Breast examination

Question 1

Breast lump DDx?

Answer 1

malignant (invasive ductal ca most common)

benign

• fibroadenoma
• breast cyst (may be painful)
• abscess (painful, hot and swollen)

Question 2

How would you investigate a breast lump?

Answer 2

Triple assessment

Question 3

Does breast dimpling imply malignancy/invasion into underlying musculature?

Answer 3

not necessary

Question 4

Why does dimpling occur?

Answer 4

Intra-mammary tumor can pull on ligament of Astley Cooper - causing dimpling of skin

Question 5

How to accentuate dimpling?

Answer 5

raise hands above head

Question 6

So pt is Dx w/ breast ca. What surgeries would you consider?

Answer 6

breast conserving - lumpectomy; wide local excision (<4 cm diameter tumor)

mastectomy - partial; total; radical (underlying musculature removed) w/ breast reconstruction

Question 7

axillary lymph nodes?

Answer 7

sentinel node Bx if clinically/USS node -ve

axillary clearance if clinically/USS/sentinel Bx +ve

Question 8

Talk abt chemotherapy on breast ca?

Answer 8

Neo-adjuvant (pre-op) chemotherapy used to shrink tumor prior to surgery

adjuvant (post-op) chemotherapy following osme surgery - depends on multiple factors including tumor size, grade, node & receptor status

Question 9

Talk abt radiotherapy on breast ca?

Answer 9

Neo-adjuvant radiotherapy not used
Adjuvant radiotherapy
- following most breast-conserving surgery
- following some mastectomies (depends on multiple factors as above)

Question 10

What abt hormonal therapy on breast ca?

Answer 10

depends on hormone receptor status of tumor

• neo-adjuvant & adjuvant therapy can be used
• eg tamoxifen, anastrozole, letrozole, trastuzumab (Herceptin)