General Surgery - Breast Flashcards
what is a fibroadenoma?
benign overgrowth of a breast lobule
features of a fibroadenoma?
painless
mobile
discrete
why is a fibroadenoma so mobile?
has no attachment to the suspensory ligaments of the chest wall
Ix for a breast lump?
examination
US <35/Mammogram >35
biopsy
how to differentiate a Phyllodes tumour and a fibroadenoma?
Phyllodes grow faster
when can a fibroadenoma be excised?
≥3cm and symptomatic
what features make up fibrocystic disease?
fibrosis
inflam
cysts
hormonal breast pain
Tx for fibrocystic disease?
NSAIDs
primrose oil/linoleic acid
COCP
what features will a breast cyst have?
smooth
mobile
distinct borders
soft
Ix for a cyst?
US + aspirate
Tx for a cyst?
aspirate if symptomatic
hormonal Tx e.g COCP
what causes lactational mastitis?
infection of the mammary ducts
bacterial or fungal
risk factors for lactational mastitis?
breastfeeding
poor position
infrequent feeding
trauma
what bacteria commonly causes lactational mastitis?
staph aureus
features of thrush lactational mastitis?
pain itch flaky cracked nappy baby has thrush (oral/nappy) baby is windy and unsettled
features of bacterial lactational mastitis?
tender
red
pus and blood in milk
red stripes on breast
Tx for thrush lactational mastitis?
continue feeding
miconozole cream for mum
gel for baby
Tx for bacterial lactational mastitis?
continue feeding
warm compress + express
NSAIDs
fluclox or erythro if pen allergic
risk factors for duct ectasia?
smoking
menopause
features of duct ectasia?
recurrent infections
yellow/green discharge
pain under nipple
nipple inversion
pathology behind duct ectasia?
subarealor mammary ducts are dilated and scarred due to chronic inflam
squamous metaplasia of ducts occurs
become keratinised and blocked
what bacteria often causes infections in duct ectasia?
streptococci
Ix for duct ectasia?
FBC (WCC raised)
US
Tx of duct ectasia?
metronidazole
drain abscesses
what complications can occur in duct ectasia?
peri areolar fistula
EXCISE
what is fat necrosis?
damage to breast tissue causing an acute injury
pathology of fat necrosis?
adipocytes are infiltrated with inflammatory cells
fibrosis and scarring occurs
risk factors for fat necrosis?
trauma
warfarin
what genetic conditions can give males gynecomastia?
kleinfelters (XXY)
prader wili
what drugs can cause gynacomastia?
steroids spironolactone alpha blockers 5 alpha reductase cannabis
e.g of an
alpha blocker
5 alpha reductase?
alpha blocker - doxasozin
5 alpha reductase inhibitors - finasteride
risk factors for breast cancer?
age BRCA1/2 not breastfeeding HRT>5yrs early menarche hormonal contraceptives low parity late menopause alcohol
symptoms of breast cancer?
lump hard gritty immobile ill defined puckering pea d'orange
what nipple changes can happen in breast cancer?
eczema (paget’s)
inverited
deviated
discharge
what type is the most common in breast cancer?
ductal adenocarcinoma
Ix for breast cancer?
examination Mammogram >35 US <35 biopsy/FNAC CT
T stages for breast cancer?
Tis - DCIS 1 - <2cm 2 - 2-5cm 3 ->5cm 4 - chest wall, skin or inflammatory
N stages for breast cancer?
1 - LN in armpit
2 - LNs stuck together
3 - LN below clavicle/above clavicle/behind sternum
surgical options for breast cancer?
wide local excision (conserves breast)
mastectomy + reconstruction
what options for reconstruction are there in breast cancer?
prothesis lastissmus dorsi flap deep inferior epigastric artery flap inferior gluteal artery flap abdo flaps
what treatment is offered if nodes are affected?
radiotherapy
OR axillary node clearance
what technique is used to identify if nodes are positive? why is this done?
sentinal node biopsy
avoid full clearance, which may cause lymphodema
what is the treatment for Her2+ve tumours?
herceptin
what treatment is used for ER +ve postmenopausal women? Rx and drug type?
letrozole
aromatase inhibitor
risk of osteoporosis
what treatment is used for ER +ve premenopausal women? Rx and drug type?
tamoxifen
selective oestrogen receptor modulator
risk of VTE and endometrial cancer
who gets breast cancer screening?
50-70yrs every 3 years
BRCA/FHx can get 2 yearly screening
how can DCIS present?
asymptomatic
microcalcification
Tx for DCIS?
wide local excision + radiotherapy
what is DCIS?
pre cancerous condition
cells of milk duct are cancerous but haven’t spread into any surrounding normal tissue
