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Surgery > Breast & endocrine > Flashcards

Breast & endocrine Flashcards

1
Q

High risk family history of breast cancer

A

3+ family members with breast cancer
OR
2+ members with breast cancer (one with bilateral disease)
OR
1+ immediate family member with breast cancer younger than 40y/o at diagnosis

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2
Q

Percentage of breast cancers confirmed by triple assessment

A

Over 90%

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3
Q

Why is mammogram more efficient in older women than younger

A

Depends on fat replacement to tell dense changes compared to loose surrounding fat

Dense breasts make mammography less sensitive to small change

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4
Q

Benefits of breast ultrasound

A
  • Determines if lesion is solid OR fluid-filled OR both
  • Used in younger patients, and as a supplemental imaging with mammography
  • Can also be used to guide biopsy
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5
Q

Findings of breast fibroadenoma on imaging

A

Elliptical shape

Regular

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6
Q

Findings of breast carcinoma on imaging

A

Invasive, irregular, shadowing

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7
Q

What does the triple test for breast cancer entail

A

Clinical examination
Imaging (mammogram or USS)
Fine needle biopsy

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8
Q

What to do if triple assessment is discordant in work up of breast lesion

A

Perform core or open biopsy to confirm diagnosis

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9
Q

What to do with results for breast lesion FNA

A

Cellular and benign - accept unless inconsistent with imaging (repeat with core biopsy)
Cellular atypia - core or open biopsy
Suspicious - repeat with core or open biopsy
malignant - progress to treatment

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10
Q

Management of breast cancer

A

Wide excision of primary tumour + mastectomy OR radiotherapy to remaining tissue
Surgical removal of sentinel nodes for assessment of local spread and need for adjuvant tx
Metastasis: chemotherapy, hormonal therapy (tamoxifen), herceptin

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11
Q

Indications for breast conserving surgery

A

Early breast cancer
Small cancers (less than 3cm or less than 4cm in large breasts)
Need for small excision without cosmetic detriment
Single tumours
T1-2 minimal nodal involvment, MO

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12
Q

Contraindications for breast conserving surgery in breast cancer

A 
T4, N2 or M1
Patient choice
Strong family history (e.g. BRCA)
Incomplete excision
Multi-centric cancers
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13
Q

Indications for total mastectomy

A 
Large cancer, small breasts
Extensive nodal disease
Multiple cancers
Patient Choice
Following attempted, failed breast conserving surgery
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14
Q

Complications of axillary clearance

A 
Seroma
Infection
Injury to motor and/or sensory nurves
Lymphoedema
reduced shoudler mobility
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15
Q

Indications for radiotherapy in breast cancer

A

Inoperable cancer
- after conservative surgery
- post-mastectomy (involved nodes, extensive primary, vascular invasion)
Advanced local disease
Metastatic disease (palliation of bone disease and local recurrence)

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16
Q

Types of systemic therapy in breast cancer

A 
Chemotherapy
Hormone therapy (e.g. tamoxifen)
Biological therapy (e.g. herceptin)
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17
Q

Clinical features of breast fibroadenoma

A

Detection of mobile lump on self-examination
May grow during pregnancy
Well-defined mobile mass (breast mouse)
Usually in upper outer quadrant

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18
Q

Ultrasound of breast fibroadenoma

A

Well-circumscribed, round-ovoid mass, generally uniform hypoechogenicity

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19
Q

Management of breast fibroadenoma

A

Core biopsy or follow-up in 6 months
Surgical excision if symptomatic or patient choice
- cryoablation also an option
If increase in size, excise to exclude malignant change

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20
Q

Clinical features of intraductal papilloma of breast

A

Nipple discharge (bloody or clear) for less than 6 months (spontaneous and intermittent), sense of fullness below the nipple relieved by passage of discharge

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21
Q

Imaging findings in intraductal papilloma of breast

A

Often normal
May have dilated duct(s), circumscribed benign appearing mass or cluster of suspicious calcifications
Solid hypoechoic mass on ultrasound
Galactography - filling defect or other ductal abnormality e.g. ectasia, obstruction or irregularity

22
Q

Causes of breast abscesses

A

RARE
most common in breast-feeding women as a complication of mastitis (primiparous women especially)
higher incidence in diabetes

23
Q

Common bacterial causes for breast abscess

A

Staph aureus
Staph epidermidis
Proteus mirbilis

24
Q

Classifications of breast abscess

A 
Puerperal abscess (breastfeeding)
Non-puerperal central abscess (mostly young women, smokers)
Non-puerperal peripheral abscess (less common, older women with underlying medical conditions e.g. DM, RA, steroids or post-breast intervention)
25
Q

Management of breast abscess

A

Continue feeding or expression of milk

Antibiotics and drainage

26
Q

Definition of fat necrosis

A

An ill-defined breast lump produced by a benign inflammatory process caused by necrosis and saponification of fatty tissues secondary to trauma

