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Year 4 > Surgery - Breast > Flashcards

Surgery - Breast Flashcards

1
Q

What are the risk factors for the development of breast cancer?

A 
Smoking
FHx
BRCA mutations
Early menarche/late menopause
HRT
Older first pregnancy

Breast feeding is protective

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2
Q

Describe the screening programme for breast cancer

A

Females 50-70yrs get mammography every 3 yrs

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3
Q

How might a symptomatic breast lump present?

A 
Pain
New lump
Skin changes
Nipple discharge
Redness/inflammation
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4
Q

Name the pre-malignancy breast conditions

A

DCIS (80%)

LCIS (20%)

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5
Q

What are the malignant types of breast cancer

A 
Ductal 
Lobular
Tubular
Medullary
Mucinous
Papillary

Can also be described by hormone receptor status:
- ER, HER2, PR…

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6
Q

How are breast lumps investigated?

A

Triple assessment:

  • history and examination
  • imaging (USS/mammography)
  • biopsy (FNA/core)
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7
Q

What are the surgical options for breast cancer?

A

(all +/- sentinel node biopsy or axillary lymph node clearance)

  • WLE
  • Mammoplasty (breast conserving)
  • Mastectomy +/- reconstruction
  • > TRAM (transverse rectus abdominus myocutaneous flap)
  • > DIEP (deep inferior epigastric perforators)

RTx always given after WLE/mastectomy

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8
Q

What are the hormonal treatment options for breast cancer?

A

Tamoxifen (oestrogen receptor antagonist) = for pre/perimenopausal women
DO NOT USE POST-MENOPAUSE AS INCREASE ENDOMETRIAL CANCER RISK

Letrazole/anostrazole - stop conversion of adrenal androgens into oestrogens = for post-menopausal women

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9
Q

What is the Nottingham prognostic index?

A

Predicts pt survival and risk of relapse

grade + stage + tumour size (cm) / 5

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10
Q

Describe male breast cancer

A
  • Uncommon <1% of all breast cancers
    • Usually presents in older men
    • Usually presents at a later stage than in females
    • Treatment very similar to female breast cancer
    • Is linked to family history in female relatives
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11
Q

Describe non-infectious benign breast disease

A 
fat necrosis
pagets disease
fibroadenoma
cyst
fibrocystic change
breast abscess
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12
Q

Describe infectious benign breast disease

A

lactational mastitis
mammary duct ectasia
periductal mastitis

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13
Q

Describe fibroadenomas

A
  • benign overgrowth of one lobule
  • younger women <30yrs
  • normally a firm, discrete, very mobile lump which does not need removed
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14
Q

Describe benign breast cyst

A

associated with fibrocystic disease

  • usually multiple/bilateral cystic lumps filled with yellow/green fluid
  • common in pre-perimenopausal women on HRT
  • identify on USS and aspirate
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15
Q

Describe breast abscess

A
  • usually caused by skin commensals (staph) and has systemic symptoms
  • common in post-partum women
  • painful, red hot skin
  • treat by USS guided aspiration and Abx
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16
Q

Describe fibrocystic breast disease

A
  • 15-55yrs
  • cyclical lumpy breasts
  • hormonal pain
  • very common in pre-menopausal women
  • diffuse lumpiness

Treatment = OCP/aspiration

17
Q

Describe fat necrosis

A
  • post-traumatic (often traumatic incident forgotten)
  • trauma causes fibrosis, local haematoma and calcification
  • may present with a lump and overlying bruising which resolves over time
18
Q

Describe Paget’s disease of the nipple

A
  • pre-cancerous, eczema like changes of the nipple skin
  • common in ELDERLY
  • take a punch biopsy to diagnose
19
Q

Describe lactational mastitis

A
  • an acute staph infection of mammary ducts
  • may form an abscess
  • no need to stop lactating
  • treat with aspiration and antibiotics
20
Q

Describe mammary duct ectasia

A
  • benign nipple retraction presenting with a slit-like nipple
  • underlying inflamed mammary ducts
  • associated with smoking
  • recurrent green discharge/abscesses

Treat with antibiotics and abscess drainage

21
Q

Describe periductal mastitis

A
  • inflammation and abscess formation around the nipple
  • ASSOCIATED with smoking
  • common in 40yr olds
  • treatment:
  • > stop smoking
  • > antibiotics
  • > drainage
22
Q

What is a Phyllodes tumour?

A

Malignant
Tear drop breast appearance
Not tender, mobile lump
Increased breast size

23
Q

List the 4 indications for mastectomy

A

1) Large tumours >5cm
2) Multifocal breast tumours
3) Diffuse DCIS
4) Large tumour relative to the patients breast size

Year 4 (28 decks)

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