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Y3 surgery old > Breast Surgery > Flashcards

Breast Surgery Flashcards

1
Q

What is mastalgia?

A

Breast pain

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2
Q

What is cyclical mastalgia vs non- cyclical mastalgia

A

Cyclical mastalgia is associated with the menstural cycle. It usually comes on a few days beforehand and subsides when the period finishes
Non cyclical mastalgia is not associated with the menstrual cycle and often caused by medications such as anti-depressants, anti- psychotics and oral contraception

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3
Q

What is the management for cyclical mastalgia?

A

Reassurance, analgesia and wearing a soft bra

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4
Q

What is second line management of mastalgia?

A

Referral to specialists, usually prescribed Danazol- an anti-gonadatrophin, usually not well tolerated due to side effects

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5
Q

What is triple assessment?

A 
One stop shop for 2 ww.
Involves:
History and examination
Imaging 
Histology- core needle biopsy as fine needle is cytology only and core needle can differentiate between invasive and in situ carcinoma.
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6
Q

What is mastitis?

A

Inflammation of breast tissue usually due to S. Aureus. Can be divided into lactational and non lactational.

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7
Q

What is the prevalence of lactational mastitis?

A

Occurs in 1/3 of breastfeeding women

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8
Q

What are the clinical features of lactational mastitis?

A

Tenderness, swollen, erythema, nipple cracking and milk stasis

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9
Q

What is the epidemiology of non- lactational mastitis?

A

Can occur in any women, less common than lactational. More likely in women with duct ectasia or peri-ductal mastitis.

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10
Q

What is the main risk factor for non- lactational mastitis?

A

Smoking as it damages the sub alveolar duct walls

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11
Q

How would you treat mastitis?

A

Antibiotic therapy and analgesia. Lactational mastitis , encourage women to continue breast feeding. If there are multiple infections- cabergoline (D2 agonist to stop breast feeding)

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12
Q

What is a complication of mastitis?

A

Breast abscess which is collection of pus in the breast, lined with granulation tissue.

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13
Q

How does a breast abscess present?

A

Usually secondary to mastitis, fluctuant, tender mass with overlying erythema.

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14
Q

What are breast cysts composed of?

A

Fluid filled cavities due to the lobules becoming distended and blocked

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15
Q

How do breast cysts present?

A

Usually in perimenopausal women.
Multiple lumps or smooth masses
Can be unilateral or bilateral

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16
Q

What do breast cysts look like on mammogram?

A

They have a typical, halo like appearance

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17
Q

How do you diagnose breast cysts?

A

Ultrasound is for a definitive diagnosis

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18
Q

When would you use ultrasound guided aspiration for breast cysts?

A

Persisting lump or symptomatic. Cancer is excluded if aspiration is free of blood or cyst disappears on aspiration. If needed, the fluid can be sent for cytology

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19
Q

What is the management for breast cysts?

A

Usually self resolves, but the chance of recurrence increases. Larger ones can be aspirated

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20
Q

What are the complications of breast cysts?

A

Increase risk the of breast cancer later.
Fibrocystic changes, fibrotic area and cysts which leads to associated with tenderness and asymmetry, this can masks malignancy

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21
Q

How do we classify breast carcinoma?

A

In situ or invasive. Ductal or lobular

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22
Q

What is an in situ carcinoma?

A 
Neoplastic population of cells limited
to ducts and lobules by basement
membrane (BM), myoepithelial cells
are preserved. Does NOT invade into vessels and
therefore cannot metastasise or kill
the patient.
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23
Q

A patient comes in with a breast mass. On examination, you notice peau d’orange. What does this mean? What type of breast cancer is it more likely to be?

A

Means lymphatic drainage of the skin of breast is involved. More likely to be an invasive breast cancer as invades LN.

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24
Q

What is the duct ectasia

A

Shortening and dilation of major lactiferous duct

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25
Q

How does mammary duct ectasia present?

A

Green/yellow discharge from nipple–> blood stained triple assessment
Palpable mass
nipple retraction

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26
Q

What would you find on mammography in mammary duct ectasia?

A

calcified and dilated ducts without malignant change

27
Q

What would you see on biopsy of mammary duct ectasia?

A

Plasma cells

28
Q

How do you treat mammary duct ectasia?

A

Conservatively usually however if there is unremitting nipple discharge, duct excision can take place

29
Q

What is the history you would expect for a patient with fat necrosis

A

trauma or radiotherapy/ surgery

30
Q

What factors determine prognosis in breast cancer?

A

1) Whether the malignant tumor is in situ or invasive. 2) The tumor stage - Tumor size, Lymph Node involvement, Distal Metastasis. 3) Grade of the tumor. 4) Histology of the tumor. 5) Gene expression profile.

31
Q

What is the most common benign growth in the breast?

A

Fibroadenoma

32
Q

What are fibroadenomas made from?

