Breast Surgery Flashcards
Risk Factors for Breast Cancer
Genetics: BRCA1/BRCA2 1st degree premenopausal relative Nulliparity 1st pregnancy >30 years Early menarche/late menopause COCP Obesity
BRCA genes increase risk of which cancers
Breast and Ovarian
Most common type of breast cancer
Invasive ductal carcinoma
What is Paget’s disease of the nipple
Eczematous change of nipple associated with malignancy
How does Paget’s disease in the breast differ from breast eczema
Paget’s disease - eczema primarily involves the nipple
Breast eczema - eczema is more lateral
What is inflammatory breast cancer
Where cancerous cells block the lymph drainage resulting in inflamed appearance of breast
What is triple assessment in breast
Clinical examination
Radiological assessment (mammography, USS)
Biopsy - usually core which allows full histology
What is the 1-5 staging in triple assessment
Exam (P), Imaging (U/M), Biopsy (B). Followed by number: 1 - normal 2 - benign 3 - uncertain 4 - suspicious for malignancy 5 - malignant
Tumour marker for breast cancer
CA 15-3
When would mastectomy be offered over wide local excision in breast cancer surgery?>
Multi focal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
When would a patient undergo axillary node clearance in breast surgery?
If there is palpable axillary lymphadenopathy
If no palpable lymphadenopathy - USS done, if USS positive sentinel node biopsy taken in surgery - if this comes back positive they undergo axillary clearance
Side effects of axillary node clearance
Lymphoedema
Functional arm impairment
What additional treatment can be given to patients who are oestrogen receptor positive
Tamoxifen - in pre menopausal women
Letrozole - in post menopausal women
What extra medication can be given to women who are HER2 receptor Postivie
Herceptin (Trastuzumab)
Breast cancer screening programme
Every 3 years - mammogram
From aged 47-73
When would breast screening be offered at a younger age
1st degree relative diagnosed <40 years
2 1st degree relatives diagnosed at any age
Benign differentials for breast lump
Fibroadenoma - young patients, mobile lump
Fibroadenosis - lumpy breasts, occur with menstruation
Cysts - soft swellings, halo appearance on mammogram
Fat necrosis - in larger women, may follow trauma
Abscess - red, hot, tender lump
What is lactational mastitis
Where breast becomes painful, tender and erythematous during breast feeding
Management of lactational mastitis
Continue breast feeding and should clear by itself
Flucloxacillin - if systemically unwell or not resolving after 12-24 hours of effective milk removal
What is mammary duct ectasia
Dilation and shortening of terminal breast ducts
Typically occurs around menopause as breast undergoes involution
Presents with nipple retraction, creamy brown/green discharge and peri-areolar lump
Management of mammary duct ectasia
Young patients - microductectomy
Older patients - total duct excision
