GP Information
Breast
Breast
Screening
– 1 in 9 women in NSW will develop breast cancer in their lifetime and 9 out of 10 women who develop breast cancer do not have a family history of breast cancer.
– The target (invited) age range for breast screening has been increased from 50-69 years to 50-74 years.
– Women aged 40-49 years and over 75 years are eligible for free screening mammograms even though they are not Formally invited.
– The proposed assessment clinic at Nepean Hospital will increase assess for the women who are found an abnormality in their screening mammogram.
For further information: Breast Screen NSW
Breast
Symptoms
– Breast awareness will help women to detect breast changes such as lump, nipple/skin changes, nipple discharge, pain and breast asymmetry early and seek medical attention from their GP’s.
– The investigation of a new breast symptom- a guide to GP’s – Cancer Australia 2006 – Read More
– If you have a patient with clinical suspicion of a breast cancer or other breast complaint we can help to expedite the investigations and subsequent management please Contact us or contact A/Prof. Edirimanne directly (mobile or email).
Individuals
at a high risk of
Breast Cancer
Familial breast cancer:
About 5% of breast cancers can be explained by an inherited gene mutation, most commonly in BRCA1 and BRCA2 genes. As our understanding of genetic basis of breast cancer is rapidly increasing more forms of familial breast cancers are being described.
– Advise about familial aspects of breast cancer and epithelial ovarian cancer- a guide to health professionals- Cancer Australia 2010 – Read More
– Calculate the risk of breast cancer in your patient- Cancer Australia 2014 – Read More
Previous radiation therapy to the chest:
Those who had received radiotherapy to the chest for conditions like lymphoma at a young age are also at risk of developing breast cancer after several decades of the treatment
– If you have a patient at high risk of breast cancer and would like assistance please Contact us or contact A/Prof. Edirimanne directly (mobile or email)
Post – operative
care after
Breast Cancer Surgery
Most breast cancer patients, especially those who had breast conserving surgery and sentinel node biopsy are discharged home on the same day or the next day morning. A/Prof. Edirimanne prefers Comfeel ®dressing which can be left in until the patients are seen at his rooms, which is 1-2 weeks after surgery.
Most patients who had mastectomy and/or axillary dissection are usually discharged home on post op day 1 or 2 with their drains in with community nurse care. Patients are also educated in drain care before discharge form the hospital. Unless otherwise specified these drains can be removed either by community nurses or GPs once drainage is about 30 mls/day on two consecutive days. Please make sure the decreased drainage is not due to a blocked drain.
Patients who had skin or nipple sparing mastectomy and immediate implant/expander reconstructions are usually discharged home after 3 days with drains in. The management of their drains is more complex and A/Prof. Edirimanne removes them himself at his rooms when appropriate. These patients remain on oral antibiotics until their drains are removed.
If you have any concern about a post-operative patient please Contact Us or A/Prof. Edirimanne directly (mobile or email).
Long term
care of
Breast Cancer Patients
Long-term follow up care of breast cancer patients a coordinated process involving breast surgeon, medical oncologist, radiation oncologist (sometimes) and the GP.
The frequency and duration of follow up by the breast surgeon is individualised to the patient. Generally, the patient is initially followed up 6 monthly and after 1-2 years, yearly for at least 5 years. Patients need yearly breast imaging that A/Prof. Edirimanne organises. Patients are given advice regarding life style modifications to reduce recurrence, to maintain breast awareness by regular self-breast examinations.
If you or the patient is concerned about a new symptom or a treatment related problem please do not hesitate to Contact Us Or A/Prof. Edirimanne directly (mobile or email).
Thyroid
Thyroid
Nodules
Thyroid nodules are common and about 7% of the population have palpable thyroid nodules and up to 50% of the population have nodules that can be demonstrated in an ultrasound. Even though the incidence of thyroid cancer is increasing (1 in 48 woman and 1 in 174 man in NSW will develop thyroid cancer by the age of 85) most thyroid nodules are not malignant.
High-risk history:
Thyroid ultrasound, thyroid Function Tests and Fine Needle Aspiration are the essential initial investigations of a thyroid nodule. FNA is indicated for a thyroid nodule in the following situations.
