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MBBS Y5 > Surgery - Breast Surgery > Flashcards

Surgery - Breast Surgery Flashcards

1
Q

how is breast cancer diagnosed / excluded?

A

triple assessment - clinical assessment - imaging (USS, mammography)- histology (FNA, core biopsy)

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2
Q

presentation of breast cancer?

A
  • new breast lump- nipple retraction / discharge - skin dimpling / oedema (peau d’orange)
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3
Q

describe characteristics of a breast cancer lump

A

NAME?

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4
Q

2WW criteria for breast cancer?

A
  • unexplained breast lump in pts 30+| - unilateral nipple discharge / retraction in pts 50+
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5
Q

describe the characteristics of a fibroadenoma

A
  • small (<3cm in diameter)- smooth- round with well-defined borders - firm - mobile - “breast mouse”
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6
Q

is a fibroadenoma worrying?

A
  • no| - no risk of going on to develop cancer
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7
Q

features of fibrocystic breast changes?

A

NAME?

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8
Q

management of fibrocystic breast changes?

A

exclude breast cancer then reduce mastalgia:- supportive bra- NSAIDs (ibuprofen)- avoid caffeine- apply heat to area- hormonal treatment

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9
Q

hormonal treatment options for mastalgia?

A
  • danazol| - tamoxifen
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10
Q

what is the most common type of breast lump?

A

breast cysts

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11
Q

which age demographic is most affected by breast cysts?

A
  • women aged 30-50| - particularly in perimenopausal period
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12
Q

features of a breast cyst?

A

NAME?

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13
Q

management of a breast cyst?

A

NAME?

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14
Q

is a breast cyst worrying?

A
  • yes| - slightly increased risk of developing breast cancer
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15
Q

is fat necrosis worrying?

A
  • no| - no increased risk of developing breast cancer
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16
Q

features of the lump in fat necrosis?

A

NAME?

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17
Q

how is fat necrosis differentiated from breast cancer?

A
  • look the same on imaging - therefore need to do histology:- FNA / core biopsy
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18
Q

management of fat necrosis?

A
  • exclude breast cancer- conservative (most resolve spontaneously- surgical excision if symptomatic
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19
Q

what is a lipoma?

A

a benign fat tumour

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20
Q

findings on examination of a lipoma?

A

NAME?

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21
Q

management of a lipoma?

A

conservative

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22
Q

what is a galactocoele?

A

milk-filled cyst blocking the lactiferous duct

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23
Q

when do women typically develop galactocoeles?

A
  • when lactating| - typically when they’ve just stopped breastfeeding
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24
Q

features of a galactocoele?

A

NAME?

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25
Q

management of a galactocoele?

A

NAME?

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26
Q

key complication of galactocoele?

A

can become infected

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27
Q

which demographic is typically affected by phyllodes tumours?

A

women aged 40-50

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28
Q

is a phyllodes tumour worrying?

A
  • yes- 50% are benign- 25% are borderline- 25% are malignant
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29
Q

management of a phyllodes tumour?

A
  • surgical removal (can still recur despite this)| - chemotherapy if it has metastasised
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30
Q

how can mastalgia be classified?

A
  • cyclical| - non-cyclical
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31
Q

features of cyclical breast pain?

A
  • comes on in first 2 weeks of cycle (luteal phase), then settles- bilateral, generalised pain- heaviness- aching- associated with other signs of premenstrual syndrome
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32
Q

signs of premenstrual syndrome?

A

NAME?

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33
Q

causes of non-cyclical breast pain? (hint: think local and non-local)

A
  • any local breast pathology- drugs (HRT, contraceptives)- pregnancy- infection (mastitis, costochondritis)- skin (shingles, post-herpetic neuralgia)
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34
Q

management of cyclical breast pain?

A

NAME?

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35
Q

is male breast enlargement common? which age groups could be affected?

A
  • yes!| - common in neonates, teens and 50s
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36
Q

pathophysiology of gynaecomastia?

A

NAME?

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37
Q

causes of gynaecomastia due to increased oestrogen?

A

NAME?

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38
Q

causes of gynaecomastia due to decreased testosterone?

A
  • age-related deficiency - hypothalamus / pituitary tumours or damage (e.g. post-radio, post-surgery)- klinefelter syndrome (XXY)- orchitis- testicular damage (e.g. due to trauma / torsion)
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39
Q

illicit and prescribed drug causes of gynaecomastia?

A

NAME?

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40
Q

investigations for gynaecomastia?

A

NAME?

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41
Q

imaging for gynaecomastia?

A

NAME?

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42
Q

management of gynaecomastia?

A

NAME?

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43
Q

define galactorrhoea

A

breast milk production not relating to pregnancy or breastfeeding

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44
Q

which hormone triggers the production of breast milk?

A

prolactin

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45
Q

how does dopamine affect prolactin levels?

A

DA suppresses prolactin release

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46
Q

in pregnancy, when does breast milk production begin?

