Breast Flashcards
Where is the Anterior Axillary fold?
Lower border of the pectoralis major muscle
Where is the Posterior Axillary fold?
Tendon of the LATISSIMUS DORSI muscle as it passes around the lower border of the teres major muscle
Which lung(s) have an OBLIQUE FISSURE?
Right AND LEFT!!!!
Which lung(s) have a HORIZONTAL FISSURE?
RIGHT ONLY!!
What is “Cooper’s Droopers” ?
Suspensory ligaments (of cooper)
Another name: Retinacula cutis
Strong fibrous processes that give support
Clinical signs/changes in breasts (5)
- Skin retraction or skin dimpling
- Dimpling of skin over carcinoma… caused by involvement and retraction of suspensory (Cooper’s) ligaments
- Nipple retraction
- Cancer involvement of mammary ducts may cause duct shortening and retraction.. or inversion of the nipple (EEK!!!)
- PALPABLE NODES……AXILLARY NODES ARE THE MOST COMMON SITE OF BREAST CA METASTASIS
What is the most common site of breast cancer metastasis?
Axillary nodes (they are palpable)
Posterior chest wall… Ligamentum Nuchae covers which spines?
C1-C6
Nerves of the breast derive from anterior and lateral cutaneous branches of the:::
4th - 6th intercostal nerves
Most common cancer in women
Breast cancer
What is the ranking of breast cancer in leading cause of cancer death in Women in the US?
2nd (1st is lung)
What is the incidence of breast cancer?
1/8 American women… much less common
What type of women do majority of the breast cancer cases occur in?
Postmenopausal women (2/3)
Most common cell type of breast cancer?
Adenocarcinoma
Explain the arterial supply to the breast.. (4)
TEST QUESTION::: “Which is NOT an arterial supply to the breast?”
- INTERNAL THORACIC ARTERY (Internal Mammary Artery)
a) Perforating branches
b) Anterior intercostal branches
i) Both branches of SUBCLAVIAN ARTERY - LATERAL THORACIC ARTERY
a) Branch of axillary artery - THORACOACROMIAL ARTERIES
a) Branch of axillary artery - POSTERIOR INTERCOSTAL ARTERIES
a) Branch of thoracic artery
Changes in the breast (3)
- Colostrum
- Multiparous women
- Elderly women
Explain changes in breast due to colostrum
Rich in protein, growth factor, helps infants intestines
- Premilk fluid that is secreted from the breast during the last trimester of pregnancy and at the beginning of nursing
- Rich in protein, growth factor, helps infants intestines….A LOT OF IMMUNITY!!
Explain changes in breast due to women w/ multiple pregnancies
Breasts enlarge and become pendulous
Explain changes in breast in elderly women
WHY?
Breasts become small and wrinkled..
B/c of the decrease in fat and atrophy of glandular tissue
Stop menstruating, stop producing LSH, FSH
What veins consist of the venous supply of the breast? (3)
- Axillary vein***
- Internal Thoracic Vein
- Posterior Intercostal Veins***
What is the significance of the axillary vein?
-Main venous drain of the breast
What is the significance of the posterior intercostal veins?
Where do they drain?
- Drain into AZYGOS and HEMIAZYGOS SYSTEM of veins alongside the bodies of the vertebrae…..
(THIS IS WHY CANCER SPREADS TO SPINE, SKULL, BRAIN) which empties into the Superior Vena Cava
-Through this route, CANCER CELLS can spread from the breast to the vertebrae…then from there to the skull and brain
What is Peau D’Orange?
- Breast cancer interferes w/ lymphatic drainage
- Skin is puffy and has pores that look like an orange-leather skinned appearance
What percent of men get breast cancer?
1% of cases
Lymphatic drainage of the breast…
TEST QUESTION: “When the lymph goes from here to here, whats the next step?”
- Axillary lymph nodes
- 75% of lymph drains into the axillary LN’s, initially to the pectoral (anterior) nodes
- Pectoral (anterior) nodes
- Parasternal nodes
- Location of most of the remaining lymph (medial) or the opposite breast - Abdominal nodes (phrenic)
- lymph from the lower breast quadrants pass deep to the abdominal nodes
State the route of lymph after going to pectoral nodes…
- Pectoral nodes
- Axillary nodes
- Infraclavicular & supraclavicular nodes
- Subclavian lymphatic trunk
Where does the lymph from parasternal nodes (remaining lymph in breast… medial or opposite) travel to?
Bronchomediastinal trunk
Where do the nerves of the breast derive from?
They derive from:
anterior and lateral cutaneous branches of the 4th-6th intercostal nerves
Define polymastia
extra breast… can occur anywhere on the “milk line”
Define polythelia
Extra nipple (can look like mole)
What are the most common side of breast cancer metastasis?
Axillary nodes!!!!!!!!
What are the clinical signs of breast cancer? (6)
- Skin retraction or skin dimpling
- dimpling of skin over carcinoma is caused by involvement and retraction of suspensory (Cooper’s) ligaments
- Nipple retraction
- Cancer involvement of mammary ducts may cause duct shortening and retraction or inversion of the nipple
- Mass
- Palpable nodes
- AXILLARY NODES are MOST COMMON SITE OF BREAST CA METS - Peau d’Orange
- interference w/ the lymph drainage of the breast by cancer - NEW!!! nipple inversion
- can occur from subareolar breast cancer
What can nipple inversion occur from?
subareolar breast cancer
What are the different surgical treatments for breast cancer?
- Stereotactic biopsy
- Lumpectomy
- Sentinel lymph node biopsy
- Simple mastectomy
- Radical mastectomy
What is the difference in mastectomies?
Simple –> breast removed down to retromammary space
Radical –> also removal of:
- pectoral muscles
- fat
- fascia
- lymph node in axillary and pectoral region
What can cause gynecomastia?
Puberty Aging Drug-related (antihypertensives, estrogen) Cirrhosis of liver Testicular tumors Pituitary adenoma
If male patient tests positive on a pregnancy test, what is this indicative of?
Testicular cancer
Male Breast Cancer:
How many cases in US / year? Average age? What do they present w/? Where does mets occur? Who should be examined? Where is it highest in world? ...Lowest??
- 1000 cases in US per year
- Average age = 59
- Present w/ painless subareolar mass
- Mets same as women… bone, lung, liver, pleura, nodes, skin
- Every man should be examined
- Highest in North America & British Isles
- Lowest in Japan and Finland
