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Scott's Notes > Breast Surgery > Flashcards

Breast Surgery Flashcards

1
Q

What are the risk factors for breast cancer?

A

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

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2
Q

What is the significance of DCIS/LCIS?

A

Non invasive premalignant diseases which present with micro calcification on mammography and increase risk of invasive cancer x10

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3
Q

What is the commonest type of breast malignancy?

A

Invasive ductal carcinoma

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4
Q

What type of tumour is phyllodes, and how does it present?

A

Stromal tumour

Presents with large non tender mobile lump

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5
Q

What is the current breast cancer screening programme?

A

Every 3 years from 30-71 - Mammography

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6
Q

How might a breast cancer present?

A

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

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7
Q

What are some sensible differentials for breast cancer?

A

Cysts
Fibroadenomas
DCIS
Duct ectsaia

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8
Q

What are the components of triple therapy?

A

Hx and clinical eam

Radiology (US only if <35, US + mammography if >35)

Pathology
Core biopsy for solid lump
FNA for cystic lump

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9
Q

What are the clinical stages of breast cancer?

A

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

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10
Q

What are the principles of breast Ca management by clinical stage?

A

1-2: Surgery

3-4: Chemo and palliate

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11
Q

What are the two surgical options for breast cancer?

A

Wide local excision with radiotherapy (80%)

Mastectomy

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12
Q

What is the gold standard investigation into breast malignancy?

A

Sentinel node biopsy

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13
Q

What complications may arise following breast surgery?

A 
Haematoma
Frozen shoulder
Long thoracic nerve palsy
Lymphoedema
Intercostobrachial nerve injury
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14
Q

What chemotherapeutic agent might be given for HER2+ve cancer?

A

Trastuzumab

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15
Q

What are the endocrine options for breast chemo, and when are they used?

A

Used in ER or PR +ve disease

Tamoxifen
SE - Menopausal Sx, endometrial cancer

Anastrazole/Letrozole
Aromatase inhibitor

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16
Q

What are the two types of mastalgia and their features?

A

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

17
Q

What is the treatment options for mastalgia?

A

1st line - EPO
OCP
Top NSAIDs
Bromocriptine

18
Q

What is the classical presentation of acute mastitis?

A

A lactating woman with a painful red breast +-abscess

19
Q

What is the management of acute mastalgia?

A

Express and hydrate

Flucloxacillin

20
Q

What is the typical presentation of fat necrosis?

A

Previous trauma
Painless, palpable and immobile
May calcify

21
Q

What is the management of analgesia?

A

Analgesia only

22
Q

What is the classical presentation of duct ectasia?

A

Post menopausal woman with:
Bilateral slit like nipples +- periareolar mass
THICK white/green discharge

23
Q

What is the management of duct ectasia?

A

Must distinguish from cancer

Surgical duct excision if mass present/discharge troublesome

24
Q

What is the typical presentation of periductal mastitis?

A

30 year old smoker with painful erythematous areolar mass associated with nipple inversion and discharge

25
Q

What is the management of periductal mastitis?

A

Broad spec Abx

26
Q

What is the classical presentation of benign mammary dysplasia?

A

40 year old with premenstrual modularity and pain (‘lumpy bumpy’)

27
Q

What is the management of benign mammary dysplasia?

A

Triple assess
Reassure with analgesia and a good bra

Danazol may be used

28
Q

What is the classical presentation of cystic breast disease?

A

Perimenopausal woman with a discinct round fluctuant mass which may be painful

29
Q

What is the management of cystic breast disease?

A

Aspirate tree/brown fluid

Consider triple assessment

30
Q

What is the typical presentation of duct papilloma?

A

45 year old with bloody discharge only

31
Q

What is the management of duct papilloma?

A

Triple assess

Excise

32
Q

What is the typical presentation of fibroadenoma?

A

A young black girl with painless, mobile rubbery masses bilaterally with Popcorn calcification on Mammography

33
Q

What is the management of fibroadenoma?

A

Reassure if <2.5cm

If >2.5cm -> surgical shell oput

34
Q

What is the typical presentation of a Phyllodes tumour?

A

Over 50 year old with a large fast growing mass that is mobile and non tdnder with epithelial involvement

35
Q

What is the management of a Phyllodes tumour?

Scott's Notes (21 decks)

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