A
  • in 2nd and 3rd trimester| - it’s normal to leak a little at this point too
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47
Q

what is galactorrhoea?

A

breast milk production which is not associated with pregnancy or breastfeeding

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48
Q

where is prolactin produced?

A

anterior pituitary

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49
Q

which hormones inhibit prolactin release?

A
  • oestrogen| - progesterone
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50
Q

what is the role of oxytocin?

A

to stimulate breast milk excretion

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51
Q

how can the causes of hyperprolactinaemia be split?

A

NAME?

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52
Q

endocrine (non-tumour) causes of hyperprolactinaema?

A
  • hypothyroidism| - PCOS
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53
Q

drug causes of hyperprolactinaemia?

A

DA antagonists (antipsychotics)

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54
Q

presentation of hyperprolactinaemia?

A

NAME?

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55
Q

which hereditary condition could predispose someone to prolactinomas?

A

multiple endocrine neoplasia type 1 (MEN1)

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56
Q

mode of inheritance of MEN1?

A

autosomal dominant

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57
Q

how big is a macroprolactinoma? how might this affect vision?

A
  • > 10mm| - bitemporal hemianopia
58
Q

causes of non-milk breast discharge?

A

NAME?

59
Q

investigations for galactorrhoea?

A

NAME?

60
Q

how is a prolactinoma diagnosed?

A

clinical picture plus MRI head

61
Q

management of galactorrhoea?

A

NAME?

62
Q

describe mammary duct ectasia

A
  • benign enlargement of breast ducts| - causes intermittent discharge
63
Q

key risk factor for mammary duct ectasia?

A

smoking

64
Q

which demographic is likely to be affected by mammary duct ectasia?

A

perimenopausal women

65
Q

presentation of mammary duct ectasia?

A

NAME?

66
Q

key characteristic of the breast lump in mammary duct ectasia?

A

pressing on the lump produces discharge

67
Q

how is mammary duct ectasia diagnosed?

A

can be found incidentally on mammogram - Hx and examination- imaging - histology (FNA, core biopsy)

68
Q

imaging used to diagnose mammary duct ectasia?

A

NAME?

69
Q

findings on mammography in mammary duct ectasia?

A

microcalcifications

70
Q

management of mammary duct ectasia?

A

NAME?

71
Q

what is an intraductal papilloma?

A

warty, benign tumour growing in a breast duct

72
Q

typical demographic affected by intraductal papillomas?

A

women aged 35-55

73
Q

presentation of intraductal papilloma?

A

NAME?

74
Q

how is intraductal papilloma diagnosed?

A

triple assessment: - Hx and examination- imaging - histology (core biopsy, vacuum-assisted biopsy)can use ductography

75
Q

finding on ductography in intraductal papilloma?

A
  • “filling defect”| - the papilloma won’t fill with contrast but the rest of the breast will
76
Q

management of intraductal papilloma?

A
  • complete surgical excision| - examine the removed tissue for atypical hyperplasia / Ca
77
Q

is there any risk of an intraductal papilloma becoming malignant?

A

although they’re benign, they’re associated with hyperplasia / Ca

78
Q

what is mastitis?

A
  • inflammation of breast tissue| - common complication of breastfeeding
79
Q

how can mastitis be prevented?

A

regularly expressing breast milk (this stops any obstruction to the duct flow)

80
Q

commonest infective cause of mastitis?

A

staph aureus

81
Q

presentation of mastitis?

A

NAME?

82
Q

management of mastitis caused by an obstruction?

A

NAME?

83
Q

management of mastitis caused by infection?

A
  • 1st line = flucloxacillin| - fluconazole if fungal cause suspected
84
Q

key complication of mastitis?

A

breast abscess

85
Q

management of a breast abscess?

A

incision and drainage

86
Q

what might a Hx of recurrent mastitis suggest?

A

candida of the nipple

87
Q

associated infections in infant when mother has nipple candida?

A
  • oral thrush| - candidal nappy rash
88
Q

presentation of candida of the nipple?

A

NAME?

89
Q

what areolar changes might be seen in candida of the nipple?

A

it may be:- cracked- flaky- shiny

90
Q

management of candida of the nipple?

A
  • both mum and baby must be treated or they’ll keep reinfecting each other- TOP miconazole 2% to nipple after each feed- PO miconazole / nystatin for baby
91
Q

how can breast abscesses be classified?

A
  • lactational| - non-lactational
92
Q

key RFs for breast abscess development?

A

NAME?

93
Q

commonest causative organism of breast abscesses?

A

staph aureus

94
Q

presentation of breast abscess?

A

NAME?

95
Q

features of the breast lump palpated in breast abscess?

A

fluctuant and tender

96
Q

examples of systemic signs of infection that may be seen in breast abscess?

A

NAME?

97
Q

management of lactational mastitis?

A

NAME?

98
Q

management of non-lactational mastitis?

A

NAME?

