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ICSM Year 6 + edits > Surgery - Breast > Flashcards

Surgery - Breast Flashcards

1
Q

When in the life course is duct ectasia of the breast most common?

A

Menopause

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2
Q

How should duct ectasia be managed?

A

Conservatively

If troublesome can be managed surgically

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3
Q

What are the signs and symptoms of duct ectasia?

A

Tender lump around areola and green nipple discharge - can be creamy

multiple ducts and associated nipple inversion

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4
Q

How should fat necrosis be investigated?

A

Imaging

Core biopsy

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5
Q

How does fat necrosis of the breast appear?

A

Firm, round lump –> hard, irregular lump

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6
Q

Which pathogen most commonly causes acute mastitis?

A

Staphylococcus aureus

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7
Q

Recall 2 risk factors for acute mastitis

A

Smoking

Nipple injury

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8
Q

How should lactational mastitis be managed?

A

Simple analgesia
Warm compresses
Continue breastfeeding

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9
Q

How should non-lactational mastitis be managed?

A

1st line: flucloxacillin
2nd line: co-amoxiclav
If MRSA –> trimethoprim

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10
Q

How can breast abscess best be imaged?

A

USS

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11
Q

How should breast abscess be managed?

A

1st - ultrasound-guided aspiration with abx and reassess in 48 hours
(admit for IV abx if acutely unwell)
2nd - Incision and drainage and culture of fluid - usually ONLY if overlying skin necrosis

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12
Q

How big does a fibroadenoma have to be to warrant excision?

A

> 3cm

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13
Q

What is intraductal papilloma of the breast?

A

Local areas of epithelial proliferation in large mammary ducts

single duct - labstix shows blood traces

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14
Q

What are the symptoms of fibroadenosis of the breast?

A

Lumpy breasts (BL) which may be painful, symptoms may be worse prior to menstruation

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15
Q

What are the symptoms of intraductal papilloma?

A

Clear/blood-stained discharge

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16
Q

How should intraductal papilloma be managed?

A

Microdochectomy

bothersome duct ectasia / young - is total duct removal if old

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17
Q

What sort of tumour might arise from a pre-existing fibroadenoma?

A

Phyllodes tumour

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18
Q

Are phyllodes tumours benign or malignant?

A

Usually benign but occasionally behave aggressively

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19
Q

What are the symptoms of phyllodes tumour?

A

Enlarging mass in women >50 years

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20
Q

How does radial scar appear on XR?

A

Stellate mass

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21
Q

How should radial scar be managed?

A

biposy +/- excision

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22
Q

Recall 4 types of breast cancer

A

Invasive ductal carcinoma
Invasive lobular carcinoma
Ductal carcinoma in-situ
Lobular carcinoma in-situ

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23
Q

Which type of breast cancer can demonstrate “comedo necrosis”?

A

DCIS

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24
Q

What is Paget’s disease of the nipple?

A

An eczematoid change of the nipple associated with an underlying brest malignancy

Weepy and crusty - excludes areola

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25
Q

When is the mammography screening in the UK?

A

Age 50-73 every 3 years

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26
Q

Recall the 2ww, consider 2ww and no 2ww criteria for breast Ca

A

2ww:
>30y, unexplained breast lump
>50y, any breast changes

Consider 2ww:

  • Skin changes suggestive of breast Ca
  • > 30y, unexplained lump in axilla

Non-2ww:
<30y, unexplained breast lump

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27
Q

What makes up the triple assesment for breast Ca?

A
  1. History and exam
  2. Imaging (Mammography >35, USS <35, MRI if implants)
  3. Pathology (FNA, core biopsy)
28
Q

Describe the lymphatic drainage of the breast

A

75% to lateral axillary nodes

25% to parasternal nodes and opposite breast

29
Q

Which receptors are all invasive breast cancers tested for?

A

Oestrogen receptor
Progesterone receptor
Her2 receptor

30
Q

What receptors are positive/ negative in low vs high grade breast cancers?

A

Low grade: ER+, PR+, Her2-

High grade: Er-, PR-, Her2 pos

31
Q

What is the receptor status of a basal-like carcinoma of the breast?

A

ER, PR and Her2 neg

32
Q

How does surgery for breast Ca differ depending on whether there is clinical axillary lymphadenopathy or not?

A

If there is CAL: axillary node clearance

If no CAL: USS and SLNB +/- axillary node clearance

33
Q

Recall 4 types of breast tumour that can be managed using wide local excision rather than mastectomy

A

Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS <4cm

34
Q

What are the indications for post-operative radiotherapy in breast Ca?

