
38
Q

fat necrosis

A

necrosis of adipose tissue after traumatic injury

  • firbsosi and local heamatomma
  • presents with painless and painful breast lump
39
Q

drugs that cause gynacomastia

A

estrogen, cimetidine, spirolactone, ketoconazole, nethyldopa, cannabis

RCSI SURGERY (7 decks)

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