Yr3 - General Surgery > Breast > Flashcards

Breast Flashcards

(63 cards)

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1
Q

Define galactorrhoea

A

Copious, bilateral, multi-ductal milky discharge - not associated with pregnancy or lactation

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2
Q

How is lactation regulated?

A

Prolactin - produced and secreted by the anterior pituitary gland
Secretion controlled by
- inhibited by dopamine - released by hypothalamus
- stimulated by TRH and oestrogen - released by pituitary

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3
Q

Causes of hyperprolactinaemic galactorrhoea

A 
Idiopathic
Pituitary adenoma
Drug-induced - SSRIs, anti-psychotics and H2-antagonists
Neurological
Hypothyroidism
Renal or liver failure
Damage to pituitary stalk
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4
Q

Investigation for galactorrhoea

A

Exclude pregnancy
Serum prolactin levels
MRI head with contrast - suspected pituitary tumour

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5
Q

Management of galactorrhoea

A 
Pituitary tumour
- dopamine agonist therapy
- trans-sphenoidal surgery
Idiopathic
- resolves spontaneously
- bilateral total duct excision
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6
Q

Define mastalgia

A

Breast pain

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7
Q

Describe the classifications of breast pain

A

Cyclical pain - associated with the menstrual cycle and affects both breasts
Non-cyclical - can be caused by medication
Extramammary - chest wall or shoulder pain

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8
Q

Investigations of breast pain

A

Breast pain in isolation with no further relevant features is not an indication for imaging
Pregnancy test

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9
Q

Management of mastalgia

A

Reassurance and pain control
Oral ibuprofen or paracetamol or topical NSAIDs
Referral to specialist

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10
Q

Define mastitis

A

Inflammation of the breast tissue

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11
Q

What is the most common cause of mastitis?

A

Infection - S.Aureus

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12
Q

Types of mastitis

A

Lactational
- first 3 months of breastfeeding or weening
- cracked nipples and milk stasis
Non-lactational
- Duct ectasia
- tobacco smoking causes damage to sub-areolar duct walls

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13
Q

Clinical features of mastitis

A

Tenderness
Swelling
Erythema

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14
Q

Management of mastitis

A

Systemic antibiotic therapy
Simple analgesics
Continued milk drainage or feeding

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15
Q

Define a breast abcess

A

Collection of pus within the breast lined with granulation tissue

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16
Q

Presentation of a breast abscess

A

Tender, fluctuant and erythematous mass
Associated fever and lethargy
Confirmed via ultrasound if needed

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17
Q

Treatment of a breast abscess

A

Empirical antibiotics
US-guided needle therapeutic aspiration
Advanced abscesses may need incision and drainage under local anaesthetic

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18
Q

Complications of a breast abscess

A

Mammary duct fistula

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19
Q

Define a breast cyst

A

Epithelial lined fluid-filled cavities

Form when lobules become distended due to blockage

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20
Q

Clinical presentation of breast cysts

A

Singular or multiple lumps
One or both breasts
Distinct smooth masses on palpation
May be tender

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21
Q

Investigations for breast cysts

A

Halo shape on mammography

Definitively diagnosed using ultrasound

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22
Q

Management of breast cysts

A

Usually no further management and self-resolve
Persisting, symptomatic or undeterminable cystic masses may be aspirated
Cancer excluded if free of blood or lump disappears

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23
Q

Complications of breast cysts

A

Risk of developing breast cancer

Fibroadenosis (fibrocystic change)

