Surgery - Breast Flashcards
What are the risk factors for the development of breast cancer?
Smoking FHx BRCA mutations Early menarche/late menopause HRT Older first pregnancy
Breast feeding is protective
Describe the screening programme for breast cancer
Females 50-70yrs get mammography every 3 yrs
How might a symptomatic breast lump present?
Pain New lump Skin changes Nipple discharge Redness/inflammation
Name the pre-malignancy breast conditions
DCIS (80%)
LCIS (20%)
What are the malignant types of breast cancer
Ductal Lobular Tubular Medullary Mucinous Papillary
Can also be described by hormone receptor status:
- ER, HER2, PR…
How are breast lumps investigated?
Triple assessment:
- history and examination
- imaging (USS/mammography)
- biopsy (FNA/core)
What are the surgical options for breast cancer?
(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
What are the hormonal treatment options for breast cancer?
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
What is the Nottingham prognostic index?
Predicts pt survival and risk of relapse
grade + stage + tumour size (cm) / 5
Describe male breast cancer
- 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
Describe non-infectious benign breast disease
fat necrosis pagets disease fibroadenoma cyst fibrocystic change breast abscess
Describe infectious benign breast disease
lactational mastitis
mammary duct ectasia
periductal mastitis
Describe fibroadenomas
- benign overgrowth of one lobule
- younger women <30yrs
- normally a firm, discrete, very mobile lump which does not need removed
Describe benign breast cyst
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
Describe breast abscess
- 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
Describe fibrocystic breast disease
- 15-55yrs
- cyclical lumpy breasts
- hormonal pain
- very common in pre-menopausal women
- diffuse lumpiness
Treatment = OCP/aspiration
Describe fat necrosis
- 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
Describe Paget’s disease of the nipple
- pre-cancerous, eczema like changes of the nipple skin
- common in ELDERLY
- take a punch biopsy to diagnose
Describe lactational mastitis
- an acute staph infection of mammary ducts
- may form an abscess
- no need to stop lactating
- treat with aspiration and antibiotics
Describe mammary duct ectasia
- 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
Describe periductal mastitis
- inflammation and abscess formation around the nipple
- ASSOCIATED with smoking
- common in 40yr olds
- treatment:
- > stop smoking
- > antibiotics
- > drainage
What is a Phyllodes tumour?
Malignant
Tear drop breast appearance
Not tender, mobile lump
Increased breast size
List the 4 indications for mastectomy
1) Large tumours >5cm
2) Multifocal breast tumours
3) Diffuse DCIS
4) Large tumour relative to the patients breast size