27
Q

Causative factors of fat necrosis of breast

A

Direct trauma

  • Seatbelt
  • breast biopsy
  • breast surgery
  • injury
28
Q

Clinical features of fat necrosis

A

history of trauma to breast
Tender mass
Solitary irregular ill-defined mass
Skin retraction

29
Q

imaging of fat necrosis of breast

A

MG: Ill-defined, irregular, spiculated mass +/- peripheral calcification
USS: hypoechoic mass +/- mural nodules

30
Q

Management of fat necrosis of the breast

A

Excisional biopsy to exclude malignancy
Follow up evaluation
minimise risk of trauma

31
Q

epidemiology of galactoceles

A

most common benign breast lesion
typically occurs in young lactating women, on cessation of lactation
RF: breast feeding, mastitis, galactorrhoea, abrupt weanint

32
Q

Clinical features of galactocele

A

Painless mass in central portion of breast occurring over weeks to months
Non-tender
Thick, creamy material on aspiration

33
Q

management of galactocele

A

No specific therapy required
Will subside in a few weeks
Needle aspiration or drainage with gentle pressure if complicated by infection

34
Q

Mammary duct ectasia definition

A

Dilation of ducts of breast with inspissation of normal secretions, arising from chronic intraductal and periductal inflammation causing fibrosis

35
Q

Clinical features of mammary duct ectasia

A

thick grey-black nipple discharge
Pain and nipple tenderness
Palpable mass with skin retraction
Firm, rounded, fixed mass

36
Q

Imaging of duct ectasia

A

MG: dilated linear branching densities in subareolar region, rod-like calcifications pointing towards nipple
US: dilated, fluid filled subareolar ducts with moving echogenic debris (often mimics intraductal papilloma)

37
Q

Management of mammary duct ectasia

A

Surgical excision with a cone of surrounding tissue if warranted by patients symptoms

38
Q

Lifetime risk of breast cancer if BRCA1 or 2 positive

A

50-85%

gene mutation present in 5-10% of all breast cancers

39
Q

Risk factors for breast cancer

A

70% OF BREAST CANCER IS IN WOMEN WITH NO KNOWN RISK FACTORS

  • older age
  • family history
  • BRCA1 or BRCA2
  • hormonal factors (early menarche, late menopause, late parity, multiparity, HRT)
  • radiation exposure
  • benign breast disease
40
Q

Protective factors for breast cancer

A

Prolonged breast feeding
Avoidance of alcohol and reducing dietary fat
Maintaining a slim body and exercise

41
Q

Biological markers in breast cancer

A

Oestrogen and progesterone (if +ve more likely to respond to hormone therapy)
HER2 gene amplified - more likely to respond to herceptin therapy

42
Q

What are the most common malignancies of the breast

A
  1. Infiltrating ductal carcinoma

2. Infiltrating lobular carcionma

43
Q

Most common location of malignant breast lesions

A

Upper outer quadrant

44
Q

Differences between clinical features of lobular and ductal infiltrating carcinomas of the breast

A

Lobular more likely to be bilateral/contralateral
Lobular more likely to be larger (due to histology, difficult to palpate smaller mass)
Slightly overall higher survival rates for lobular than for ductal

45
Q

Most common types of thyroid cancers

A 
Papillary carcinomas (80%)
Follicular carcinomas (10%)
Medullary thyroid carcinomas (5-10%)
Anaplastic carcinomas
Primary thyroid lymphomas
Primary thyroid sarcomas
46
Q

Risk factors for papillary carcinoma of the thyroid

A

OCP use
Benign thyroid nodules
Late menarche
Nulliparity/late age at first birth
May be associated with uncommon familial syndromes
Most common thyroid cancer associated with radiation to head and neck
Most common thyroid cancer in children

NOT ASSOCIATED WITH MEN SYNDROMES

47
Q

Histological features of papillary carcinoma of the thyroid

A

Large thyrocytes with abnormal nucleus and cytoplasm
- “orphan annie” eyes = large round cells with dense nucleus and cytoplasm
Psammoma bodies
Thyroglobuln +ve, keratin +ve, calcitonin -ve, CEA -ve

48
Q

Features of follicular carcinoma of the thyroid

A

Macroscopic:
Encapsulated, solitary, often necrotic/haemorrhagic areas
Microscopic:
Well-defined follicles containing colloid (similar to normal thyroid)

49
Q

Thyroid cancers associated with MEN syndromes

A

Medullary thyroid carcinoma associated with MEN2a and MEN2b

50
Q

Radioisotope uptake in thyroid cancers

A

Thyroid cancers are non-secretory therefore they do not take up radioactive iodine (Cold nodules)

Surgery (8 decks)

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