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Surgery.(General 2).Breast > 2. Carcinoma of the female breast.(Spread and grading) > Flashcards

2. Carcinoma of the female breast.(Spread and grading) Flashcards

1
Q

Spread of breast cancer

A

l- Direct (Local) spread

ll- Lymphatic Spread

III- Blood spread

lV - Transcoelomic spread

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2
Q

Direct (Local) spread of breast carcinoma

A
  • 1st within the breast tissue itself,
  • then to the skin, pectoral muscle and fascia,
  • then to serratus anterior muscle and chest wall.
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3
Q

Lymphatic Spread of breast carcinoma

A

Pathogenesis

Bailey & love note on Lymphatic Spread

Routes

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4
Q

Pathogenesis of Lymphatic Spread of breast carcinoma

A

By both embolization & Permeation

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5
Q

Bailey & love note on Lymphatic Spread of breast carcinoma

A

The site of the tumour within the breast does not dictate which nodes will be involved:

Axillary L.N: 75-80%

Internal mammary L.N: 20-25%

Posterior intercostal L.N, subscapular L.N, Intercostal L.N: 3%

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6
Q

Routes of Lymphatic Spread of breast carcinoma

A

according to the site of the tumour within the breast:

Lateral quadrants

Upper quadrants

medial quadrants

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7
Q

Lateral quadrants Routes of Lymphatic Spread of breast carcinoma

A

drains into pectoral L.N then to central L.N then to apical L.N

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8
Q

Upper quadrants Routes of Lymphatic Spread of breast carcinoma

A

Pierce pectoralis major muscle & clavipectoral fascia directly to the apical L.N

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9
Q

medial quadrants Routes of Lymphatic Spread of breast carcinoma

A

drain into internal mammary L.N of both sides then to mediastinal L.N

or Reach the lymphatics of rectus sheath and then:

1) to the porta hepatis and liver through lymphatics in the falciform ligament
2) To umbilicus (sister Joseph nodules of mayo-clinic)

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10
Q

Blood spread of breast carcinoma

A
  1. Common sites
  2. Bone secondaries
  3. The order of frequency of bony metastases
  4. Blood micro-metastases
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11
Q

Common sites of Blood spread of breast carcinoma

A
  1. Bone
  2. Lung
  3. Liver
  4. Brain
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12
Q

Bone secondaries in Blood spread of breast carcinoma

A

Bone secondaries are very common and are osteolytic, very rarely osteosclerotic

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13
Q

The order of frequency of bony metastases in Blood spread of breast carcinoma

A

1- Lumber vertebrae

2- femur

3- thoracic vertebrae

4- Ribs

5- Skull

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14
Q

Blood micro-metastases in Blood spread of breast carcinoma

A

The carcinoma of the breast considered a systemic disease from the start as it spreads by blood micro-metastases very early

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15
Q

explain the frequent Bone dissemination in the absence of lung metastases

A

It has been suggested that tumour cells may spread via the paravertebral venous plexus, which has direct connections with the breast through the posterior intercostal veins

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16
Q

why is the carcinoma of the breast considered a systemic disease from the start

A

as it spreads by blood micro-metastases very early

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17
Q

Trans-coelomic spread of breast carcinoma

A
  1. Pathogenesis

2. Common sites

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18
Q

Pathogenesis of Trans-coelomic spread of breast carcinoma

A

It’s now proved to be due to retrograde lymphatic permeation

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19
Q

Common sites of Trans-coelomic spread of breast carcinoma

A

a) Ovaries: krukenburg’s tumour.

b) Nodules in Douglas pouch : Blumer’s shelf nodules.

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20
Q

what is the krukenburg’s tumour

A

any secondaries affecting the ovaries

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21
Q

Blumer’s shelf nodules

A

Nodules in Douglas pouch (Transcoelomic spread of cancer breast)

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22
Q

Staging of cancer breast by

A

TNM classification

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23
Q

TNM classification in staging of cancer breast

A
  1. Primary tumour (T)
  2. Regional lymph nodes (N)
  3. Metastasis (M)
24
Q

Primary tumour (T) in TNM classification in staging of cancer breast

A

Tx

T0

Tis

T1

T2

T3

T4a

T4b

T4c

25
Q

Meaning of Tx in Primary tumour (T) in TNM classification in staging of cancer breast

A

can’t be assessed

26
Q

Meaning of T0 in Primary tumour (T) in TNM classification in staging of cancer breast

A

No evidence of primary tumour.

