finals Flashcards
mastitis (± abscess) - investigations
mastitis - clinical
abscess - refer breast clinic, USS breast, 2ww if not lactational
mastitis without abscess - management
warm compress
keep feeding - express if can’t
breastfeeding counsellor
10-14d fluclox if:
infected, systemically unwell, fissure
no better after 12-24h
safety net!! return if not better
mastitis with abscess - management
refer breast clinic:
fluclox - s.aureus
USS-guided aspiration
2ww if not lactational
how should you image breasts?
<40y - USS
>40y - USS + mammogram
breast lump - investigation
triple assessment:
clinical assessment
imaging
core biopsy
breast lump - differentials
benign nodularity
fibroadenoma
cyst
cancer
breast cancer - management
triple assessment:
1) USS breast AND axilla AND mammogram (all ages)
2) core biopsy
3) CT staging
then:
1) sentinel biopsy
2) if +ve - axillary clearance or radio (axillary nodes follow sentinel)
3) wide excision + whole breast radio, or mastectomy ± radio
4a) hormonal therapy if ER+
4b) biological therapy if HER2
4c) adjuvant chemo
5) reconstruction
DCIS - management + followup?
<4cm - wide local excision
>4cm - mastectomy
annual mammogram + clinical exam for 5y
mastalgia - management
topical/NSAIDs - cyclical + noncyclical
tamoxifen
can image for reassurance
suspected fibroadenoma - investigation
triple assessment:
examination - firm, v mobile
imaging - depends on age as per
core biopsy - tho no need if <25y + USS + exam are benign
fibroadenoma - prognosis + management
none but excise if >3cm
may shrink over time but most stay same
may increase in pregnancy
breast cyst - investigation + management
triple assessment - black centre on USS
treatment not needed
if painful/lump - US-guided fluid aspiration
breast screening - who for and how often?
50-70y every 3y
or if RFs eg BRCA mutation, hx supra diaphragmatic irradiation for hodgkin’s lymphoma
how does a malignant lump look on mammogram?
hyperdense
well-demarcated
irregular
spiculated
what are the common sites for metastasis of breast cancer?
brain
lung
bone
what muscles are used in a breast reconstruction?
latissimus dorsi flap
deep inferior epigastric perforators (DIEP) flap (tummy tuck)
additional treatment for HER2+ women
herceptin (trastuzumab)
additional treatment for ER+ women
pre-menopausal - tamoxifen 5 years
post-menopausal - aromatase inhibitor (anastrozole) + bisphosphonates (prevent bone mets)
fibroadenoma - what is it? (explanation)
unknown cause - ?hormones
breasts made of lobules (milk-producing glands) + ducts that carry it
surrounded by glandular, fibrous + fatty tissue
fibroadenomas - when glandular tissue + ducts grow over a lobule
mastitis - causes/RFs
milk stasis - poor attachment
less feeding on breast
dummy + bottle use, tight bra
infectious or non infectious - staph aureus if so
role of aromatase inhibitors in ER+ postmenopausal women? risk?
post-menopause, oestrogen is made by aromatisation in peripheral tissues (aromatase enzyme)
risk osteoporosis
pre-menopause - made by ovary
tamoxifen - SEs + risks
hot flushes, vaginal dryness, menopausal sx, menstrual disturbance
endometrial cancer
VTE
biological therapy in breast cancer - herceptin (traztuzumab) - use? CI?
HER2+ cancers - but only useful in 25%
CI - hx heart problems
role of chemo in breast cancer
downstage a primary lesion
post-surgery depending on stage, eg if there’s axillary node disease
breast cancer - RFs
BRCA 1 + 2 - assoc ovarian too FH - 1st degree + premenopausal HRT + COCP obesity nulliparity early menarche + late menopause ionising radiation
inflammatory breast cancer - skin sign
peau d’orange