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24
Q

Define mammary duct ectasia

A

Dilation and shortening of major lactiferous ducts

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25
Presentation of duct ectasia
Coloured green/yellow nipple discharge Palpable mass Nipple retraction
26
Investigations for duct ectasia
Mammorgraophy - dilated calcified ducts | Biopsy - multiple plasma cells
27
Management of duct ectasia
Conservatively | Duct excision
28
Define fat necrosis
Ischaemic necrosis of fat lobules to due acute inflammatory response
29
Causes of fat necrosis in the breast
Blunt trauma to breast | Previous surgical or radiological intervention
30
Presentation of fat necrosis
Usually asymptomatic Lump Acute inflammatory response can persist -> chronic fibrotic change -> solid irregular lump
31
Investigations of fat necrosis
Positive traumatic history | Hyperechoic mass on ultrasound
32
Management of fat necrosis
Self-limiting | Analgesic management and reassurance
33
Describe a fibroadenoma
Proliferation of stromal and epithelial tissue Most common benign growth Occur in women of reproductive age
34
Examination of fibroadenoma
Highly mobile lesions Well-defined Rubbery Can be multiple and bilateral
35
Malignancy potential of fibroadenoma
Very low
36
Describe a adenoma
Benign glandular tumour | Occur in older population
37
Examination of adenoma
Nodular | Easily mimic malignancy - undergo escalation for triple assessment
38
Describe a papilloma
Benign breast lesion Occur in subareolar region 40-50 years
39
Presentation of papilloma
Nipple discharge | Similar to ductal carcionmas
40
Malignancy potential of papilloma
High if multi-ductal -> microdochectomy
41
Define a lipoma
Benign adipose tumour Asymptomatic Soft and mobile Low malignant potential
42
Define phyllodes tumour
Rare fibroepithelial tumour - comprised of epithelial and stomral tissue Older age group
43
Management of phyllodes tumour
Wide excision or mastectomy - malignant potential
44
Triple assessment stages
Examination Imaging Histology
45
Define gynaecomastia
Development of breast tissue in males | Due to an imbalance of oestrogen and androgens
46
Causes of gynaecomastia
``` Lack of testosterone - androgen insensitivy - testicular atrophy - renal disease Increased oestrogen levels - liver disease - hyperthyroidism - obesity - adrenal tumours Medication - digoxin - metronidazole - spironolactone Idiopathic ```
47
Examination of gynaecomastia
Rubbery or firm mass | Starts from underneath nipple and spreads outwards
48
Management of gynaecomastia
Reverse underlying cause Reassurance Tamoxifen Surgery
49
Define carcinoma in situ
Malignancies are contained within the basement membrane | Pre-malignancy condition
50
Types of carcinoma in situ
Ductal carcinoma in Situ - most common | Lobular carcinoma in Situ
51
Management of carcinomas in situ
``` DCIS - complete wide excision - complete mastectomy LCIS - monitoring - bilateral prophylactic mastectomy ```
52
Types of invasive carcinoma of the breast
Ductal carcinoma - 85% Lobular carcinoma - 10 % - older women Medullary carcinoma Colloid carcinoma
53
Risk factors for breast cancer
``` Female sex Increased age Mutations to certain genes - BRCA1 and BRCA2 Family hisotry in first degree relative Previous benign disease Obesity Alcohol consumption Exposure to unopposed oestrogen - early menarche - late menopause - nulliparous women ```
54
Clinical features of breast cancer
``` Symptomatically or asymptomatically via screening Breast lumps Asymetry Swelling Abnormal nipple discharge Nipple retraction Skin changes Mastalgia Palpable lump in axilla ```
55
Diagnosis of breast cancer
Triple assessment Examination Imaging Histology/cytology
56
Criteria for UK breast screening
50-70 years old | Mammogram every 3 years
57
Define Paget's disease of the nipple
Involvement of epidermis by malignant ductal carcinoma cells
58
Presentation of Paget's disease of the nipple
Itching or redness of nipple/areola Flaking and thickened skin Painful and sensitive
59
Investigations for Paget's disease of the nipple
Biopsy | Complete breast and axilla examination
60
Management of Paget's disease of the nipple
Surgical | Radiotherapy
61
Surgical treatment of breast cancer
Breast conserving - wide local excision Mastectomy Axillary surgery - identify sentinel node by injecting blue dye
62
Hormone treatments of breast cancer
Tamoxifen - blockade of oestrogen receptors - increased risk of thromboembolism and uterine carcinoma Aromatase inhibitors - binding to oestrogen receptors to inhibit further malignant growth - post-menopausal patients Immunotherapy - Herceptin for human epidermal growth factor receptor (HER-2 positive) - can cause cardiotoxicity
63
Oncoplastic management of breast cancer
Therapeutic mammoplasty - WLE with breast reduction - nipple and areola preserved Flap formation - latissimus dorsi flap - transverse rectus abdominal muscle flap - deep inferior epigastric perforator flap
Yr3 - General Surgery
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