Breast Surgery Flashcards
what increases risk of breast cancer
Long oestrogen exposure
increasing age
previous breast cancer
mutations e.g BRCA
What is the most common type of breast cancer
Invasive ductal carcinoma Feels Hard (scirrhous) Can cause Paget's disease of nipple - itching, redness, crusting and discharge from the nipple
What are the other types of breast cancer
Invasive lobular
Medullary - younger, feels soft
Inflammatory - pain, swelling, erythema, peau d’orange
Papillary
Mucinous - elderly, no skin tethering or nipple inversion
what is the usual presentation of breast cancer
Painless lump, often upper outer quadrant ± axillary nodes
Skin changes - Paget’s, peau d’orange
Nipple = discharge and inversion
Can spread to muscle and or skin locally
Can cause arm oedema
Spread to bones - bone pain, raised Ca
spread to lungs - dyspnoea, pleural effusion
Spread to liver - abdo pain, hepatic impairment
Spread to brain - headache, seizures
when does breast cancer screening occur
Every 3 years from 47-73
What is the tripple assessment
Hx and Ex
Us if <35, mammogram if >35
Biopsy/FNA
what is the Rx for breast cancer
WLE + radiohtherapy
Masectomy if large, multifocal or nipple involvement
Senitnal lymph node biopsy - inject dye into tumour and take out these lymph nodes for frozen section –> if +ve axillary clearance and radio
Complications of surgery - frozen shoulder, long thoracic nerve palsy, lymophodema
Chemo - 5FU, epirubicin, Cyclophosphamide
Traztuzumab (herceptin) if HER2 positive
Tamoxifen (antagonist to E2 in breast, agonist in uterus) if ER positive –> can cause menopausal symptoms and endometrial Ca
Anastrazole can reduced ostrogen (aromatase inhibitor - better for post menopausal)
If pre-menopausal and ER+ consider gosrelin (GnRH analogue) or ovarian ablation
Acute mastitis
Lactating Painful red breast May have lump near nipple --> abscess encourage to continue breast feeding Fluclox + incision and drainage if abscess
Fat necrosis
Associated w/ previous trauma
painless, palpable non mobile mass
analgesia
Duct ectasia
Post menopausal - 50-60 Slit like nipple Often bilateral Peri-aeriolar mass Thick green/white discharge May be calcified on mammography Rx = surgical duct excision if mass present or discharge troublesome
Periductal mastitis
Smokers, ~30y painful, erythematous sub-areolar mass Assoc w/ inverted nipple ± purulent discharge, May have abscess or discharging fistula Broad Spec Abx
Bening mammary dysplasia
30-50
Pre-menstural breast nodularity and pain, usually upper quadrant
lumpy bumpy breast
triple assessment
Reassurance, analgesia, good bra, evening primrose oli
Danazol occasionally used (suppresses gonadotrophin secretion)
Cystic breast disease
Peri-menopausal >40 Distinct fluctuant round mass Often painful aspirate - green-brown fluid If there blood triple assess
Duct papilloma
40-50 commenst cause of bloody discharge Not usually palpable triple assess excise - increase risk of Ca
Fibroadenoma
<35, rare post menopausal, more common if blaxk most common benign tumour painless mobile rubbery mass often multiple and bilateral Reasssure + follow up if <2.5cm Shell out surgically if >2.5cm
