breast Flashcards
breast extends from
2nd to 6th rib and the sternal border to the mid axillary line
circular except the tail of spence
what are the strands of connective called that hold the breast upward
cooper’s ligament
make up of the breast where milk is produced
lobules
what carries breast milk to the tissue
ducts
C5-7
what does it do
LONG THORACIC
supplies serrates anterior
medial to the thoracodorsal nerve
nerve responsible for sensory to the breast tissue
lateral cutaneous nerve T4
injury to the long thoracic causes
winged scapula
lymphatics are important because
guide the surgery
usually do core biopsies in radiologist
invasive ductocarcenoma
staging and treatment is based on lymphatics
1st lymph node that drains out of the breast
sentinel node
(gatekeeper)
this is the node in which the tumor drains
how do they perform a sentinel node in a sentinel node biopsy
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
this hormone stimulates breast development
estrogen
progesterones role in breast development
stimulates breast lobules
anti estrogen pill therapy is given to
women at risk of developing breast cancer
and to prevent reoccurrence
need to bring pt in within ____ if she says she feels a mass
what should the PCP do
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
neoadjunctive chemo
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
screening mammogram
when would you use them and what views are utilized
according to Candice every year after 40? but according to USPS 50-74 EVERY 2 YEARS
craniocaudal
medial lateral oblique
what does a diagnostic mammogram involve
special views and usually with an ULS
usually the two regular views
how to document mass
mass is a 1 o clock right breast three centimeters from the nipple
how to inspect and evaluate a pt who states they have observe a mass
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
breast pain
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
nipple inversion
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
red breast
what is on your ddx
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
inflammatory breast cancer
red and inflamed because the cancer is disturbing the lymphatics
swollen
but usually not warm and tender
micro calcifications
precancerous signs that can be detected on mammogram
if suspicious biopsy recommended
breast implants studies
would still do mammogram
maybe a ULS
not MRI that is a adjunctive test
go to for women <30 with a mass
ULS
most women under 30 just have a cyst
when to order FNA
usually just for suspicious lymph nodes
you do core biopsy for the rest
stereotactic core biopsy
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
serum antigen tests associated with breast cancer
15-3
27-29
most women with breast cancer are diagnosed after age
50
if under that age usually genetic testing is done (referral to cancer genetics)\
high risk screening
clinical breast exam every 6 mos
Mammogram once a year
MRI once a year
risk factors for breast cancer
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)
role of receptors in breast cancer
estrogen is most common (75%)
progesterone (65%)
which receptors do we treat with chemo
HER2 + -herceptin
and triple negative -chemo first
BRCA1 is associated with
tipple negative breast cancers
and pancreatic cancer
pancreatic cancer screening
long standing history of low back pain and jaundice
no way to screen
usually life span is about 6 months after diagnoses
BRCA 1 and BRCA 2 treatment
5-10% are genetic mutations
can do high risk screening or mastectomy
how does breast cancer in men differ
1% incidence
usually detected later in life 60-70
RF for breast cancer in men
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)
most common type of breast cancer in men
infiltrating ductal carcinoma
most breast cancers in men are
estrogen receptor +
(85%)
so need to block estrogen
evaluation of breast cancer in men
FNA of lymph node
core biopsy
most will have stage I
non invasive breast cancer
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)
invasive breast cancer
can only be defined with core biopsy with microscope
has left the duct
need to check lymph nodes with sentinel lymph node biopsy
paget’s
breast disease of the nipple
need to do a biopsy
(no surg treat with chemo?)
presentation of inflammtory breast cancer
(less than 1/3 suspect cellulitis)
pain
burning
red or purple
peu de orange signifies lymphatic blockage
most malignant
lumpectomy vs mastectomy
sub-nipple biopsy
take tissue from underneath the nipple.
axillary dissection
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
who is at risk of lymphedema
older
heavier
axillary dissection
removed a bunch of lymph nodes and disrupted the lymphatic channels
