Clinical

Question 1

CFs of fat necrosis

Answer 1

• Firm lump eventually shrinks in size until resolution
• Difficult to differentiate from other causes of breast lump
• ~40% will describe Hx of trauma

Question 2

Rx of mastalgia

Answer 2

• Reassurance -> no Ca
• Supportive bra
• Reduce dietary fat + caffeine
• Severe mastalgia affecting ADLs =-> estrogen suppression

Question 3

Approach to nipple d/c

Answer 3

• Spontaneous vs. squeezing @ nipple
• Single vs. multiple duct d/c (check x1 duct d/c for Hb)
• Bloody d/c requires triple assessment (5-10% = Ca)

Question 4

XR features of Ca on mammography

Answer 4

• Microcalcifications within / without lesions

- Areas of increased density or irregularity

Question 5

Most common presenting breast Sx

Answer 5

• Breast lump / lumpiness 36%
• Painful breast lump 33%
• Mastalgia 17.5%
• Nipple d/c 5%
  Nipple retraction 3%

Question 6

Most important part of clinical assessment

Answer 6

• Pt’s age -> increasing age -> increased breast Ca incidence
• In younger pt’s the pathology is much more likely to be benign
• Duration of Sx
• Ca = slow

Question 7

Screening of high risk females

Answer 7

• <50yo then mammography + MRI

Question 8

Triple assessment

Answer 8

1. Clinical exam
2. Imaging (US +/- mammogram)
3. Bx - core vs. FNA

Question 9

Benign breast conditions <25yo

Answer 9

Stromal = juvenile hypertrophy

Lobular = fibroadenoma

Question 10

Benign breast conditions 25-40

Answer 10

Cyclical activity = cyclical mastalgia, cyclical nodularity (diffuse/local)

Question 11

Benign breast conditions 30-55

Answer 11

Involution

Lobular = palpable cysts

Ductal = ductal ectasia

Stromal = sclerosing lesions

Question 12

CFs of ductal ectasia

Answer 12

• Nipple d/c = chessy

- Nipple retraction = slit-like (in contract to breast Ca where the whole nipple is pulled in)

Question 13

CFs of ductal papilloma

Answer 13

• Nipple d/c = serous or blood-stained

Question 14

Principles of breast infection

Answer 14

1. Give appropriate Abs early to reduce incidence of abscess formation
2. If an abscess is suspected -> confirm presence of pus prior to aspiration
3. Excl. breast Ca using imaging + consider core Bx in any inflamm. lesions NOT improving w/ ABx

Question 15

ABx Rx of breast infection

Answer 15

• Lactating = flucloxacillin

- Non-lactating = augment DF

Question 16

Staging of breast Ca (T)

Answer 16

T1 = <2cm

T2 = 2-5cm

T3 = >5cm

T4a = involves chest wall

4b = involvement of skin

4c = a + b

4d = inflamm.

Question 17

Staging of breast Ca (N)

Answer 17

N0 = no LNs

N1 = mobile LN on ipsilateral side

N2 = fixed LN on ipsilateral side

N3 = internal thoracic LN on ipsilateral side (rarely detectable)

Question 18

Staging of breast Ca (M)

Answer 18

M0 = no mets

M1 = distant mets incl. supraclavicular nodes

Question 19

Most common location of breast Ca

Answer 19

• Upper outer quadrant

Question 20

Rx of DCIS

Answer 20

Low grade = WLE

High grade = WLE + adjuvant radiotherapy

Question 21

Possible adjuvant hormonal therapy

Answer 21

1. Oophrectomy - surgical, radiation, chemical (goserelin)
2. Tamoxifen -> competitive partial oestrogen receptor antagonist
3. Aromatase inhibitors -> anastrozole / letrozole

Question 22

Cx of breast surgery

Answer 22

1. Haematoma
2. Infection

If performing axillary clearance

1. Thoracodorsal nerve (C6-8) = atrophy of lat dorsi, prominent scapular
2. Long thoracic nerve (C5-7) = winged scapula
3. Intercostobrachial nerve = loss of sensation to upper / inner aspect of arm
4. Lymphoedema