O&G:Breast

Question 1

4 common complaints attending breast clinic?

Answer 1

• Lump
• Pain
• Nipple chagnes
• Asymmetry

Question 2

What is mastalgia?

Answer 2

Pain in breast
No incection
Can be cyclic or non-cyclic

Question 3

What is mastitis?

Answer 3

Non infective:
- Results from obstruction of milk drainage from one section of the breast, which may be due to: Badly postitioned baby, restriction of feeding, blocked ducts, compression via bra or fingers
- Swollen, red, painful area on breast.
- Tachycardia, pyrexia, aching/flu like feeling.
- Resolves on relieving obstruction by feeding
Infective:
- If non-infective isnt cleared
- Staph Aureus is most common organism
- Use flucloxacillin or cefalexxin

Question 4

What is breast abcess?

Answer 4

Possible complication of poorly managed infective mastitis. May need surgical drainage under anaesthetic.

Question 5

Breast cancer: hx taking?

Answer 5

Lump: Size, onset, pain, cyclical change?

Discharge: Milky, bloody, yellow/green

Inversion

Skin changes: eczema, dimpling, ulceration

Systemic sx: W loss, fever, lethargy, pain, gland swelling

Question 6

Risk factors for breast cancer

Answer 6

• Prev hx of BC
• FH of breast cancer
• BRCA1/2
• Nullparity or child 1 after 30
• Not having breast fed
• Early menarche and late menopause
• Radiation to chest
• HRT w/ preogesterone
• COCP

Question 7

Triple investigation for breast cancer?

Answer 7

• Examination
• Imaging
  - USS before 40
  - Mammogram post 40
• Biopsy

Question 8

Discharge red flags in breast cancer?

Answer 8

Bloody
Spontaneous
Persistent
Single duct

Question 9

What is fibroadenoma?

Answer 9

Most common type of benign breast tumour. Young, premenopausal women Well defined round shape, rubbery, painless.

Question 10

Why mastectomy?

Answer 10

• Multiple tumours or large tumour in small area
• Lumpectomy not good enough to give good cosmetic result
• Abormal surrounding tussue
• Ill defined margins
• reduce chacne of spread
• Extensive DCIS

Question 11

Why lumpectomy?

Answer 11

• Smaller area removed

- Improved cosmetic appearance

Question 12

S/E of total axillary clearance?

Answer 12

Lymphoedema.

Question 13

What is sentinel node biopsy?

Answer 13

Sentinel node biopsy is a surgical procedure used to determine whether cancer has spread beyond a primary tumor into your lymphatic system. The sentinel nodes are the first few lymph nodes into which a tumor drains

Question 14

What treatments do patients have alongisde WLE?

Answer 14

• Radiotherapy.

S/e: Pneumonitis, pericarditis, rib fracture.

Question 15

What is Tamoxifen?

Answer 15

Oestrogen receptor blocker.

S/e: Hot flushes, weight gain, mood changes, VTE

Question 16

What is Anastrozole?

Answer 16

Peripheral oestrogen synthesis inhibitor.

Question 17

What is trastuzumab (herceptin)

Answer 17

Used on breast cancers that is HER2 receptor positive.

s/e: fever, cough

Question 18

Stages of breast cancer?

Answer 18

1: Confined to breast, mobile
2: Growth confined to breast, mobile. Lymph nodes in ipsilateral axilla involved.
3: Tumour fixed to muscle. Ipsilateral LN matted.
4: Complete fixation to chest wall. Distant mets.

Question 19

TNM staging?

Answer 19

T:
- T1 <2cm
- T2 2-5cm
- T3 >5cm
- T4 chest wall
N:
- N1: Mobile ipsilateral LN
- N2: Fixed nodes
M
- M1: Distant mets

Question 20

Types of bc?

Answer 20

• Infiltrating ductal carcinoma
• Lobular carcinoma
• medullary carcinoma
• Colloid mucoid cancer

Question 21

What is pagets disease of the nipple?

Answer 21

Itchy, red, scaly or crusted nipple, from direct extension of intraductal adenocarcinoma.

Question 22

Diagnosis of pagets?

Answer 22

Biopsy

Dont confuse with Nipple eczema, which would be: Bilateral, non-deforming and waxes and wanes.

Question 23

Treatment of pagets?

Answer 23

Mastectomy or lesser surgery+/-radiotherapy

Question 24

What are fibroadeomas?

Answer 24

Benign tumours that are common in young women, age 20-24 is peak.
Arise in breast lobules and are composed of fibrous and epithelial tissue.

Question 25

Presentation of fibroadenoma?

Answer 25

• Firm
• Non-tender
• Highly mobile palpable lumps

Question 26

treatment of fibroademoas?

Answer 26

Can be tx with surgical excision if necessary.