Surgery Flashcards
What are the stagings for breast tumours?
Stage 1- confined to breast mobile
Stage 2- growth confined to breast, mobile, lymph nodes ipsilateral axilla
Stage 3- tumour fixed to muscle (not chest wall), ipsilateral lymph nodes matted and may be fixed, skin involvement larger than tumour
Stage 4- complete fixation of tumour to chest wall, metastases
What side effect should patients on tamoxifen look out for?
Vaginal bleeding as it rarely causes uterine cancer
What is a sentinel node biopsy?
Decreases needless axillary clearances in lymph node -ve patients
Patent blue die and/or radiocolloid injected into periareolar area or tumour
Gamma probe/visual inspection is used to identify the sentinel node
The sentinel node is biopsied and sent for histology and immunohistochemistry- further clearance if sentinel node+ve
How are prognostic factors calculated in breast cancer?
Nottingham prognostic index (NPI)
NPI= 0.2 x tumour size (cm) + histological grade + nodal status
What are predisposing conditions for inguinal hernias?
Males Chronic cough Constipation Urinary obstruction Heavy lifting Ascites Past abdominal surgery
What are the types of breast cancer?
Ductal carcinoma in situ (DCIS) Invasive ductal carcinoma (IDC) (tubular/medullary/mucinous/papillary/cribiform) Lobular carcinoma in situ Invasive lobular carcinoma Inflammatory breast cancer
What are the stages of wide local excision?
Insertion of needle during ultrasound Intra-operative USG Make an incision Raise the flaps Deliver the wire Lumpectomy Marking the specimen Mark the cavity with clips
What are the stages of a sentinel lymph node biopsy?
The hot spots are marked on the axilla prior to incision
Blue dye is injected in the subareolar region (lateral aspect of axilla next to the tumour)
Manual massage is used to aid the drainage to the sentinel lymph node
The incision is selected beneath the axillary hair line
Clavipectoral fascia is identified
Further dissection down the blue channel
Node is dissected from surrounding tissue
The channels are clipped to avoid spillage of the dye
Axilla is examined for additional hot nodes
Final digital examination of the area to identify palpable nodes
Lymph node is sent to cytology
What are the risks of breast cancer surgery?
Infection
Seroma- collection of fluid under the skin which may need draining. Impairs the healing process
Poor healing, areas around wound may lose blood supply
Lymphoedema
Chronic pain after mastectomy
Depression/anxiety
Hematoma- not common due to electrocautery
Venous thromboembolism
When is a mastectomy favoured over local wide incision?
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS > 4cm
