breast surgery Flashcards

1
Q

list the three main criteria for a 2ww referral for people with Br Ca

2 always
2 consider

A

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

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2
Q

what would be your management with people aged under 30 with an unexplained breast lump with or without pain - refer / not / how urgent?

A

non-urgent referral

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3
Q

what is the suspected diagnosis in a woman less than 30 with a discrete, non-tender, highly mobile lump

A

Fibroadenoma

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4
Q

middle aged woman (30-50 especially)
lumpy painful breasts - may be painful
symptoms may worsen just before menstruation

A

BREAST CYSTS
fibrocystic changes (fibroadenosis)
(benign mammary dysplasia)
(fibrocystic disease

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5
Q

Most common around the menopause

May present with a tender lump around the areola (an associated abcess) +/- a green nipple discharge**

A

mammary duct ectasia

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6
Q

May present with blood stained discharge

local areas of epithelial proliferation in large mammary ducts

A

duct papilloma

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7
Q

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

A

fat necrosis

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8
Q

common in lactating women

red, hot, tender swelling

A

breast abcess

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9
Q

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?

A

inflammatory disease of the breast

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10
Q

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?

A

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.

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11
Q

brown-green nipple discharge?

A

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.

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12
Q

what are the four main types of BrCa?

A
  1. invasive ductal Ca(most common)
  2. invasive lobular ca
  3. ductal Ca in situ
  4. lobular Ca in situ
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13
Q

describe the features of malignancy that would suggest mastectomy as the best option?

A
Multifocal tumour	
Central tumour
Large lesion in small breast	
DCIS >4cm	
Patient Choice
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14
Q

describe the features of malignancy that would suggest widE local excision as the best option?

A
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS <4cm
Patient choice
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15
Q

when might radiotherapy be offered post surgery? and what are the criteria post each surgery..

A

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

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16
Q

what adjuvant hormonal therapy should be used if a women is ER+ve and

a. pre-menopausal
b. peri-menopausal
c. post-meno

A

a. tamoxifen (anti-oestrogen)
b. tamoxifen
c. anastrozole (aromatase inhibitor)

(NB - more than half of brca are oestrogen recpetor postiive - rate is roughly equivalnent to the age of the patient…)

NB - ER+ve is a good prognosis

17
Q

what are some side effects of tamoxifen..?

A

increased risk of endometrial cancer
VTE
menopausal Sx..

18
Q

discuss the HER-2 receptor.

a. what does it mean for prognosis
b. how can it be treated with adjuvant biological therapy

A

a. bad prognosis

b. Herceptin (tratuzumab)

19
Q

what is the use of proliferative markers such as Ki67?

A

show increased proliferation if high

use chemotherapy

20
Q

what does a persistent lump spanning at least one menstrual cycle and irregularity suggest? (and fixed..)

A

Breast cancer!

21
Q

how would you distinguish paget’s disease of the nipple and eczema of the nipple?

A

Pagets usually affects the nipple first, then pushes out
Pagets often assoc with DCIS or invasive carcinoma
Eczema tends to predominantly affect the areolar region

22
Q

non-malignant breast disease with thick green nipple discharge, occurring with breast involution

A

duct ectasia

23
Q

blood stained nipple discharge in younger women
what is the Dx?
how to investigate?

A

Intraductal papillomata are the commonest cause of blood stained nipple discharge in younger women. There is seldom any palpable mass. An ultrasound is required and possibly a galactogram.

24
Q

what can happen to fibroadenomas in pregancy?

A

can enlarge

25
Q

desrcribe the TNM staging system in breast cancer:

A

The T staging is as follows: T1 <2cm, T2 2-5cm, T3 5+cm, T4a invades chest wall, T4b invades skin (includes ulceration or oedema), T4c invades chest wall and skin, T4d inflammatory breast cancer.

26
Q

blood stained discharge from the breast - what is the problem?

A

duct papilloma

27
Q

what is a galactocele

A

clogged milk duct, often when the woman is postpartum. The resulting discharge is milky-creamy in nature.

28
Q

can hormonal changes in the menopause cause nipple discharge?

A

YES. But this will be bilateral and a clear-white colour.