A

They are proliferations of stromal and epithelial tissue

33
Q

How do fibroadenomas feel on palpitation?

A

They are highly mobile lesions, well defined and rubbery, with most less than 5cm

34
Q

What is the prognosis of a fibroadenoma?

A

They have very low malignant potential and can be left in situ with routine follow ups over a 2 year period, up to 30% will get smaller

35
Q

What are the indications of excision of a fibroadenoma?

A

Greater than 3cm in diameter or patient preference

36
Q

Define invasive breast cancer

A

Neoplastic cells invade beyond the BM into the stroma. They can invade vessels and metastasise to LN and other sites.

37
Q

How does invasive breast cancer present?

A

Mass or abnormality on mammogram. Gradual breast enlargement. PMH or FHx of breast cancer

38
Q

What would you find on examination of breast with invasive breast cancer?

A

Lump - hard, painless, irregular margins, fixed to the skin or chest wall. Skin dimpling, Peau d’orange, discharge that is bloody or unilateral. Nipple retraction.

39
Q

What does Peau d’orange show?

A

Involvment of lymphatic drainage of the skin.

40
Q

How can invasive breast cancer be classified?

A

Ductal or lobular. Ductal is more common

41
Q

A woman attends your clinic with a breast lump. What differentials are possible?

A

Fibroadenoma, fibrocystic breast, fat necrosis, intraductal papilloma, breast abscess, Phyllodes tumour (a tumour that grows in stroma of breast). Radial scar, atypical ductal hyperplasia, atypical lobular hyperplasia.

42
Q

Name two risk factors for breast cancer

A

Age, obesity, gene mutations - BRCA1, BRCA2. Early menarche or late menopause (as longer exposure to hormones). PMH of breast cancer or breast disease. Fix of breast or ovarian cancer. Previous treatment using radiation. Exogenous oestrogen use - long term OCP or HRT.

43
Q

What is the difference between a ductal carcinoma and lobular carcinoma of the breast (both non-invasive)?

A

Ductal - limited to the ducts by the basement membrane. Lobular - limited to the lobules by the basement membrane.

44
Q

How does non-invasive ductal carcinoma in situ present (DCIS)?

A

No Sx apart from lump present, and bloody nipple discharge.

45
Q

How are DCIS or LCIS detected?

A

Through screening

46
Q

How does LCIS present?

A

Rarely presents as a palpable mass. Found incidentally.

47
Q

Define Paget’s disease

A

A disease of the nipple associated with breast cancer. 97% have an underlying neoplasm.

48
Q

How does Paget’s disease present?

A

Rough, red and ulcerated nipple. Itching of the nipple or areola. Flaking and thickened skin around nipple. Pt may mention bloody or yellow discharge.

49
Q

What would be seen on examination of a pt with Paget’s disease?

A

Painful and sensitive nipple. Flattened nipple.

50
Q

A woman (60yrs) with a PMH of breast cancer has a mastectomy. She is then started on an aromatase inhibitor. What is the main complication of these drugs in post menopausal women?

A

Increases risk of osteoporosis.

51
Q

How do fibroadenomas present?

A

In a woman of reproductive age. Is rubbery, v mobile, well defined, multiple, bilateral, less than 5cm (usually)

52
Q

How are fibroadenomas managed?

A

They have a v low malignant potential so are left in situ with 2 year follow up appts.

53
Q

You find a fibroadenoma of 5cm. How do you manage it?

A

Excision (as over 3cm).

54
Q

Name 2 RF for fibroadenomas.

A

Young age - below 35. Prior hx of benign breast disease. Obesity. Fix of multiple adenomas. COCP before 20yrs.

55
Q

You have examined a woman and think she has fibrocystic change. How would she have presented to get to this differential?

A

Nodularity (uni or bilateral). Lumps are smooth. Woman is perimenopausal. May have pain which is worse before period.

56
Q

What investigations would you like to do for fibrocystic changes?

A

Mammography - see halo like appearance.

USS for definitive diagnosis. If cysts are recurrent or symptomatic - can aspirate the cysts.

57
Q

How are fibro cysts managed?

A

Usually self resolve. If large - can be aspirated.

58
Q

What is the link between fibrocystic changes and breast cancer?

A

increases likelihood of breast cancer by 2-3x.

59
Q

features of pagets disease of the nipple?

A

Weepy crusty lesion on the nipple with the areola spared until later

60
Q

Nice guidelines about unexplained breast lump?

A

Women aged >30 with an unexplained breast lump using 2WW

61
Q

malignancy associated with blood stained discharge?

A

Papilloma

Passbook says most duct papillomas unlikely to be malignant ?

62
Q

Females <30y/o with a non-tender, discrete and mobile lump?

A

Fibroadenoma

63
Q

What is a complication associated with axillary node clearance?

A

arm lymphedema and functional arm impairment

64
Q

When can you excise a fibroadenoma?

A

When it is greater than 3.5cm

Y3 surgery old (6 decks)

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