Breast

Question 1

___________ (off 2nd intercostal nerve) sensation to medial arm; can or cannot sacrifice?

Answer 1

Intercostobrachial nerve; CAN sacrifice

Question 2

_________ nerve to serratus anterior, injury= ______

Answer 2

Long thoracic nerve; winged scapula

Question 3

_______ nerve to latissimus dorsi, injury= ________

Answer 3

Thoracodorsal nerve; weak arm adduction/pull ups

Question 4

_________ nerve to pec major and minor

Answer 4

Medial pectoral nerve

Question 5

______ nerve to pec minor only

Answer 5

lateral pectoral nerve

Question 6

_______: Valveless vertebral veins, allow direct mets to _____

Answer 6

Batson’s plexus; mets to spine

Question 7

Poland syndrome: _______, _______, ______

Answer 7

amastia, hypoplastic shoulder, no pectoralis

Question 8

Mastodynia Rx?
____, ____, ___, ____
____ not useful

Answer 8

danazol; OCP; evening primrose oil; tamoxifen (?); vit E not useful

Question 9

______: thrombophlebitis of superficial vein of breast. Cord like mass laterally; Rx: ______.

Answer 9

Mondor’s disease; rx NSAIDs

Question 10

Breast Cancer T sizes:
T1 \_\_\_\_
T2 \_\_\_\_
T3 \_\_\_\_
T4 \_\_\_\_

Answer 10

T1 < 2cm
T2 2-5cm
T3 >5cm
T4 skin or chest wall involvement

Question 11

breast ca ‘grave signs’ = ______, ______

Answer 11

peau d’orange, inflammation

Question 12

Breast cancer N stuff
N1 ______
N2 ______
N3 ______

Answer 12

N1 positive ax nodes
N2 matted or fixed nodes
N3 internal mammary nodes

Question 13

Breast cancer stages:
Stage I \_\_\_\_
Stage II \_\_\_\_\_ or \_\_\_\_
Stage III \_\_ or \_\_
Stage IV \_\_\_\_

Answer 13

I: T1
II: up to T2N1 or T3N0
III: T4 or N2
IV: Mets (includes supraclav node; unlike lung CA)

Question 14

Breast mets: ___, ____, _____

Answer 14

bone, lung, brain

Question 15

_______: a marker for breast CA, implies worse prognosis. _______ now available for Rx.

Answer 15

Her 2 neu; Herceptin

Question 16

___, ___, ____ all indicate worse prognosis in breast ca

Answer 16

erb b 2, p 53, cathepsin

Question 17

1 cm tumor is around how old?

Answer 17

~5 year old

Question 18

_______ reduces risk 50% in high risk bu inreases risk of ______ cancer and ____.

Answer 18

Tamoxifen; endometrial cancer, DVT

Question 19

_________ raises risk x 4 for breast cancer

Answer 19

atypical hyperplasia (only finding in fibrocystic that increases risk)

Question 20

ER +/- PR +/- ____; is better than ER PR __ which is better than ER PR __ which is better than ER PR __

Answer 20

ER+PR+ > ER-PR+ > ER+PR- > ER-PR-

Question 21

DCIS ____% develop invasive carcinoma; is or is not a precursor?

Answer 21

50%; is a precursor

Question 22

DCIS Rx
usually _____
high grade/large tumor/poor margins _____

Answer 22

usually lumpectomy + RT;

mastectomy for high grade, etc.

Question 23

___% of DCIS recurrence is invasive

Answer 23

50%

Question 24

LCIS ____% develop invasive carcinoma (either breast)

Answer 24

30-40%; is a marker of risk

Question 25

Rx options for LCIS | ___, _____, ____

Answer 25

nothing, tamoxifen or bilateral mastectomy

Question 26

Comedo breast cancer: Multicentric or localized? ____ Rx? ____ Good or poor prognosis? ___

Answer 26

Multicentric; mastectomy; poor

Question 27

Paget's disease of the breast: ____ lesions on the ___ (part of breast) There is underlying ____ or ____

Answer 27

eczematous lesions on nipple; underlying DCIS or Ductal Ca

Question 28

``` Cystosarcoma Phyllodes or 'Phyllodes tumor' ____% malignant? ___ Large or small? ____ Rare or common nodal mets? ____ Spread? Heme/lymph ____ ```

Answer 28

10% malignant; large; rare nodal mets; hematogenous

Question 29

Rx for cystosarcoma phyllodes or "Phyllodes tumor'

Answer 29

wide local excision, rarely mastectomy, NO axillary node dissection

Question 30

BRCA: ___% have cancer by age 70

Answer 30

85%

Question 31

BRCA1 a/w ___ cancer (____%)

Answer 31

ovarian cancer; 50%

Question 32

BRCA2 a/w ______

Answer 32

male breast cancer

Question 33

Indications for RT after mastectomy: ___ nodes ____ involvement _____

Answer 33

>4 nodes; skin or chest wall involvement; positive margins

Question 34

``` Stewart Treves: _________ in __________ limb. Presents with _______ on arm. Occurs ______ (time) s/p ______ ```

Answer 34

lymphangiosarcoma in lymphedematous limb; purplish mass on arm; 10 years s/p MRM

Question 35

_____: No risk of CA. #1 cause of bloody nipple discharge (although 1/2 are serous)

Answer 35

Intraductal Papilloma