– First-degree relative with thyroid cancer – External beam radiotherapy as a child
– Ionizing radiation as a child or adolescent
– Previous thyroid cancer treated with hemi thyroidectomy
Suspicious features on ultrasound:
– Punctate micro-calcification
– Intra-nodular vascularity – Infiltrative margins
– Taller than wider on transverse view
– Loss of halo
– Abnormal cervical lymph nodes
Bethesda cytological classification is the current standard of reporting of thyroid cytology.
Radioisotope thyroid scan is only helpful is the patient is hyperthyroid.
The following patents with thyroid nodule will benefit from a surgical consultation.
– Bethesda category 3 or above on FNA cytology
– Suspicious features on ultrasound
– Benign nodules which are large, with continuing growth, pressure symptoms (dyspnoea, dysphagia, change in voice etc.) or causing disfigurement
Multi
Nodular
Goiter
(MNG)
Prevalence of sporadic MNG is ~ 5%
Risk of cancer in a nodule in a MNG is the same as a solitary nodule. 3-16% MNG can have incidental thyroid cancer.
The following patients with MNG will benefit from a surgical consultation:
– Suspicion for malignancy
– Pressure symptoms (dyspnoea, dysphagia, change in voice etc.)
– Retro-sternal extension
– Hyperthyroidism (toxic MNG)
– Disfigurement
– Evidence of on going growth on-serial ultrasound examinations
Hyperthyroidism
Common causes of thyrotoxicosis include Graves’ disease, multi nodular goiter (Toxic) and solitary toxic thyroid nodule.
Radioisotope thyroid scan is helpful to differentiate these conditions.
The management of a hyperthyroid patient involves input from an endocrinologist.
The following patients with hyperthyroidism will benefit from a surgical consultation as surgery is one of the definitive treatment options:
– Solitary toxic thyroid nodule
– Toxic MNG
– Graves’ disease patients with suspicion for malignancy, large goiters with pressure symptoms, eye involvement, difficulty in control with medications, inability to tolerate medications or of younger age
If you have a patient with a thyroid condition and would like assistance please Contact Us or contact A/Prof. Edirimanne directly (mobile or email).
Post – operative
care after
Thyroid Surgery
Most Hemi/Partial thyroidectomy patients are discharged on post–op day 1 and Total thyroidectomy patients on post-op day 2. A/Prof. Edirimanne will see the patients 1 week after the surgery at his rooms. They have steri-strip® dressings and a Prolene® stitch that is to be removed about 5 days after the operation. Patients who had Total thyroidectomy are commenced on Thyroxine prior to their discharge with thyroid function tests done 4-6 weeks later. Temporary hypoparathyroidism is fairly common after total thyroidectomy and can last few days to several weeks after surgery. A/Prof. Edirimanne currently use routine calcium and vitamin D supplementation policy with weaning or stopping the supplements once the parathyroid gland function is recovered.
If you have any concerns about A/Prof. Edirimanne’s post operative thyroid patient please Contact Us or contact A/Prof. Edirimanne directly (mobile or email)
Long term
care of
Thyroid Cancer Patients
Long term care of thyroid cancer patients involves the endocrine surgeon, endocrinologist and nuclear medicine physician who discuss the management in a multidisciplinary meeting.
A/Prof. Edirimanne follows up thyroid cancer patients in association with his endocrinology colleagues. The follow up generally involves clinical assessment, neck ultrasound and blood tests such as thyroid function tests, serum thyroglobulin (in well differentiated thyroid cancer) and other tumour markers.
If you have any concerns regarding A/Prof. Edirimanne’s thyroid cancer patient please Contact Us or contact A/Prof. Edirimanne directly (mobile or email).
Parathyroid
Primary Hyperpara-thyroidism
(PHPT)
PHPT is the most common cause of hypercalcaemia in the community. Incidence of PHPT is 3-4/1000 in general population and rises to 2-3/100 in postmenopausal women.
Even though patients with mild PHPT who are completely asymptomatic can be observed, surgery still remains the only effective long-term treatment.
The following patients will benefit from a surgical consultation:
– Very high calcium levels which itself poses a medical threat – Organ dysfunction associated with PHPT such as renal stones, osteoporosis or worsening osteopaenia, pancreatitis etc.
