Breast Surgery Flashcards
What are the risk factors for breast cancer?
FHx
1 1st deg relative 2x risk
BRCA1 =-> Breast + Ovarian Ca
BRCA 2-> Breast ca
Oestrogen exposure Early menarche Late menopause Nulliparity Obesity HRT/OCP
Others
Proliferative breast disease
Prev bresast Ca
Old age
What is the significance of DCIS/LCIS?
Non invasive premalignant diseases which present with micro calcification on mammography and increase risk of invasive cancer x10
What is the commonest type of breast malignancy?
Invasive ductal carcinoma
What type of tumour is phyllodes, and how does it present?
Stromal tumour
Presents with large non tender mobile lump
What is the current breast cancer screening programme?
Every 3 years from 30-71 - Mammography
How might a breast cancer present?
Lump
Often painless, in outer quarter and may involve axillary lymph nodes
Skin
Pagets (persistent eczema)
Peau d-orange
Nipple
Inversion, discharge
Mets
Pathological #s, SOB, abdopain, seizures
What are some sensible differentials for breast cancer?
Cysts
Fibroadenomas
DCIS
Duct ectsaia
What are the components of triple therapy?
Hx and clinical eam
Radiology (US only if <35, US + mammography if >35)
Pathology
Core biopsy for solid lump
FNA for cystic lump
What are the clinical stages of breast cancer?
1 - confined to breast, mobile, no LNs
2 - 1 + ipsilateral axillary nodes
3 - 2 + fixation to muscle, LN matted and fixed, large skin involvement
4 - Complete fixation to chest wall + mets
What are the principles of breast Ca management by clinical stage?
1-2: Surgery
3-4: Chemo and palliate
What are the two surgical options for breast cancer?
Wide local excision with radiotherapy (80%)
Mastectomy
What is the gold standard investigation into breast malignancy?
Sentinel node biopsy
What complications may arise following breast surgery?
Haematoma Frozen shoulder Long thoracic nerve palsy Lymphoedema Intercostobrachial nerve injury
What chemotherapeutic agent might be given for HER2+ve cancer?
Trastuzumab
What are the endocrine options for breast chemo, and when are they used?
Used in ER or PR +ve disease
Tamoxifen
SE - Menopausal Sx, endometrial cancer
Anastrazole/Letrozole
Aromatase inhibitor
What are the two types of mastalgia and their features?
Cyclical
35 year olds, premenstraul pain relieved by menstruation common bilaterally in upper outer quadrants
Non-cyclical
45 year olds with severe lancing breast pain w back ache
What is the treatment options for mastalgia?
1st line - EPO
OCP
Top NSAIDs
Bromocriptine
What is the classical presentation of acute mastitis?
A lactating woman with a painful red breast +-abscess
What is the management of acute mastalgia?
Express and hydrate
Flucloxacillin
What is the typical presentation of fat necrosis?
Previous trauma
Painless, palpable and immobile
May calcify
What is the management of analgesia?
Analgesia only
What is the classical presentation of duct ectasia?
Post menopausal woman with:
Bilateral slit like nipples +- periareolar mass
THICK white/green discharge
What is the management of duct ectasia?
Must distinguish from cancer
Surgical duct excision if mass present/discharge troublesome
What is the typical presentation of periductal mastitis?
30 year old smoker with painful erythematous areolar mass associated with nipple inversion and discharge
