breast surgery Flashcards
list the three main criteria for a 2ww referral for people with Br Ca
2 always
2 consider
Always refer If:
1. They are aged 30 and over and have an unexplained breast lump with or without pain or
2. They are aged 50 and over with any of the following symptoms in one nipple only:
- Discharge
- Retraction
- Other changes of concern
Consider referring if:
1. With skin changes that suggest breast cancer or
2. Aged 30 and over with an unexplained lump in the axilla
what would be your management with people aged under 30 with an unexplained breast lump with or without pain - refer / not / how urgent?
non-urgent referral
what is the suspected diagnosis in a woman less than 30 with a discrete, non-tender, highly mobile lump
Fibroadenoma
middle aged woman (30-50 especially)
lumpy painful breasts - may be painful
symptoms may worsen just before menstruation
BREAST CYSTS
fibrocystic changes (fibroadenosis)
(benign mammary dysplasia)
(fibrocystic disease
Most common around the menopause
May present with a tender lump around the areola (an associated abcess) +/- a green nipple discharge**
mammary duct ectasia
May present with blood stained discharge
local areas of epithelial proliferation in large mammary ducts
duct papilloma
common in obese women with large breasts
may follow trivial / unnoticed trauma
INFLAMMATORY RESPONS - lesion starts off firm and round, then develops into a hard irregular breast lump
fat necrosis
common in lactating women
red, hot, tender swelling
breast abcess
what would a progressive erythema and oedema of the breast in the absence of signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3 suggest?
inflammatory disease of the breast
smoker, recurrent episodes of infection in the right breast. On examination, she has an indurated area at the lateral aspect of the nipple areolar complex. Imaging shows no mass lesions. What is the most likely diagnosis?
Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav. Mondor’s disease of the breast is a localised thrombophlebitis of a breast vein.
brown-green nipple discharge?
duct ectasia
commonly occurs with aging..
As the ducts shorten and dilate a degree of symmetrical slit like retraction occurs. A small amount of cheese like discharge may occur.
what are the four main types of BrCa?
- invasive ductal Ca(most common)
- invasive lobular ca
- ductal Ca in situ
- lobular Ca in situ
describe the features of malignancy that would suggest mastectomy as the best option?
Multifocal tumour Central tumour Large lesion in small breast DCIS >4cm Patient Choice
describe the features of malignancy that would suggest widE local excision as the best option?
Solitary lesion Peripheral tumour Small lesion in large breast DCIS <4cm Patient choice
when might radiotherapy be offered post surgery? and what are the criteria post each surgery..
Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds.
Mastectomy:
For women who’ve had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes