Breast Flashcards
What is the functional unit of a breast?
Lobules that contain terminal ducts. This is where milk is produced. Ductules and ducts convey milk to the nipple.
Lymphatic drainage of the breast is through which nodes?
Axillary, mammary, central nodes
How are nodes characterized (level 1, etc)
Based on relation to pec minor
level 1 nodes are lateral to pec minor
level 2 nodes are beneath it
level 3 nodes are medial to it
What ligaments support the breast?
Cooper’s ligaments
What nerves are in the axilla, and what do they innervate?
Thoracodorsal nerve- motor fn to lat. dorsi (dmg = weakness in shoulder abduction)
LTN- motor fn to serr. anterior (dmg = winged scapula)
List the kinds of benign breast lesions
simple cysts
fibroadenomas
papillomas
fibrocystic dz - group including firm nodular lesions, cysts, epithelial hyperplasia
Are phyllodes tumors malignant or benign?
They have “low malignant potential”
Most common malignant lesions of the breast
lobular carcinoma ductal carcinoma (most common) these can be non-invasive/in situ (don't penetrate the BM) or can be invasive (do penetrate BM)
What is inflammatory breast cancer?
Tumor invades the lymphatic channels.
May have warmth/tenderness at site of cancer.
Erythema and skin excoriation- peau d’orange
Paget’s dz
Tumor cells invade the epidermal layer of skin
Can have nipple or areolar excoriation
Risk factors for breast ca
age hx of BC in 1st degree relative atypical hyperplasia personal hx of BC LCIS (lobular carcinoma in situ)
Most common tumor in young women?
Fibroadenoma
Most common cause of bloody nipple discharge?
Intraductal papilloma (benign)
Most common breast malignancy?
Ductal carcinoma
Constitutional sx of cancer
weight loss
nausea
malaise
bone pain (if skeletal mets)
Fibroadenoma physEx characteristics
well-circumscribed
mobile
Concerning signs on physEx
breast asymmetry
dimpling or retractions
excoriation or edema of skin
^all are extremely sensitive for malignancy
also, firmness and indistinct borders
may have lymphadenopathy, bloody discharge
Mammogram characteristics susp for malignancy
Densities w irreg margins Spiculated lesions (spiky) Microcalcifications Rodlike/branching patterns Changes from prev mammogram
Dx eval for non-palpable abnormalities on mammogram
Needle-directed biopsy- place a needle at the lesion using mammography, then surgeon uses needle to locate lesion
Dx eval for palpable masses
FNA, aspirate sent to cytology.
If a palpable mass is aspirated, what characteristics make malignancy unlikely
If all of these criteria are present, unlikely:
mass completely disappears after aspiration
it doesn’t return
fluid is hemoccult-negative
if these criteria are NOT met, need to do a biopsy
Lumpectomy
removal of lesion w negative margins
mastectomy
removal of all breast tsu on the affected side
axillary node dissection
removal of all level 1 and level 2 nodes (lateral and beneath pec minor)
Modified radical mastectomy
mastectomy + ax node dissection
Sentinel node biopsy
inject blue dye/radioactive sulfur colloid around tumor, wait for it to go to lymph nodes.dissect only the lymph node that is blue/radioactive and send it to path.
if it’s positive for ca, go back later a dissect the other ax lymph nodes
What is DCIS? and Rx?
ductal carcinoma in situ PRE-malignant lesion. 2 rx options: local excision w neg margins + radiation mastectomy without radiation
What is LCIS? and Rx?
lobular carcinoma in situ
a “condition” not a lesion- pts have incrsd risk of ca but can be in either breast, unrelated to lesion biopsied.
2 rx options:
careful follow-up (physEx, mammography)
bilateral prophylactic mastectomy (more extreme, only in selected cases)
Rx for Stage I or II breast ca
surgical removal of tumor w negative margins, assess regional lymph nodes (sentinel node biopsy)
can do lumpectomy or mastectomy.
if mastectomy, add radiation
Indications that favor mastectomy for Stg I or II
multiple tumors prior radiation large lesions positive lumpectomy margins. if choosing mastectomy, add radiation.
Rx for Stage III or IV
Surgical resection for local control plus rad or chemo, since surgery only treats local, known.
Endocrine therapy for BC
if tumor expresses estrogen receptor- has 30% chance of responding to endo therapy. if it also expresses progesterone receptor, the probability increases to 70%.
How do aromatase inhibitors work?
They prevent the production of estrone and estradiol.
They are generally better than tamoxifen.
Chemo regimens
CMF: cyclophosphamide, methotrexate, 5-fluorouracil
AC: doxorubicin and cyclophosphamide
Tamoxifen
Pgx of BC based on staging
5 year dz-free survival: stg 1 80% stg 2 60% stg 3 20% stg 4 unlikely presence of estrogen and progesterone receptors improves survival rates.
