2.3.5. Breast Cancer/Arm

Question 1

What are the ominous signs of breast cancer? (There are 3)

Answer 1

dimpling, retraction, and abnormal contours (of the skin)

Question 2

Anatomically, what causes the ominous signs of breast cancer (dimpling, retraction, abnormal contours)?

Answer 2

Traction on the suspensory ligaments of Cooper by a growing breast cancer. These cancers can invade Cooper’s ligaments, thus stiffening the normally elastic ligaments.

Question 3

Why should you have a women raise her arms above her head during a breast exam?

Answer 3

Raising her arms tightens Cooper’s ligaments, allowing you to check for dimpling and other signs of breast cancer. It is ABNORMAL to see dimpling.

Question 4

Dimpling of the breast indicates what?

Answer 4

ADVANCED breast cancer that has invaded Cooper’s ligaments (and had therefore BROKEN through the BASEMENT MEMBRANE and spread)

Question 5

What does the “peau d’orange” (orange peel) appearance of breast skin indicate?

Answer 5

It signals the obstruction of the dermal lymphatic circulation by cancer cells that puckers and firms up the skin like an orange peel. This also indicates that the cancer has BROKEN through the BASEMENT MEMBRANE and spread

Question 6

What changes in breast appearance indicate that the cancer has broken through the basement membrane and spread?

Answer 6

Dimpling of the skin and the “peau d’orange” appearance

Question 7

In breast cancer, the malignant cells usually originate in what structure (what tissue)?

Answer 7

The duct tissue in the breasts (can also occur in the lobules)

Question 8

What does “in situ” mean?

Answer 8

Cancer cells are dividing but haven’t pierced the basement membrane

Question 9

Generally speaking, what is the prognosis for in situ breast cancer?

Answer 9

“In situ breast cancer is curable 100% of the time” -Dr. Shriver

Question 10

Why is the prognosis better if the cancer has not crossed the basement membrane?

Answer 10

Because the vascular and lymph systems are on the other side of the basement membrane; once the cancer crosses, it can spread through these systems.

Question 11

What does “invasive” mean?

Answer 11

The cancer has crossed the basement membrane

Question 12

Why has it become common practice to not remove the pectoralis muscles when removing the breast?

Answer 12

Breast cancer rarely breaches the pectoralis fascia

Question 13

What is the most significant risk factor for getting breast cancer?

Answer 13

Age

Question 14

Explain the TNM classification system for “cancer staging”

Answer 14

Each cancer is staged by the TNM classification system:
T stands for Tumor size
N stands for spread of cancer to the lymph Nodes
M stands for distant Metastasis

Question 15

What is the benefit of staging your patient’s cancer?

Answer 15

It allows you to compare your patient’s cancer with published risk factors and to come up with a treatment plan (and prognosis) for each stage of spread

Question 16

What is a “sentinel” lymph node?

Answer 16

The first lymph node that the cancer will drain into. In case of established cancerous dissemination it is postulated that the sentinel lymph node(s) is the first organ reached by metastasizing cancer cells from the tumor.

Question 17

In what area of the breast is most cancer found?

Answer 17

The breast is divided into quadrants. ~40% of cancers are found in the superolateral quadrants (think upper outer - closest to the axilla on each side) and the tail of Spence.

Question 18

Why are the parasternal (internal mammary) nodes particularly important?

Answer 18

If the cancer has spread to these nodes, it has penetrated into the chest cavity and can spread quickly and undetected.

Question 19

Explain the three levels that the axillary nodes are grouped into

Answer 19

Level 1: lateral to the pectoralis minor
Level 2: behind the pectoralis minor
Level 3: medial to the pectoralis minor

Question 20

What is a simple mastectomy?

Answer 20

The breast is removed down to the retromammary space.

Question 21

What is a radical mastectomy?

Answer 21

Involves the removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region

Question 22

What is a lumpectomy?

Answer 22

Only the tumor and surrounding tissues are removed

Question 23

What is the most common method of surgical removal, when possible?

Answer 23

Lumpectomy

Question 24

Where is the most common site for metastasis from breast cancer?

Answer 24

The axillary lymph nodes

Question 25

What are the general features as seen on ultrasonography that make a breast mass more suspicious for cancer (as opposed to being a benign cyst)?

Answer 25

Lesions that are “taller than wide” with irregular borders, angular margins, ductal extension and posterior acoustic shadowing

Question 26

In relation to the axillary vein, where are the lymph nodes located that are removed during an axillary dissection for breast cancer?

Answer 26

Inferiorly to the axillary vein