Surgery (inc breast) Flashcards
Green nipple discharge like cheese with slit retraction of the nipple
Mammary duct ectasia
Hard irregular lump with skin tethering in obese women after small trauma
Fat necrosis
Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral
Blood stained nipple discharge
Papilloma
Snowstorm sign on ultrasound of axillary lymph nodes
breast implant rupture
reddening and thickening of the nipple/ areola. It may resemble eczema
pagets disease of the breast
Bilateral, small volumes of pale or colourless discharge in a teenager
hormonal changes of puberty
what is pagets disease of the breast
intraductal carcinoma
requires immediate referral
Chemotherapy regimes
FEC-D chemo for node +ve
Aromatase inhibitors for post menopause (anastrozole) and tamoxifen for pre menopause in ER +ve
Herceptin (trastuzumab) for HER2 +ve
Management of breast fibroademoma
Over 3cm and discomfort then surgical excision
mobile firm and smooth breast lump
fibroadenoma
Breast feeding - tender fluctuant mass
Abscess
Creamy nipple discharge and nipple inversion
Duct ectasia
Reason for neo-adjuvant chemo
Downsize the rumour to allow breast conserving surgery rather than mastectomy
After surgery for breast cancer:
- no mets
- mets in axilla
No mets: radio
Mets in axilla: cytotoxic chemo
BRCA1 inheritance
There is a 50/50 chance of siblings and children of BRCA1 carrier to also have the gene
Fibroadenoma vs Fibroadenosis
Adenoma: discrete, mobile and non-tender
Adenosis: lumpy breasts worsen during menstruation
Duct ectasia treatment
Reassurance
Fibroadenoma management
Routine breast clinic referral
Most common breast cancer
Invasive ductal cardinoma
Risk factor of aromatase inhibitors
Osteoporosis
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is positive then they should have a sentinel node biopsy to assess the nodal burden
Grey gelatinous surface
Mucinous carcinoma
Bloody nipple discharge with comedo necrosis
Ductal carcinoma in situ
Tumour less than 4cm
Wide local excision
Halo sign on mammogram
Breast cyst - aspiration if symptomatic
Breast screening
3 years
Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds
Periductal mastitis is common in smokers and may present with recurrent infections
