surgery Flashcards
What are the breast cancer predisposing factors?
- BRCA1/BRCA2: 40% risk of ovarian/breast cancer
- COCP: protects against ovarian cancer
- Nulliparity
- Having children > 30: increases risk 2x compared to women having child < 25
- Not breastfeeding
- Obesity
- Ionising radiation
- Early menarche, late menopause
- p53 gene mutations
- Family history in premenopausal first degree relative
What is the most common type of breast cancer?
Invasive ductal carcinoma (non-special type breast cancer; the only one classified in this category with worse prognosis)
What is the second most common breast cancer and other types?
Invasive lobular carcinoma (this and all others are considered special type and they have better prognosis)
What is Paget’s disease of the nipple?
It is an eczematoid change in the nipple associated with underlying malignancy, present in 1-2% of breast cancers
what is the current screening programme for breast cancer?
mammogram for women 50-70 every 3 years
when to refer someone for breast cancer
> 30 and unexplained lump in breast +/- pain
50+ with any of the following in ONE NIPPLE only: discharge, retraction or other changes of concern
when to consider referral- breast cancer
skin changes suggesting breast cancer
30+ with axilla lump unexplained
when non-urgent breast cancer referral
when < 30 and unexplained lump
breast cancer management
- usually surgery- mastectomy or wide local excision (unless very frail)
- radiation after to reduce recurrence risk
- chemotherapy neoadjuvant to aid surgery or adjuvant
- hormone therapy in tumours in which hormone receptors have been detected!!!
indications for wide local excision or mastectomy
small breast large tumour, if in situ>4 cm, if multifocal, if central : mastectomy
large breast smaller tumour, solitary lesion, peripheral, and DCIS< 4cm: wide local
testicular cancer risk factors
cryptorchidism
mumps orchitis
infertility
family history
klinefelters syndrome
most common type of testicular cancer
germ cell tumours, divided into seminomas and non-seminomas
in what age group of men is testicular cancer the most common malignancy? when is the peak incidence of testicular cancer
20-30 year olds, but its peak incidence is in 30-40s
testicular cancer presentation
painless lump in testes
may sometimes have pain
gynecomastia
hydrocele
what are the germ cell tumour markers in testicular cancer?
seminomas: hCG may be elevated in 20% of cases
non - seminomas: AFP and/or beta-hCG elevated in 80-85%
LDH elevated in 40% of germ cell tumours
testicular cancer diagnostic investigation
ultrasound
testicular cancer management
treatment depends on whether tumour is a seminoma or non- seminoma.
orchidectomy
chemotherapy and radiotherapy may be given depending on staging and tumour type
prognosis of testicular cancer
5 year survival of seminoma around 95% if stage 1
and for teratoma (an example of non seminoma) its around 85% if stage 1
but generally good