– Patients with constellation of non-specific symptoms associated with PHPT such as aches/pains, lethargy, confusion, depression, deteriorating cognitive function, constipation etc. These patients may notice improvement in their symptoms and overall quality of life after surgery.
– Younger patients
The following investigations help to establish the diagnosis of PHPT and rule out the causes of secondary hyperparathyroidism:
– Serum corrected calcium
– Serum PTH – Serum Vitamin D
– Serum creatinine level
– +/- 24 hour urinary calcium excretion / urinary calcium: creatinine excretion ratio to exclude Familial Hypocalciuric Hypercalcaemia (FHH)
The following investigations help to localize the responsible parathyroid adenoma:
– Parathyroid ultrasound
– Sestamibi scan
– Parathyroid CT protocol (4D parathyroid CT)
If you have a patient with hypercalcaemia and/or suspicion of primary hyperparathyroidism and would like assistance please Contact Us or contact A/Prof. Edirimanne directly (mobile or email).
Secondary Hyperpara-thyroidism
Some patients with secondary hyperparathyroidism as a result of end stage renal failure may benefit from parathyroid surgery. This is a decision that involves multidisciplinary input from other specialists such as renal physicians and endocrinologists.
Post – operative
care after
Parathyroid Surgery
Patients who had either Minimally Invasive Parathyroidectomy (MIP) or four-gland neck exploration are usually discharged home next day. They have steri-strip® dressing and a Prolene® stich that needs to be removed 5 days after surgery. They will be seen at A/Prof. Edirimanne’s rooms in 1-2 weeks and again in 3-6 months with serum corrected Ca, PTH and Vitamin D blood tests.
If you have any concern regarding A/Prof. Edirimanne’s post-operative parathyroid patient please Contact Us or contact A/Prof. Edirimanne directly (mobile or email).
Adrenal
Adrenal
Nodules
Adrenal nodules are common and found in 4-5% of cross sectional imaging studies. Nodules that are suspicious for cancer or overproduce hormones will benefit from surgery.
Could it be invasive cancer (primary or metastasis)?
– Size (cut off of 3-4 cm)
– Evidence of growth
– Suspicious features on imaging
– CT adrenal protocol
– MRI adrenal protocol
– PET
Is it secreting excessive hormones (functional)?
– Patient may be symptomatic
– Clinical signs
– Serum K
Screening tests:
– Conn’s: Plasma aldosterone concentration to plasma renin activity ratio
– Cushing’s: 24 hour urinary cortisol or overnight dexametahsone suppression test
– Pheochromocytoma: 24 hour urinary fractionated metanephrines and catacholeamines or plasma free metanenephrines
If you have a patient with a finding of an adrenal nodule and would like assistance please Contact Us or contact A/Prof. Edirimanne directly (mobile or email).
General Surgery
Breast and Endocrine Surgery is a sub-specialty of General Surgery. A/Prof. Edirimanne had full training specialist general surgery. He continues to regularly perform emergency general surgery and selected elective general surgery operations.
Emergency
General
Surgery
As a part of the Acute Surgical Unit (ASU) of Nepean Public Hospital and On-call General Surgical roster of Norwest Private Hospital and Sydney Adventist Hospital, A/Prof. Edirimanne regularly performs a number of general surgical operations as required. These include laparoscopic appendix and gall bladder surgery, emergency hernia and bowel surgery.
Elective
General
Surgery
Dr. Edirimanne performs selected types of elective (planned) general surgical operations including:
– Laparoscopic Gall bladder surgery
– Groin (inguinal and femoral) and umbilical hernia repair
– Lymph node surgery of neck, axilla (armpit) and groin
– Surgical lumps such as lipoma, sebaceous cysts etc.
Dr. Edirimanne has a regular general surgical public operating list at Blue Mountains District Hospital in Katoomba that allows suitable public patients with above general surgical conditions to have their surgery with a short waiting time.
If you have a patient with above general surgical conditions and would like to refer please Contact Us or contact A/Prof. Edirimanne directly (mobile or email).
Referrals
If you have a routine referral Please Contact Us
If you have an urgent referral please do not hesitate to phone or SMS A/Prof. Edirimanne on his mobile or send an email.