Breast surgery Flashcards
What is part of the breast triple assessment?
clinical assessment
imaging
+/- biopsy
If there is a scaly nipple, what should you suspect?
Paget’s disease of the breast
How does breast eczema usually present?
affects areola and usually spares nipple
If you suspect breast cancer in a patient <40, what imaging should be done?
ultrasound +/- core biopsy
mammogram if malignant
breasts are generally denser so mammogram less good in younger patients
If you suspect breast cancer in a patient <40, what imaging should be done?
mammogram + ultrasound +/- core biopsy
What is the number system used to assess breast cancer?
1 = normal
2 = benign
3 = indeterminate, probably benign
4 = suspicious for malignancy
5 = highly suspicious for cancer
What is the gold standard biopsy type for breast cancer?
core biopsy (not fine needle aspiration)
Describe cyclical breast pain
mild breast pain
<5 days before menstrual cycle
dull, aching or burning
no association with cancer
exacerbation of sx prior to menopause, most resolves
Describe non-cyclical breast pain
shorter pain
usually unilateral
exacerbations of pain for no clear reason and difficult to treat
generally not associated with cancer (0.4% is cancer)
What are some other origins of mastalgia?
scapular bursitis
costochondritis
lateral extramammary pain syndrome
cervical radiculopathy
Breast pain management
supportive bra, day and night
weight loss
caffeine reduction
medications - SSRI, OCP, HRT
topical NSAIDs
vitamin E supplements
Clear nipple discharge cause
intraductal papilloma
Milky nipple discharge causes
physiological up to 2 years after breastfeeding
prolactinoma
Purulent nipple discharge cause
periductal mastitis - antibiotics, drainage of collection, smoking cessation
Multi-coloured nipple discharge cause
duct ectasia - normal ageing of breast/ducts
Blood-stained nipple discharge causes
intraductal papilloma
malignancy
Non-proliferative benign breast lesions
cysts
duct ectasia
fibroadenoma
lipoma
Proliferative benign breast lesions
sclerosing adenosis
intraductal papillomas
Breast cancer risk factors
age
gender
genetics/family history
oestrogen exposure (early menarche, late menopause, nulliparous, pregnancy age>35, not breastfeeding)
OCP - weak risk
HRT (beyond age 55, risk returns to normal 5 years after stopping)
previous benign breast disease
obesity
alcohol
previous radiation exposure (eg. mantle radiotherapy for lymphoma)
Non-invasive breast cancer subtypes
ductal carcinoma in situ
lobular carcinoma in situ
Invasive breast cancer subtypes
invasive ductal carcinoma
invasive lobular carcinoma
other types: tubular, micropapillary, apocrine, metaplastic
What receptors are all breast tumours routinely screened for?
oestrogen receptor (ER)
progesterone receptor (PR)
HER2
What breast cancer type has worst prognosis?
triple negative
What genes are tested for in breast cancer?
BRCA1
BRCA2
PALB2
ATM
CHEK2
Indications for genetic testing in patients without a personal history of breast cancer
1st degree relative with breast or serous ovarian cancer
AND
combined pathology-adjusted manchester score>20 or BOADICEA score >10%
AND
no living affected individual available for genetic testing
AND
no deceased affected individual with tissue available for testing
Indications for genetic testing in patients with breast cancer
breast cancer <30y
bilateral breast cancer <50y
triple negative breast cancer <60y
male breast cancer
non-mucinous ovarian cancer
breast cancer and a 1st degree relative with breast cancer (both <45y)
ashkenazi jewish ancestry
What risk-reducing strategies can be used for patients at high risk of breast cancer due to genetics? (eg. BRCA 1/2)
surgery - bilateral prophylactic mastectomy
risk-reducing salpingoophrectomy
chemoprevention - tamoxifen daily for 5y
Who is offered a mammogram in NHS screening?
women aged 50 to 71 offered a mammogram every 3 years
women over 71 can request the screening continues if they wish
