Breast surgery Flashcards
Describe the histology of benign breast cancer conditions.
- Well circumscribed
- Unencapsulated
- Clean margins
- Columnar cell hyperplasia
- Fibrocystic changes
Name the benign breast conditions.
- Fibrocystic changes
- Fibroadenoma
- Breast cyst
- Lactational mastitis
- Periductal mastitis
- Duct ectasia
- Fat necrosis
Benign breast conditions
What are the symptoms and presentation of fibroadenoma?
- Common in adolescent women;
- Firm;
- Non tender;
- Highly mobile;
- Upper outer quadrant.
Benign breast conditions
How is the diagnosis of fibroadenoma made?
Most appropriate investigation:
- Ultrasound
If required:
- FNAC
- Biopsy
What is the histology presentation of fibroadenoma?
HIGH YIELD
- ⬇︎ stromal cellularity;
- Overgrowth of fibrous and glandular tissue;
- Duct-like epithelium with fibrous bridging (????);
- Well circumscribed;
- Unencapsulated;
- Clear margins;
- Separated from the surrounding fatty tissues.
Benign breast conditions
What are the symptoms and presentation of fibrocystic changes?
- Affects premenopausal women;
- Pain and lumpiness of breast.
Benign breast conditions
What are the symptoms and presentation of breast cyst?
- Fluid filled round mass;
- Asymptomatic or painful.
What are the symptoms and presentation of lactational mastitis?
Symptoms:
- Unilateral and firm;
- Erythema in a wedged shaped area;
- Tender breast;
- Usually on the first 3 months of breast-feeding;
Cause:
- S. Aureus
Rx:
- Analgesics;
- Warm compress;
- Keep on breast-feeding;
- Flucloxacillin;
- Penicillin allergy: erytromycin / clarithromycin
Benign breast conditions
What are the symptoms and presentation of periductal mastitis?
Symptoms:
- Green nipple discharge;
- Peri-areolar mass;
- Nipple rectration;
- Periareolar redness
- Hot and tender breast
Cause:
- S. Aureus
Risk factor:
- Smoking
Rx:
- Analgesics;
- Warm compress;
- Co-amoxiclav;
- Penicillin allergy: erytromycin / clarithromycin
Benign breast conditions
What are the symptoms and presentation of duct ectasia?
Symptoms:
- Green or brown nipple discharge;
- Nipple rectration;
- Subareolar mass (near the nipple);
- Perimenopausal and postmenopausal women;
Cause:
- Dilation of breast ducts;
Risk factor:
- Smoking
Benign breast conditions
What are the symptoms and presentation of fat necrosis?
Symptoms:
- Firm localized lump
- Erythema
Cause:
- Trauma
What are the symptoms and presentation of duct / mamillary fistula?
Cause: sequelae of periductal mastitis.
Symptoms:
- Pain around areola;
- Sweeling;
- Redness;
- Fever;
Risk factor:
- Smoking
- Periductal mastitis
Rx:
- Fistulectomy
- Antibiotics
Describe the types of mastalgia.
Cyclical:
- Bilateral breast pain;
- Starts 1-3 days before the menstrual cycle;
- Common in young women;
Non-cyclical:
- Not related to menstrual cycle;
- Usually unilateral;
- > 40 years of age;
What is the Rx of mastalgia?
- Analgesia
- Supportive better fitting bra during the day;
- Soft supportive bra at night.
In relation to mastalgia, when should a patient be given an urgent referral?
If presenting with:
➜ Mastalgia + Discrete lump + Family h/o of breast cancer.
What are the symptoms of intercostobrachial neuralgia?
➔ Pain in the area of the intercostobrachial nerve.
Affects the:
- Chest;
- Upper arm;
- Axilla.
What is the cause of intercostobrachial neuralgia?
- Breast surgery;
- Axillary lymph node dissection.
What is the cause of intraductal papilloma?
➔ Benign tumour due to a papilloma (wart) within the breast ducts.
Common in women between 35-55 YO.
What are the symptoms of intraductal papilloma?
- Serous or bloody nipple discharge;
- (Sometimes) lump
near the areola;
DDx between:
- Duct ectasia;
- Breast cancer;
- Intraductal papilloma.
Duct ectasia
- Green/brown discharge;
- Inverted nipples;
- Mass near areola;
Breast cancer
- Hard, irregular mass;
- Not restricted to the areola area;
Intraductal papilloma
- Serous/bloody discharge;
- Lump near areola.
What are the symptoms of Paget’s disease (breast)?
- Bloody nipple discharge;
- Dry areolar skin ➝ itching;
- Ulcerated nipples;
◆ Chronic: Inverted nipple.
What is the investigation of Paget’s disease (breast)?
- Skin punch biopsy.
What are the investigations of choice for breast disorders?
In terms of age.
➜ Ultrasound:
- Women < 40 years.
➜ Mammography:
- Women ≥ 40 years.
Describe how is the mammogram screening done.
Age 50-70 years:
- Every 3 years.
Age 40-70 yearsEvery 1 year if:
- Family history;
- BRCA gene positive
Describe what is Phyllodes tumour.
- Benign fibro-epithelial tumour;
- Common in 40-50 year (pre-menopausal women);
- Fast growing;
- Painless;
- Large size.
What are the indications for prophylatic mastectomy?
- Strong family history;
- Positive BRCA;
- Breast cancer in one breast;
- Biopsy suggestive of lobular carcinoma;
- Biopsy suggestive of atypical hyperplasia.
What are the complications seen post mastectomy?
- Upper limb
lymphoedema(due to removal of axiliary lymph nodes); -
Frozenshoulder(due to reduced shoulder movement); -
Scar tissue cordingin the armpit.
What is the management of complications seen post mastectomy?
- Exercise
- Compression bandaging for lymphoedema
- Scar mobilisation
What is the management when breast cancer is suspected?
- 2 week wait referral to breast clinic;
Breast clinic:
- < 40 Ultrasound
- > 40 Mammogram
- Biopsy (core needle or FNAC)
Histopathology
What are the labs requested in breast cancer?
Histopathology
- Oestrogen receptor (ER)
- Progesterone receptor (PR)
- Human epidermal growth receptor 2 (HER2)
ER positive breast cancer:
- Premenopausal ➝ Tamoxifen
- Postmenopausal ➝ Anastrozole (aromatose inhibitors)
- Men ➝ Tamoxifen
HER 2 positive breast cancer:
- Trastuzumab
When doing treatment for breast cancer with tamoxifen, which medication should be added?
Biphosphonates.
In a pregnant woman, what treatment is recommended for breast cancer?
- Surgery;
- Chemotherapy (not on the 1st trimester).
Radiotheraphy is not recommended.
