General Surgery (Breast) Flashcards
What is Mastitis?
Inflammation of breast tissue
What are the two types of Mastitis
Lactational Mastitis - usually presents during the first 3 months of breast feeding or during weaning
Non Lactational Mastitis - occurring in Women with other conditions such as duct ectasia
What is the link between Tobacco and Breast disease?
Tobacco causes damage to sub-areolar duct walls predisposing to bacterial infection
Give three clinical features of Mastitis
Tenderness
Swelling
Erythema
How is Mastitis managed?
Simple Analgesia
Antibiotics
If breast feeding - encouraged to continue
Name a complication of Mastitis
Breast Abscess
What is a Breast Abscess?
Collection of pus within the breast lined with granulation tissue
Presents with systemic symptoms of fever and lethargy
What are Breast Cysts?
Epithelial lined fluid filled cavities, formed when lobules become distended due to blockage
Normally affects peri-menopausal age group
Can be single/multiple distinct smooth masses
Describe two investigations for Breast Cysts
Mammography (classic halo shape) Needle Aspiration (sent for cytology)
How are Breast Cysts managed?
Generally self resolving
Can be aspirated for aesthetic reasons
Advise patient to monitor as they do have a higher risk of Breast Cancer
What is Mammary Duct Ectasia?
Dilation and shortening of lactiferous ducts common in the peri-menopausal age group
Give 3 clinical features of Mammary Duct Ectasia
- Green/Yellow nipple discharge
- Palpable Mass
- Retracted Nipple
Describe two investigations for Mammary Duct Ectasia
Mammography (dilated calcified ducts with no other features of malignancy)
Biopsy (multiple plasma cells)
How would you manage Mammary Duct Ectasia?
Conservative unless persistent discharge (duct excision)
What is Fat Necrosis of the breast?
Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules
Name 3 causes of Fat Necrosis
Trauma
Previous Surgery
Previous Radiation
How does Fat Necrosis present?
Normally presents asymptomatically/as a lump
Less commonly can present with fluid discharge/skin dimpling/pain/nipple inversion
Fat Necrosis may mimic malignancies on mammograms, so what investigations coud you do?
Core Biopsy
Ulstrasound (Hyperechoic mass)
Name five types of benign breast lumps
Fibroadenoma Adenoma Papilloma Lipoma Phyllodes Tumour
How does a Fibroadenoma present?
Highly mobile, well defined and rubbery mass (breast mouse)
Where do Papillomas present?
Typically in sub-areolar region
Often with bloody/clear nipple discharge
What are Phyllodes Tumours?
Rare fibroepithelial tumours that grow rapidly
Should be excised as 1/3 have malignant potential
What is Gynaecomastia?
When males develop breast tissue due to imbalanced ratio of oestrogen and androgen
Usually benign but breast cancer can develop in 1%
Describe the physiological causes of Gynaecomastia
Adolescent - delayed testosterone surge in response to Oestrogen
Elderly - Decreasing testosterone levels
Describe the pathological causes of Gynaecomastia
Lack of testosterone (Klinefelters, Androgen Insensitivity)
Increased Oestrogen (Liver Disease)
Medication (Digoxin, Metronidazole, Spironolactone)
How is Gynaecomastia managed?
Treat underlying cause
Tamoxifen can alleviate symptoms
What is Carcinoma In-Situ?
Tumour contained within basement membrane so seen as a pre-malignant condition
What are the two types of Carcinoma In-Situ?
Ductal (more common, lower chance of invasive disease)
Lobular (rarer, higher chance of invasive disease)
What is the most common type of Invasive Breast Cancer?
Over 75% ductal carcinoma
Almost all subtypes arise in the terminal lobular duct
Give 5 risk factors for Breast Cancer
Female BRCA1/2 FH Obesity Exposure to unopposed oestrogen
Give 5 features of Breast Cancer
Breast Lump/Asymmetry Nipple Discharge (may be bloody) Nipple retraction Peau D'Orange Axillary Lump
What is a Triple Assessment?
Methods of investigation for concerning breast lumps
Examination, Imaging, Histology/Cytology
How is the prognosis of Breast Cancer calculated?
Nottingham Prognostic Index
Receptors (ER,PR,HER2)
Who is screened for Breast Cancer?
Women aged 50-70 every 3 years
What is Paget’s Disease of the Nipple?
Malignant cells migrate from ducts to nipple’s surface causing roughening/reddening and ulceration of the nipple
What is Sentinel Node Biopsy?
Removing first lymph node that the breast tissue drains to, found by injecting blue radioactive dye
For Oestrogen receptor positive cancers, name two hormonal treatments
Tamoxifen (SERM) - Premenopausal
Letrozole (Aromatase Inhibitors) - Postmenopausal
For HER2 receptor positive cancers, name a hormonal treatments
Herceptin
Describe three oncoplastic reconstruction techniques for Breast Cancer
Lat Dorsi - for smaller breasts, can be free or pedicled
TRAM - Transverse Rectus Abdominal Muscle
DIEP - Deep Inferior Epigastric Perforator
Describe the T of TNM staging for Breast Cancer
T1 <2cm T2 2-5cm T3 >5cm T4a Invaded chest wall T4b Invaded skin T4c Invaded chest wall and skin T4d Inflammatory
What is Fibroadenosis?
Painful/Nodular condition of the breast
Name a side effect of Aromatase Inhibitors
Osteoporosis
In what mechanism is the BRCA gene inherited?
Autosomal Dominant
