Breast Flashcards
Breast cancer incidence
1 in 8 lifetime for women
2% of women less than 30 get breast cancer
Risk factors for breast cancer
Nulliparity
Age at menarche (55)
Cancer of breast (self or family)
Pregnancy of first child > 30
Benign biopsy of breast is risk factor for breast cancer
Breast cancer symptoms
No symptoms, mass, pain (most are painless), nipple discharge, edema, nipple retraction, dimple, nipple rash
Workup for breast cancer
Mammogram - look for mass, microcalcifications, stellate/speculated mass
Biopsy
- FNA (can’t tell invasive vs in situ), core (can be rad guided) and excisional
U/S good for cysts
CXR (for lung mets)
LFTs (for liver mets)
Labs: Calcium, alk phos (both change with bone mets)
Check for estrogen and progesterone receptors to assess adjuvant treatment
Benign breast changes
Fibrocystic changes = rubbery and cystic changes in breast, varies with menstrual cycle
Fibroadenoma = collagen in swirls, most common in young women
- Phyllodes is variant that can be malignant
Intraductal papilloma = most common cause of bloody nipple discharge
Premalignant breast changes
DCIS (may progress to malignancy) - 1cm perform lumpectomy with 1cm margins + radiation OR total mastectomy
LCIS - incidental on bx. Seen as risk factor for breast cancer, always monitor other breast
Malignant breast changes
Invasive ductal carcinoma = #1
Invasive lobular
Inflammatory = most lethal
Paget’s = nipple changes with discharge
Breast cancer staging
1 = tumor 5cm N0
3A = > 5cm tumor with mobile nodes OR any size with fixed axillary nodes
3B = Any tumor with ipsilateral internal mammary nodes OR peu d’orange OR chest wall invasion OR inflammatory cancer OR breast skin ulceration
4 = distant mets
Breast cancer treatment
1) Lumpectomy, axillary node dissection OR sentinal node w/radiation - stage 1 and 2
contraindicated if had previous radiation, +margins, extensive DCIS — Do mastectomy
2) Modified radical mastectomy: breast, axillary nodes (II and I), nipple removed, place drains
Radical = take breast, pec major and minor, axillary nodes
Simple = entire breast removed but nodes left in place
3) Chemo - generally offered to women with stage 2 or more who are premenopausal
- role of neoadjuvant is good if want to conserve breast but must stage before beginning therapy to appreciate disease extent
4) Antiestrogen treatment - given for 5 years to people who are receptor +
Where do breast mets go?
LN
Lung
Liver
Bones
Brain
Levels of axillary nodes
Level 1 = lateral to pec minor
Level 2 = deep to pec minor
Level 3 = medial ro pec minor
Nerves that can be injured during breast surgery
Long thoracic nerve - innervates serratus anterior (winged scapula)
Thoracodorsal nerve - innervates lats
Medial pectoral nerve - innervates pec minor and major
Lateral pectoral nerve - innervates pec major