27
Q

Meaning of Tis in Primary tumour (T) in TNM classification in staging of cancer breast

A

Carcinoma in situ ( DCIS, LCIS or Paget’s disease with no mass )

28
Q

Meaning of T1 in Primary tumour (T) in TNM classification in staging of cancer breast

A

Tumour less than 2 cm greatest diameter.

29
Q

Meaning of T2 in Primary tumour (T) in TNM classification in staging of cancer breast

A

Tumour 2-5 cm.

30
Q

Meaning of T3 in Primary tumour (T) in TNM classification in staging of cancer breast

A

Tumour > 5 cm or fixation to pectoral muscle.

31
Q

Meaning of T4a in Primary tumour (T) in TNM classification in staging of cancer breast

A

Tumour of any size with direct extension to chest wall

32
Q

Meaning of T4b in Primary tumour (T) in TNM classification in staging of cancer breast

A

Tumour of any size with skin fixation

33
Q

Meaning of T4c in Primary tumour (T) in TNM classification in staging of cancer breast

A

Inflammatory carcinoma

34
Q

chest wall includes all of the following except:

  • ribs
  • intercostal muscle
  • serratous anterior muscle
  • pectoral muscle and fascia
A

pectoral muscle and fascia

35
Q

Regional lymph nodes (N) in TNM classification in staging of cancer breast

A

N0

N1

N2

N3

36
Q

Meaning of N0 in Regional lymph nodes (N) in TNM classification in staging of cancer breast

A

No L.N metastasis.

37
Q

Meaning of N1 in Regional lymph nodes (N) in TNM classification in staging of cancer breast

A

Mobile ipsilateral axillary L.N

38
Q

Meaning of N2 in Regional lymph nodes (N) in TNM classification in staging of cancer breast

A

Fixed ipsilateral axillary L.N

39
Q

Meaning of N3 in Regional lymph nodes (N) in TNM classification in staging of cancer breast

A

Ipsilateral supraclavicular L.N

other textbooks consider:
N3:palpable ipsilateral internal mammary L.N
M1: palpable ipsilateral supraclavicular L.N

40
Q

Metastasis (M) in TNM classification in staging of cancer breast

A

M0

M1

41
Q

Meaning of M0 in Metastasis (M) in TNM classification in staging of cancer breast

A

No distant metastasis

42
Q

Meaning of M1 in Metastasis (M) in TNM classification in staging of cancer breast

A

Distant metastasis including contralateral Axillary L.N and breast

(or palpable ipsilateral supraclavicular L.N)

43
Q

Interpretation of TNM classification in staging of cancer breast

A

Clinical Significance of stages

Interpretation of stages

44
Q

Clinical Significance of stages in Interpretation of TNM classification in staging of cancer breast

A

Clinical Significance of stage one and two

Clinical Significance of stage three

Clinical Significance of stage four

45
Q

Clinical Significance of stage one and two in Interpretation of TNM classification in staging of cancer breast

A

Curable breast cancer

46
Q

Clinical Significance of stage three in Interpretation of TNM classification in staging of cancer breast

A

Locally advanced breast cancer

47
Q

Clinical Significance of stage four in Interpretation of TNM classification in staging of cancer breast

A

metastatic breast cancer

48
Q

Interpretation of stages of TNM classification in staging of cancer breast

A

Stage 0

Stage I

Stage IIA

Stage IIB

Stage IIIA

Stage IIIB

Stage IIIC

Stage IV

49
Q

Interpretation of Stage 0 of TNM classification in staging of cancer breast

A

Tis N0 M0

50
Q

Interpretation of Stage I of TNM classification in staging of cancer breast

A

T1 N0 M0

51
Q

Interpretation of Stage IIA of TNM classification in staging of cancer breast

A

T2 N0 M0

T1 N1 M0

T0 N1 M0

52
Q

Interpretation of Stage IIB of TNM classification in staging of cancer breast

A

T3 N0 M0

T2 N1 M0

53
Q

Interpretation of Stage IIIA of TNM classification in staging of cancer breast

A

T0-3 N2 M0

T3 N1-2 M0

54
Q

Interpretation of Stage IIIB of TNM classification in staging of cancer breast

A

T4 N0-2 M0

55
Q

Interpretation of Stage IIIC of TNM classification in staging of cancer breast

A

any T N3 M0

56
Q

Interpretation of Stage IV of TNM classification in staging of cancer breast

A

any T any N M1

Surgery.(General 2).Breast (8 decks)

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