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Surgery > Surgery - Breast > Flashcards

Surgery - Breast Flashcards

1
Q

What are the major types of benign breast lump?

A

Fibroadenosis/Fibrocystic Change
Fibroadenoma
Cysts

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2
Q

What is Fibroadenosis/Fibrocystic change?

A

Combination of localised fibrosis, inflammation, cyst formation, hormone driven breast pain

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3
Q

How does Fibroadenosis/Fibrocystic change present?

A

Between menarche/menopause
‘lumpy breasts’
cyclical pain/swelling

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4
Q

What is Fibroadenoma?

A

Benign overgrowth of one lobule of the breast, usually solitary

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5
Q

How does Fibroadenoma present?

A 
25-35
Painless
Highly mobile 
Smooth
Well demarcated
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6
Q

What are Breast Cysts?

A

Cavities lined by flattened epithelium derived from the ductal unit, filled with watery fluid

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7
Q

How do Breast Cysts present?

A

Perimenopausal women

Round symmetrical lumps, occasionally w/ pain

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8
Q

What is the most common type of breast cancer?

A

Invasive adenocarcinomas

  • 90% invasive ductal carcinoma
  • 5% invasive lobular carcinoma
  • 5% lobular/ductal in-situ
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9
Q

What is the role of oestrogen receptors in breast cancer treatment?

A

Oestrogen receptor +ve or -ve
-+ve has a better prognosis
HER2 & progesterone receptors are therapeutic targets

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10
Q

How common is breast cancer?

A

Lifetime risk of 1 in 8
Incidence increases w/ age
5% related to BRCA1/2
40% detected on screening

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11
Q

What are the pathological consequences of breast cancer?

A

Paget’s disease of the nipple
Local spread
Lymphatic spread
Vascular spread

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12
Q

Describe Paget’s disease of the nipple

A

Spread of intra-ductal carcinoma leading to eczematous changes around nipple

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13
Q

Describe local spread

A

Into overlying skin –> tethering/nipple retraction

Intro pectoral mm –> deep fixation of tumour

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14
Q

Describe lymphatic spread

A

Can prevent lymphatic drainage –> Peau d’orange

Axillary/clavicular nodes commonly involved

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15
Q

Describe vascular spread

A

Distal dissemination commonly to bone, lung, ovaries

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16
Q

What are the risk factors for carcinoma of the breast?

A 
Genetic factors (PH, FH, BRCA) make up 25% of risk
Environmental factors make up 75% of risk
-early menarche/late menopause
-nulliparity (late age of first child)
-not breast feeding
-HRT
-obesity
-smoking
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17
Q

Describe the diagnosis of a breast lump

A

Triple assessment

  • clinical examination
  • breast imaging (USS + mammography if >35)
  • cytology (FNAC if cystic, biopsy if solid)
18
Q

How does a typical carcinoma appear on mammography?

A

Spiculated mass lesion with associated microcalcification

19
Q

What is the drawback of FNAC cytology?

A

Cannot distinguish b/w in situ and invasive cancers

20
Q

What is the advantage of core biopsies?

A

Tissue architecture preserved

Invasion and grading determined

21
Q

How should fibroadenosis/fibrocystic change be managed?

A

Reassurance
Anti-inflammatories
Topical evening primrose oil
Hormone manipulation (COC)

22
Q

How are fibroadenomas managed?

A

1/3 regress, 1/3 stay the same, 1/3 enlarge

  • generally don’t require treatment
  • remove if >4cm
23
Q

How should breast cysts be managed?

A

Drain w/ USS guidance

-if fluid suspicious sent away from cytology

24
Q

What is fat necrosis?

A

Occurs following trauma to breast

-mimics neoplastic disease

25
Q

What is a phylloides tumour?

A

Rapidly growing benign tumours of stroma

26
Q

How are breast carcinomas staged?

A

TNM

  • T1 <2cm, T2 2-5cm, T3 >5cm, T4 fixed to chest wall
  • N0 = no nodes, N1 = mobile ipsilateral N2 = fixed
  • M0 = no distant mets M1 = distant mets
27
Q

What investigations are appropriate in suspected metastatic breast carcinoma?

A

Liver USS
CXR
Bone scan

28
Q

What are the surgical options for treating breast cancer?

A

Wide local excision
Simple mastectomy
Regional lymph node removal +/- sentinal biopsy

29
Q

What is wide local excision?

A

Breast-conserving surgery used if breast is of adequate size & tumour not central
-check margins

30
Q

When is a simple mastectomy preferred?

A

Large tumours
Small breasts
Central location of tumour
Late presentation w/ complications

31
Q

How is a sentinel node biopsy performed?

A

Dye injected into/around tumour bulk

  • identifies nodes draining tumour
  • if +ve requires full axillary clearance
32
Q

What additional options are available for managing breast cancer?

A

Adjuvant radiotherapy
Chemotherapy (if nodal disease/high grade)
Hormonal therapy (if ER/HER +ve)

33
Q

What hormonal management options are available for breast cancer?

A

Tamoxifen (pre/peri menopausal)
Aromatase inhibitors (if post menopausal)
Herceptin (if HER2 +ve)

34
Q

What is the NPI?

A

Nottingham Prognostic Index

-(tumour size*0.2) + grade + nodal status

35
Q

What is the prognosis of breast cancer?

A 
10 YEAR SURVIVAL
NPI <2.4 = 95%
NPI 2.4-3.4 = 85%
NPI 3.4-4.4 = 70%
NPI 4.4-5.4 = 50%
NPI >5.4 = 20%
36
Q

How should nipple discharge be managed?

A 
Clear = physiological sx 
Milky = preg/hyperprolactinaemia
Green = physiological (peri-menopausal) OR fibroadenotic cyst
Bloody = urgent referral
37
Q

What is periductal mastitis?

A

Infection of ducts beneath nipple

-more common in smokers/nipple piercings

38
Q

How should periductal mastitis be managed?

A

Flucloxacillin

39
Q

What is mastalgia?

A

Generally is either cyclical/non-cyclical

40
Q

How should mastalgia be managed?

A

Evening primrose oil

Tamoxifen/danazol if cyclical pain

Surgery (9 decks)

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