Breast

Question 1

What is the functional unit of a breast?

Answer 1

Lobules that contain terminal ducts. This is where milk is produced. Ductules and ducts convey milk to the nipple.

Question 2

Lymphatic drainage of the breast is through which nodes?

Answer 2

Axillary, mammary, central nodes

Question 3

How are nodes characterized (level 1, etc)

Answer 3

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

Question 4

What ligaments support the breast?

Answer 4

Cooper’s ligaments

Question 5

What nerves are in the axilla, and what do they innervate?

Answer 5

Thoracodorsal nerve- motor fn to lat. dorsi (dmg = weakness in shoulder abduction)
LTN- motor fn to serr. anterior (dmg = winged scapula)

Question 6

List the kinds of benign breast lesions

Answer 6

simple cysts
fibroadenomas
papillomas
fibrocystic dz - group including firm nodular lesions, cysts, epithelial hyperplasia

Question 7

Are phyllodes tumors malignant or benign?

Answer 7

They have “low malignant potential”

Question 8

Most common malignant lesions of the breast

Answer 8

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)

Question 9

What is inflammatory breast cancer?

Answer 9

Tumor invades the lymphatic channels.
May have warmth/tenderness at site of cancer.
Erythema and skin excoriation- peau d’orange

Question 10

Paget’s dz

Answer 10

Tumor cells invade the epidermal layer of skin

Can have nipple or areolar excoriation

Question 11

Risk factors for breast ca

Answer 11

age
hx of BC in 1st degree relative
atypical hyperplasia
personal hx of BC
LCIS (lobular carcinoma in situ)

Question 12

Most common tumor in young women?

Answer 12

Fibroadenoma

Question 13

Most common cause of bloody nipple discharge?

Answer 13

Intraductal papilloma (benign)

Question 14

Most common breast malignancy?

Answer 14

Ductal carcinoma

Question 15

Constitutional sx of cancer

Answer 15

weight loss
nausea
malaise
bone pain (if skeletal mets)

Question 16

Fibroadenoma physEx characteristics

Answer 16

well-circumscribed

mobile

Question 17

Concerning signs on physEx

Answer 17

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

Question 18

Mammogram characteristics susp for malignancy

Answer 18

Densities w irreg margins
Spiculated lesions (spiky)
Microcalcifications
Rodlike/branching patterns
Changes from prev mammogram

Question 19

Dx eval for non-palpable abnormalities on mammogram

Answer 19

Needle-directed biopsy- place a needle at the lesion using mammography, then surgeon uses needle to locate lesion

Question 20

Dx eval for palpable masses

Answer 20

FNA, aspirate sent to cytology.

Question 21

If a palpable mass is aspirated, what characteristics make malignancy unlikely

Answer 21

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

Question 22

Lumpectomy

Answer 22

removal of lesion w negative margins

Question 23

mastectomy

Answer 23

removal of all breast tsu on the affected side

Question 24

axillary node dissection

Answer 24

removal of all level 1 and level 2 nodes (lateral and beneath pec minor)

Question 25

Modified radical mastectomy

Answer 25

mastectomy + ax node dissection

Question 26

Sentinel node biopsy

Answer 26

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

Question 27

What is DCIS? and Rx?

Answer 27

ductal carcinoma in situ
PRE-malignant lesion.
2 rx options:
local excision w neg margins + radiation
mastectomy without radiation

Question 28

What is LCIS? and Rx?

Answer 28

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)

Question 29

Rx for Stage I or II breast ca

Answer 29

surgical removal of tumor w negative margins, assess regional lymph nodes (sentinel node biopsy)
can do lumpectomy or mastectomy.
if mastectomy, add radiation

Question 30

Indications that favor mastectomy for Stg I or II

Answer 30

multiple tumors
prior radiation
large lesions
positive lumpectomy margins.
if choosing mastectomy, add radiation.

Question 31

Rx for Stage III or IV

Answer 31

Surgical resection for local control plus rad or chemo, since surgery only treats local, known.

Question 32

Endocrine therapy for BC

Answer 32

if tumor expresses estrogen receptor- has 30% chance of responding to endo therapy. if it also expresses progesterone receptor, the probability increases to 70%.

Question 33

How do aromatase inhibitors work?

Answer 33

They prevent the production of estrone and estradiol.

They are generally better than tamoxifen.

Question 34

Chemo regimens

Answer 34

CMF: cyclophosphamide, methotrexate, 5-fluorouracil
AC: doxorubicin and cyclophosphamide
Tamoxifen

Question 35

Pgx of BC based on staging

Answer 35

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.