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Surgery > breast > Flashcards

breast Flashcards

1
Q

breast extends from

A

2nd to 6th rib and the sternal border to the mid axillary line

circular except the tail of spence

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2
Q

what are the strands of connective called that hold the breast upward

A

cooper’s ligament

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3
Q

make up of the breast where milk is produced

A

lobules

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4
Q

what carries breast milk to the tissue

A

ducts

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5
Q

C5-7

what does it do

A

LONG THORACIC

supplies serrates anterior

medial to the thoracodorsal nerve

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6
Q

nerve responsible for sensory to the breast tissue

A

lateral cutaneous nerve T4

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7
Q

injury to the long thoracic causes

A

winged scapula

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8
Q

lymphatics are important because

A

guide the surgery

usually do core biopsies in radiologist

invasive ductocarcenoma

staging and treatment is based on lymphatics

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9
Q

1st lymph node that drains out of the breast

A

sentinel node
(gatekeeper)
this is the node in which the tumor drains

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10
Q

how do they perform a sentinel node in a sentinel node biopsy

A

radioactive isotope is injected into the breast

as well as blue dye

helps us find the sentinel node

and it is REMOVED

so we usually see two incisions, one where the node biopsy was done and one where the actual mass was taken out

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11
Q

this hormone stimulates breast development

A

estrogen

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12
Q

progesterones role in breast development

A

stimulates breast lobules

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13
Q

anti estrogen pill therapy is given to

A

women at risk of developing breast cancer

and to prevent reoccurrence

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14
Q

need to bring pt in within ____ if she says she feels a mass

what should the PCP do

A

1 week

exam her and document

don’t try to work it up, don’t send for a biopsy

if you feel something send her to a breast center to see a breast surgeon

usually you will get a diagnostic mammo and then send to a center for a biopsy

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15
Q

neoadjunctive chemo

A

given before surgery for triple negative (estrogen, progesterone, HER2 negative)

can completely get rid of that before surgery

the same goes for lymph node involvement

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16
Q

screening mammogram

when would you use them and what views are utilized

A

according to Candice every year after 40? but according to USPS 50-74 EVERY 2 YEARS

craniocaudal
medial lateral oblique

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17
Q

what does a diagnostic mammogram involve

A

special views and usually with an ULS

usually the two regular views

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18
Q

how to document mass

A

mass is a 1 o clock right breast three centimeters from the nipple

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19
Q

how to inspect and evaluate a pt who states they have observe a mass

A

arms above her head

flex pectoralis

sitting up (?) palpate the breast and lymph nodes

make sure the patient is relaxed

how to differentiate a suspicious lymph node from regular: hard fixed, usually 2cm

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20
Q

breast pain

A

not really an emergency

without a mass

if she recently had a mammogram do not order another one if there is nothing else going on

maybe bring her back in a month

try to evaluate if it is around her cycle

21
Q

nipple inversion

A

very common

document it in her chart

ask her how long this has been going on

if it is new–> get a diagnostic mammogram and send to a specialist

can see this in new weight loss

22
Q

red breast

what is on your ddx

A

need to have inflammatory breast cancer on your differential

treat with antibiotics and see her back in a week

if not resolved need to work up

23
Q

inflammatory breast cancer

A

red and inflamed because the cancer is disturbing the lymphatics

swollen
but usually not warm and tender

24
Q

micro calcifications

A

precancerous signs that can be detected on mammogram

if suspicious biopsy recommended

25
Q

breast implants studies

A

would still do mammogram

maybe a ULS

not MRI that is a adjunctive test

26
Q

go to for women <30 with a mass

A

ULS

most women under 30 just have a cyst

27
Q

when to order FNA

A

usually just for suspicious lymph nodes

you do core biopsy for the rest

28
Q

stereotactic core biopsy

A

this is the x ray guided biopsy that we usually see unless you see a mass on ULS and then you would have a ULS guided core biopsy

29
Q

serum antigen tests associated with breast cancer

A

15-3

27-29

30
Q

most women with breast cancer are diagnosed after age

A

50

if under that age usually genetic testing is done (referral to cancer genetics)\

31
Q

high risk screening

A

clinical breast exam every 6 mos

Mammogram once a year

MRI once a year

32
Q

risk factors for breast cancer

A

hormone replacement therapy

radiation to the chest wall (non Hodgkins lymphoma)

obesity
(estrogen produced by fat cells)

late menopause

first pregnancy after 35

infertility and nulliparity

alcohol abust

2-5 drinks a day
roughly 7 drinks a week for women

(liver not making binding proteins for the transport of alcohol)

33
Q

role of receptors in breast cancer

A

estrogen is most common (75%)

progesterone (65%)

34
Q

which receptors do we treat with chemo

A

HER2 + -herceptin

and triple negative -chemo first

35
Q

BRCA1 is associated with

A

tipple negative breast cancers

and pancreatic cancer

36
Q

pancreatic cancer screening

A

long standing history of low back pain and jaundice

no way to screen

usually life span is about 6 months after diagnoses

37
Q

BRCA 1 and BRCA 2 treatment

A

5-10% are genetic mutations

can do high risk screening or mastectomy

38
Q

how does breast cancer in men differ

A

1% incidence

usually detected later in life 60-70

39
Q

RF for breast cancer in men

A 
testicular cancer
klienfelters 
transgender receiving estrogen therapy
hx of family breast cancer
gynecomastia
liver cirrhosis and alcohol and abuse

hx of prostate cancer and BPH with hormone tx of finasteride

BRCA1 or BRCA2
(40% breast CA)

40
Q

most common type of breast cancer in men

A

infiltrating ductal carcinoma

41
Q

most breast cancers in men are

A

estrogen receptor +
(85%)
so need to block estrogen

42
Q

evaluation of breast cancer in men

A

FNA of lymph node
core biopsy
most will have stage I

43
Q

non invasive breast cancer

A

DCIS
confined to the duct

ductal carcinoma in situ

usually seen as calcifications
can’t feel lit

remove it surgically

radiation
pill therapy

(Lobular you would not see calcification)

44
Q

invasive breast cancer

A

can only be defined with core biopsy with microscope

has left the duct

need to check lymph nodes with sentinel lymph node biopsy

45
Q

paget’s

A

breast disease of the nipple

need to do a biopsy

(no surg treat with chemo?)

46
Q

presentation of inflammtory breast cancer

A

(less than 1/3 suspect cellulitis)

pain
burning
red or purple

peu de orange signifies lymphatic blockage

most malignant

47
Q

lumpectomy vs mastectomy

A

sub-nipple biopsy

take tissue from underneath the nipple.

48
Q

axillary dissection

A

if a woman has had chemo and at the time of surgery she still has cancer in her lymph node

if cancer is still in the lymph node after chemo and during surgery

49
Q

who is at risk of lymphedema

A

older
heavier
axillary dissection

removed a bunch of lymph nodes and disrupted the lymphatic channels

Surgery (18 decks)

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