criteria if which present warrants treatment for mastitis
- systemically unwell
- nipple fissure present
- symptoms not improving after 12-24 hours of effective milk removed
- culture indicates infection
Breast cancer referral for a woman over 30?
have an unexplained breast lump (with or without pain)
Breast cancer referral for a woman over 50? with what symptoms in a single nipple?
- discharge
- retraction
any other concerning changes
pattern of eczematous skin changes occuring in
a) pagets disease
b) eczema
in Pagets: involves the nipple primarily and only latterly spreads to the areolar
opposite in eczema
how is diagnosis of pagets disease of breast made?
- punch biopsy
- mammogram
- USS
prior to surgery what is the management in presence & absence of palpable axillary lymphadenopathy?
- palpable: axillary node clearance at primary surgery
- non palpable: pre-operative axillary ultrasound
management if woman with no palpable axillary lymphadenopathy has pre-operative axillary ultrasound
- if positive
?
positive: sentinel node biopsy?
4 types of breast cancer features that make wide local excision the choice of surgery over mastectomy?
- solitary lesion
- peripheral tumour
- small lesion in large breast
- DCIS < 4cm
4 types of breast cancer features that make mastectomy the choice of surgery over wide local excision?
- multifocal tumour
- central tumour
- large lesion in small breast
- DCIS > 4 cm
what treatment should always be offered following wide local excision & why?
radiotherapy
as this may reduce the recurrence by 2/3rds.
which women require radiotherapy following mastectomy?
for T3-T4 tumours
and those with 4 or more positive axillary lymph nodes
hormonal therapy of choice for post menopausal women with oestrogen receptor positive tumours?
Aromatase inhibitors = anastrozole or letrozole
important side effects of tamoxifen?
- VTE
- Menopausal symptoms
- increased risk of endometrial cancer
who is contraindicated for trastuzumab?
- patients with a hx of heart disorders
when can neoadjuvant chemo be used?
either prior or after surgery in a number of criteria e.g. if have axillary node disease
marker used to montor response to breast cancer treatment & disease recurrence
CA 15-3
apearance of breast in inflammatory breast cancer
progressive, erythema and oedema of the breast
typical symptoms of duct ectasia?
- greenish nipple discharge
- peri-areolar lump
- around menopause
- slit like retraction of nipple
- cheese like discahrge
why does duct ectasia occur?
reflects a shortening and widening of the terminal breast ducts around th enipple
discrete soft fluctuant areas in UOQ & mammogram halo sign
breast cyst
what is the major adverse effect of aromatase inhibitors?
osteoporosis
episode of clear nipple discharge which has blood when tested & originates from a single duct
intraductal papilloma
comedo necrosis
feature of high nuclear grade ductal carcinoma in situ
grey gelatinious surface when lump is sliced apart
mucinous carcinoma
