Breast Flashcards
1
Q
Name part of the breast that extends to the axillary fossa
A
Axillary tail of spence
2
Q
What determines breast size and shape?
A
Genetics, race and diet
3
Q
Vertical and transverse relations of breast
A
Extends 2/3rd to 6th rib vertically
Sternum to midaxillary line
4
Q
The breast rests on top of what tissue
A
Deep pectoral fascia
5
Q
Function of retromammary space
A
Aid in pectoral movement
6
Q
What does the pectoral fascia cover?
A
Pectoralis major
7
Q
Two thirds of the breast lies on pectoral fascia. Where does the other third lie?
A
Fascia of serratus anterior
8
Q
What attaches the breast tissue to the dermis?
A
Suspensory ligaments of Cooper
9
Q
What type of tissue is the nipple made up of?
A
Collagenous, dense connective tissue
Elastic fibres
Bands of smooth muscle
10
Q
Approximate position of the nipple
A
4th ICS
11
Q
Dermatome of the Nipple
A
T4
12
Q
What is the areola?
A
Skin covering containing sweat and sebaceous glands
13
Q
Purpose of sebaceous secretions of areola
A
Protective lubricant
14
Q
How many lobules are there in one breast?
A
Around 15-20
15
Q
What structures drain the lobules of the breast?
A
Lactiferous ducts
16
Q
Name the dilated portion of the lactiferous ducts
A
Lactiferous sinus
17
Q
How is the breast divided for anatomical and pathological descriptipon?
A
Quadrants
Superolateral/medial
Inferolateral/medial
18
Q
When does breast development begin?
A
4th week
19
Q
Where do mammary crests extend from in initial breast development?
A
Axilla to inguinal region
20
Q
Where do mammary crests persist after development?
A
Pectoral region
21
Q
The mammary crest gives rise ot which structures in breast development?
A
Primary mammary bud
22
Q
From what structure do lactiferous ducts and branches originate?
A
Secondary mammary buds
23
Q
What is polymastia?
A
Extra breast
24
Q
What is plythelia?
A
Extra nipple
25
What is athelia and amastia?
Absence of nipple and breast
26
What is the blood supply to the breast?
Thoracoacromial artery
Internal mammary artery
Lateral thoracic artery
27
Nerve supply to the breast
Sensory fibres from anterior and lateral cutaneous branches of 4-6th intercostal nerves
Sympathetic supply to blood vessels and smooth muscle
28
From which quadrant is the majority of breast lymphatic drainage?
Lateral quadrant to axillary nodes
29
To where does lymph from medial parts of the breast drain to?
Parasternal nodes or opposite breast
30
Other lymph nodes in addition to axillary that provide drainage in the breast
Supraclavicular
| Inferior cervical
31
What investigation can be used to gauge metastasis in the breast?
Sentinel lymph node biopsy
| -Radiolabelled colloid detection to map lymph drainage
32
What type of tissue surrounds the lobules in the breast?
Dense fibrocollagenous connective tissue
33
What type of tissue is intralobular breast tissue?
Loose connective tissue
34
What is the milk secretory component in breast tissue?
Terminal lobular duct
35
Which types of cells line the ducts and acini in the breast?
Luminal epithelial cells and myoepithelial cells
36
What structures are absent in the neonatal breast?
Alveoli
| Do contain lactiferous ducts
37
What changes occur in the breast during puberty?
Branching of lactiferous ducts
Granular polyhedral cells (alveoli)
Adipocytes fill with lipids
38
What changes occur in the breast post menopause?
Atrophy of of lobules and ducts
| Replacement of glandular tissue with fatty tissue
39
What changes occur in the breast during pregnancy?
Enlarged lobles
Dilated acini
Epithelium - cuboidal to low columnar
Colostrum available few days after birth
40
What does colostrum contain?
Protein rich fluid with antibodies
41
What changes occur in the breast during lactation?
Acini distended with milk
| Thinner septa
42
What reflex triggers milk production?
Neurohormonal when child suckling
| Prostanglandin and oxytocin driven
43
Diagnostic investigations in breast
History and examination
Imaging - Mammography and Ultrasound
Cytology - FNA and core biospy
44
Breast cancer accounts for what percentage of cancers in women?
20 percent
45
Types of benign breast tumours
```
Fibroadenoma (most common)
Duct papillomas
Adenomas
Connective tissue tumours
Phyllodes tumour
```
46
Which type of breast cancer is Paget's disease associated with?
Ductal or invasive carcinoma
47
At what age are women offered breast cancer screening in Scotland?
50-74
| Every 3 years
48
What standard views are taken in mammography?
Mediolateral oblique
| Craniocaudal
49
What additional views may be utilised in mammography?
```
Coned
Magnification view
True lateral
Extended CC
Eclund
```
50
What factors indicate need for earlier screening in patients?