99
Q

which ABx can be offered in non-lactational mastitis?

A

need to be broad-spec to cover anaerobes:- co-amox- erythromycin / clarithromycin + netronidazole

100
Q

management of breast abscess?

A

NAME?

101
Q

advice for women who are breastfeeding with mastitis +/- breast abscess?

A
  • continue breastfeeding - if this is too painful, try to regularly express breast milk- there’s no harm to baby here
102
Q

what is the most common form of cancer in the UK?

A

breast Ca

103
Q

RFs for breast Ca?

A
  • female sex- increased oestrogen exposure (early periods, late menopause)- obesity- smoking- FHx (1st deg relatives)
104
Q

does the COCP affect breast Ca risk? for how long?

A
  • yes, it slightly increases it| - this goes away 10 years after stopping the pill
105
Q

does HRT affect breast Ca risk?

A
  • yes| - worse with combined HRT
106
Q

which chromosome holds the BRCA1 gene?

A

17

107
Q

which chromosome holds the BRCA2 gene?

A

13

108
Q

which cancers are associated with the BRCA1 gene?

A

NAME?

109
Q

which cancers are associated with the BRCA2 gene?

A
  • breast Ca| - ovarian Ca
110
Q

give some examples of types of breast Ca

A

NAME?

111
Q

how does inflammatory breast cancer present?

A
  • similarly to mastitis / breast abscess- swollen, warm, tender breast- pitting skin (peau d’orange)
112
Q

presentation of paget’s disease of the nipple?

A
  • erythematous, scaly rash| - looks like eczema on nipple
113
Q

what could paget’s disease of the nipple be a sign of?

A
  • DCIS| - invasive breast Ca
114
Q

which type of breast Ca is most likely to metastasise?

A

invasive breast Ca

115
Q

how is breast Ca screened for in the UK?

A

all women aged 50-70 are offered a mammogram every 3 years

116
Q

which pts are screened more regularly for breast Ca (due to higher risk)?

A
  • 1st deg relative with breast Ca under 40- 1st deg male relative affected- 1st deg relative with bilateral breast Ca- two 1st deg relatives affected
117
Q

chemoprevention for pts at high risk of breast Ca?

A
  • tamoxifen if premenopausal| - anastrozole if postmenopausal
118
Q

surgical intervention to prevent breast Ca in high-risk pts?

A

bilateral mastectomy

119
Q

presentation of breast Ca?

A
  • lump - nipple retraction / discharge- skin dimpling (peau d’orange)- lymphadenopathy (esp in axilla)
120
Q

describe the lump in breast Ca

A

NAME?

121
Q

2WW criteria for suspected breast Ca?

A
  • unexplained breast lump in pt aged >30| - unilateral nipple changes in pt aged >50
122
Q

components of the triple diagnostic assessment of breast Ca?

A

NAME?

123
Q

how do you choose between USS and mammography in suspected breast Ca?

A
  • USS better for lump assessment in younger women| - mammography better in older women
124
Q

how are lymph nodes assessed in breast Ca pts?

A
  • USS axilla| - biopsy of any abnormal nodes
125
Q

what are the 3 types of breast Ca cell receptor?

A

NAME?

126
Q

what is triple -ve breast Ca? prognosis of this?

A
  • where there are none of the 3 cell receptors present| - worst prognosis because there’s nothing to target with the treatment
127
Q

breast Ca is likely to metastasise to which 4 sites?

A

NAME?

128
Q

how is breast Ca staged?

A

using TNM system and the following: - LN assessment, biopsy- MRI breast and axilla- liver USS (mets)- CT TAP (mets)- isotope bone scan (bony mets)

129
Q

surgical management of breast Ca?

A

NAME?

130
Q

key complication of axillary LN clearance?

A

chronic lymphoedema (impaired lymph drainage)

131
Q

presentation of chronic lymphoedema?

A

area affected gets really swollen

132
Q

non-surgical management of chronic lymphoedema?

A

NAME?

133
Q

how can chronic lymphoedema be prevented?

A

don’t take blood on the same side as where someone has had axillary LN clearance

134
Q

common SEs of radiotherapy?

A

NAME?

135
Q

what are the 3 ways chemotherapy can be used in breast Ca treatment?

A
  • as a neoadjuvant (to shrink the tumour before surgery)- as an adjuvant (post-surgery to reduce recurrence)- as treatment of mets / recurrent cases
136
Q

drug offered to premenopausal women with ER+ breast Ca?

A

tamoxifen

137
Q

drugs offered to postmenopausal women with ER+ breast Ca?

A

aromatase inhibitors:- letrozole- anastrozole- exemestane

138
Q

complication of tamoxifen therapy?

A

endometrial Ca!

139
Q

how long is hormone therapy used in breast Ca?

A

5 - 10 years

140
Q

which drugs can be used in the treatment of HER2+ breast Ca?

A

NAME?

MBBS Y5 (27 decks)

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