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Finals > Breast surgery > Flashcards

Breast surgery Flashcards

1
Q

what is the most common breast cancer?

A

invasive ductal - NST

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2
Q

what is pagets disease of the nipple?

A

it is eczematoid changes of the nipple that indicates an underlying malignancy

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3
Q

what is the pathophysiology of inflammatory breast cancer?

A

cancerous cells block the lymph drainage

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4
Q

what are the risk factors for breast cancer?

A

BRCA1/2, first degree relative, nulliparity, early menarche, late menopause, COCP, previous surgery, PMHx, p53 mutations, not breast feeding, radiation, obesity

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5
Q

what is the referral criteria for breast cancer?

A

> 30 with unexplained lump with or without pain, >50 with nipple changes, consider if skin changes or axillary lump >30

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6
Q

what is the breast cancer screening programme?

A

50-70 every 3 years, >70 make own appointments
refer if >1 relative and age <40, bilateral, male, ovarian, jewish, sarcoma, glioma, complicated, paternal history, screen early if increased risk

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7
Q

what is the presentation of breast cancer?

A

thickening, lump, change in size or shape of breast, dimpling, inflammation, nipple retraction, discharge, peeling, pitting, crusting

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8
Q

how is breast cancer investigated and managed?

A

ix: H&E, mammogram, U/S, biopsy, CT/MRI, SLNB
mx: surgery - mastectomy or WLE (solitary, small, peripheral, DCIS<4cm), radiotherapy, hormonal therapy, biologics, chemo

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9
Q

summarise breast abscess?

A

it can be lactational or non-lactational - cannot drain and therefore collection of WBC and pus. Can be infective. The risk factors are smoking, damage to nipple, underlying breast disease, caused by S Aureus etc. Presents with nipple discharge (purulent), localised pain, tenderness, warmth, erythema, hardening, swelling, fluctuant, fatigue, fever, sx sepsis
mx: lactational: massage, breast feed, express, analgesia, heat, abx
non: analgesia, ABx: co-amox or macrolide, treat cause
abscess: refer, ABx, U/s, I&D or aspiration, M,C&S of fluid

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10
Q

what are the differentials for breast lumps?

A

fibrocystic disease (mastalgia, cyclical, lumps), breast cancer, fibroadenoma (painless, smooth, round, firm, mobile), phyllodes tumour (connective tissue, large, fast growing), lipoma (soft, painless, mobile), fat necrosis (painless, firm, irregular), galactocele (after stopping breast feeding, firm, mobile, under areola), cysts

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11
Q

what is gynaecomastia?

A

it is enlargement of the breast tissue in males, that is caused by imbalance between oestrogen and testosterone, increased prolactin, hyperthyroidism, drugs, hypothalamus or pituitary conditions, increased oestrogen, idiopathic, physiological, and decreased testosterone

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12
Q

how is gynaecomastia investigated and managed?

A

ix: bloods - FBC, U&Es, LFTs, TFT, testosterone, SHBG, E2, prolactin, LH, FSH, bhCG, AFP
karyotyping
USS, mammogram, biopsy, testicular US, CXR
mx: conservative, stop causative drug, tamoxifen, surgery

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13
Q

what is galactorrhoea?

A

it is breast milk that is not due to pregnancy or breast feeding - in response to prolactin
can be caused by increased prolactin, endocrine disorders, drugs

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14
Q

how does galactorrhoea present?

A

milk, menstrual cycle irregularities, decreased libido, ED, gynaecomastia

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15
Q

what can non milk discharge be?

A

mammary duct ectasia, duct papilloma, abscess

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16
Q

how does prolactinoma present?

A

associated with MEN, micro or macro, headache, bitemporal hemianopia

17
Q

how is galactorrhoea investigated and managed?

A

ix: serum prolactin, PT, U&Es, LFTs, TFTs, MRI
mx: underlying cause, dopamine agonists, transsphenoidal surgical removal

18
Q

summarise breast pain?

A

can be cyclical or non-cyclical. It is not a symptom of breast cancer.
cyclical: hormones: 2w prior to and stops during menstruation. other sx of premenstrual syndrome: low mood, bloating, fatigue, headaches, usually bilateral, generalised and heaviness/aching
non-cyclical: 40-50y, localised: medications, infection, pregnancy, chest wall, skin
ix: diary, r/o cancer, infection, pregnancy
mx: conservative, supportive bra, NSAIDs, warmth, avoid caffeine, hormonal e.g. tamoxifen

19
Q

what is lactational mastitis?

A

it is inflammation of the breast tissue during breast feeding, with or without infection usually due to obstruction (accumulation of milk) or infection (S Aureus)

20
Q

how does lactational mastitis present?

A

breast pain and tenderness, erythema of focal area, local warmth, inflammation, fever, nipple discharge

21
Q

how is lactational mastitis managed?

A

conservative - express, massage, heat, analgesia
flucloxacillin or erythromycin, M,C&S
I&D for abscess
treat candida

22
Q

what is a complication of the management of lactational mastitis?

A

after abx can get candida infection - recurrent and associated with oral or nappy rash
sore bilateral nipples, tenderness, itching, soreness, cracked, flaky, shiny areola, oral or nappy rash in baby
topical miconazole 2% to each nipple after each feed
baby: miconazole gel or nystatin

23
Q

what is mammary duct ectasia?

A

it is dilatation of large ducts in the breast due to inflammation usually in smokers and periomenopause

24
Q

how does mammary duct ectasia present?

A

nipple discharge, tenderness, pain, nipple retraction or inversion, lump

25
Q

how is mammary duct ectasia investigated and managed?

A

ix: H&E, triple assessment, ductograhy, ductoscopy, discharge cytology
mx: conservative, r/o cancer and reassure, symptomatic with warmth, analgesia, supportive bra, ABx, excision of duct

26
Q

what is intraductal papilloma?

A

it is a warty lesion in a duct of the breast due to proliferation of epithelial cells - benign but can be associated with breast cancer or atypical hyperplasia

27
Q

how does intraductal papilloma present?

A

35-55y, asymptomatic, clear, blood stained discharge, tenderness, pain, lump

28
Q

how is intraductal papilloma investigated and treated?

A

ix: H&E, triple assessment, ductography
mx: surgical excision, look at tissue for hyperplasia or cancer

Finals (16 decks)

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