Family history
| Past radiation exposure
51
How is cancer assessed in a mammogram?
```
Mass
Assymetry
Architectural distortion
Calcifications
Skin changes
```
52
What type of tumour appears as 'popcorn calcification' in a mammogram?
Calcified fibroadenoma - benign
53
What investigation can distinguish solid mass from cyst?
Ultrasound
54
What investigation is first line for ?breast cancer in under 40s?
Ultrasound - no radiation
55
How will benign breast tumours apear on ultrasound?
Smooth, oval shape
| Acoustic enhancement
56
How can malignant tumours be differentiated from benign on ultrasound?
Irregular outline
Interrupts architecture
Acoustic shadowing
Anterior halo
57
What is the indication for MRI in breast cancer diagnosis?
Indeterminate diagnosis following triple therapy
Breast implants
Recurring disease
Screening high risk women
58
Curative treatment for cysts in breast
Aspiration
59
When would cystic fluid be kept for sample on aspiration?
If blood stained or residual mass after aspiration
60
Complications of aspiration
```
Pain
Haematoma
Fainting
Infection
Pneumothorax
```
61
What 3 conditions can nipple discharge be indicative of?
Duct ectasia
Intraduct papilloma
Intraduct carcinoma
62
Risk factors for breast cancer
```
Age
Previous breast cancer
Previous radiation exposure
Family history - genetic BRCA 1 or 2
First pregnancy at later age
HRT
OCP
Alcohol
Weight
Early menarche
Late menopause
```
63
Symptoms of breast cancer
```
Palpable mass
Mastalgia - persistent unilateral pain
Nipple discharge
Nipple changes
Change in size or shape of breast
Lymphoedema - swellling in axilla
Dimpling of breast skin
```
64
What investigations can be used in staging of breast cancer?
Bloods - FBC, U&Es, LFTs. Calcium and phosphate
| Chest and abdominal X ray
65
Factors indicating greater risk of recurrence of breast cancer
Nottingham Porgnostic Index
Steroid receptor status
HER 2 status
Lymphovascular invasion
66
Preventative therapy for breast cancer recurrence
Local radiotherapy
| Systemic - hormonal, chemotherapy, targeted immunotherapy
67
Complications of radiotherapy
```
Skin reaction - telangiectasis
Radiation pneumonitis
Cutaneous radionecrosis
Osteonecrosis
Angiosarcoma
```
68
In which group of patients with breast cancer would hormonal therapy be used?
Oestrogen receptor positive
69
Mechanism of action of tamoxifen
Blocks oestrogen receptor
70
Dose recommended of tamoxifen
20mg daily 5-10 years
71
Side effects of tamoxifen
Thromboembolic events
| Increased risk of uterine carcinoma
72
In which group of patients is aromatase inhibitors recommended for breast cancer treatment?
Postmenopausal
73
Examples of aromatase inhibitor medication
Arimidex, Letrozole
74
Recommended course of aromatase inhibitors
Daily for 5 years
75
Mechanism of action of aromatase inhibitors
Blocks oestrogen synthesis
76
Side effect of aromatase inhibitor use
Osteoporosis
77
What type of medication is trastuzumab?
Herceptin
| Monoclonal antibody against HER 2 receptors
78
What must be monitored during immunotherapy treatment?
Heart function
| Cardiotoxicity is common side effect
79
Indications for breast conserving treatment
Localised operable disease
| No evidence of metastasis
80
Most common breast conserving treatment
Wide Local Excision
81
What is removed in a mastectomy?
All of the tissue in the affected breast along with portion of overlying skin
82
Indication for mastectomy
```
Multifocal disease
High tumour to breast tisue ratio
Disease recurrence
Patient choice
Risk reducing cases
```
83
Why is axillary surgery also performed alongside WLE and masectomies?
To assess nodal status and remove any nodal disease
84
Two examples of axillary surgery
Sentinel node biopsy
| Axillary node clearance
85
Complications of axillary node clearance
Paraesthesia
Seroma formation
Lymphoedema
86
Factors that can indicate need to consider risk reducing breast surgery
Strong family history of breast and ovarian cancer
BRCA 1, BRCA 2, PTEN or TP53
Previous history of breast cancer
87
Examples of oncoplastic treatment and surgical reconstructive techniques
Therapeutic mammoplasty
| Flap formation
88
Types of flap formation
Latissimus dorsi
Transverse Rectus Abdominis flap (TRAM)
Deep Inferior Epigastric Perforator Flap (DIEP)
89
What is involved in therapeutic mammoplasty?
WLE and breast reduction
| Smaller, uplifted breast with nipple and areola preserved
90
What is the advantage of DIEP, over TRAM and Latissimus Dorsi Flap formation?
No reduction in abdominal strength