A

Following any wide local excision
Following a mastectomy IF:
- T3 or T4 OR
- 4 or more pos LNs

35
Q

When is hormone therapy indicated in breast Ca?

A

If ER+

36
Q

What options are there for hormone therapy in breast Ca?

A

If pre/peri-meonpausal –> tamoxifen (SERM)

If post-menopausal –> anastrazole (aromatase inhibitor)

37
Q

Recall some side effects of tamoxifen

A

Amenorrhoea
Endometrial Ca
PV bleed
VTE

38
Q

What is the main side effect of anastrazole to be aware of?

A

Osteroporosis

39
Q

When is biological therapy indicated in the treatment of breast Ca?

A

If Her2 +

40
Q

Recall an example of a biological therapy for breast Ca

A

Trastuzumab (herceptin)

cannot be used for patients with CVS disease

41
Q

What score is used to guide prognosis in breast cancer?

A

Nottingham prognostic index

Tumour Size x 0.2 + Lymph node score(From table below)+Grade score(From table below).

42
Q

What is the most important prognostic factor for breast cancer?

A

Axillary LN spread

43
Q

Describe the different appearanes of nipple discharge and their causes

A

Green: smokers
Yellow multi-duct: duct ectasia
Blood-stained: malignancy
Milky, bilateral, multi-duct: prolactinoma

44
Q

What are the 2 occasions that an MRI would be used to investigate breast cancer?

A

Any malignancy suspected after USS in women <40y

Lobular cancers

45
Q

At what size should excision be offered for a breast fibroadenoma?

A

> 3cm

46
Q

How does the adjuvant medical treatment of oestrogen receptor-positive breast cancer depending on whether a woman is pre- or post-menopausal?

A

Pre-menopausal: tamoxifen

Post-menopausal: anastrazole

47
Q

Main reason for neo - adjuvant therapy in breast cancer

A

Downsize the tumour before surgery, allow conservation of the breast

No masectomy

48
Q

What are the 5 main methods for treating Breast Cancer?

A

surgery
radiotherapy
hormone therapy
biological therapy
chemotherapy

49
Q

How does the presence of palpable axillary lymphadenopathy pre surgery determine Mx of breast cancer?

A
  1. No palpable axillary - USS - if negative - SLNB
  2. If Yes - axillary node clearance

2. Can lead to arm lymphoedema and functional arm impairment

50
Q

Not wide - excision

Factors to have a masectomy

A
  • Multifocal tumour
  • Central tumour
  • Large lesion in small breast
  • DCIS > 4cm
51
Q

When is whole breast radiotherapy offered to women?

A

After wide-local excision

reduce risk of reoccurance by 2/3

52
Q

When is adjuvant hormonal therapy offered?

A

Tumours positive for hormonal receptors

53
Q

If systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection; what should be done with a patient with lactational mastitis

A

Non - lactional mastitis management

e.g. PO flucloxacillin

54
Q

If less than 3 lymph nodes post breast conserving surgery with adjuvant radiotherapy show micromets at sentinel node biopsy what should be done?

A

No further management

Only regional adjuvant therapy and radiotherapy if >4 / poor prognostic factors

55
Q

What is a sentinel lymph node and what is the biopsy?

A
  • First lymph node cancer would spread to
  • Radioactive substance, determine close lymph nodes -> then removed biopsied to determine presence of cancer

Risks of lymphoedema

56
Q

Cancer marker for breast cancer

A

Ca 15-3

57
Q

Most common type of breast cancer

A

Invasive ductal carcinoma

58
Q

Snowstorm sign in breasts indicates what

A

extracapsular breast implant rupture

leakage of silicone into lymphatic system

59
Q

What is periductal mastitis mainly associated with?

A

Smoking

60
Q

If post breast surgery no nodal involvement and receptor negative what should be done

A

FEC - chemo

if nodal FEC-D chemo

61
Q

irregular lump on the lateral aspect of her right breast associated with skin tethering

A

Fat necrosis

Can go firm to irregular - may follow trauma

62
Q

What is tamoxifen

A

selective oestrogen receptor modulator (SERM)

63
Q

Anastrozole

What is the end effect of aromastase inhibitors?

A

reduced peripheral synthesis of oxygen

64
Q

Treatment for cyclical mastasia

A

supportive bra and simple analgesia

refer if not respond after 3 months

65
Q

Halo sign

A

breast cyst

66
Q

Quantify quality colour

A

Characterise breast secretions

ICSM Year 6 + edits (28 decks)

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