Breast Flashcards
Hormone responsible for duct development
Estrogen
Hormone responsible for lobular development
Progesterone
Hormone responsible for breast swelling, growth of glandular tissue
Estrogen
Hormone responsible for increased maturation of glandular tissue, withdrawal causes menses
Progesterone
Hormones to cause ovum release
FSH, LH surge
Winged scapula, innervates serratus anterior
Long thoracic nerve
Weak adduction, innervates latissimus dorsi
Thoracodorsal nerve
Innervates pectoralis major and pectoralis minor
medial pectoral nerve
Innervates pectoralis major only
lateral pectoral nerve
Most commonly injured nerve w/ ALND and modified radical mastectomy
Intercostobrachial nerve (numbness in medial arm/axilla)
Blood supply to breast is from (4)
internal thoracic a
intercostal a
thoracoacromial a
lateral thoracic a
Valveless vein plexus that allows direct hematogenous metastasis of breast cancer to spine
Batson’s plexus
Primary axillary adenopathy
1 in lymphoma
What node status is + supraclavicular nodes
N3 disease
Most common bug in breast abscess
s. aureus
Noncyclical mastodynia, erythema of breast, creamy discharge from nipple
Periductal mastitis
Poland Syndrome
Hypoplasia of chest wall
Amastia
Hypoplastic sholder
No pectoralis muscle
Treatment of mastodynia
Danazol OCP NSAIDs Evening primrose oil Bromocriptine
Mondor’s disease
Superficial vein thrombophlebitis of breast
Feels cordlike
Tx w/ NSAIDs
Which types of fibrocystic disease have to be resected due to cancer risk (2)
Atypical ductal
Lobular hyperplasia
**Does NOT need negative margins
Most common cause of bloody nipple discharge
Intraductal papilloma
Prominent fibrous tissue compressing epithelial cells
Fibroadenoma
What 3 criteria must be met in patient <40 w/ suspected fibroadenoma to observe
1) mass needs to feel clinically benign
2) US/Mammo consistent w/ fibroadenoma
3) FNA/CNBx to confirm fibroadenoma
If not 3/3 then requires excisional biopsy
If >40 then –> excisional biopsy
Most aggressive subtype of DCIS
Comedo pattern - high risk for recurrence
Treatment for DCIS
Lumpectomy and XRT
Need 1cm margins
Treatment for Comedo type DCIS
Simple mastectomy and SLNB
DCIS on mammogram
Cluster of calcifications on mammogram, not palpable
LCIS on mammogram
No calcifications, not palpable
What type of cancer do patients w/ LCIS develop
Ductal CA
Margins needed for LCIS
Do NOT need negative margins
LN Levels Mastectomy
I: lateral to pec minor
II: deep to pec minor
III: medial to pec minor
Nodes between pec major and pec minor
Rotter’s nodes
Most common site for distant metastasis
bone (lung, liver, brain)
BRCA I lifetime risk
Female Breast cancer
Ovarian Cancer
Male Breast Cancer
60
40
1
BRCA II lifetime risk
Female Breast cancer
Ovarian Cancer
Male Breast Cancer
60
10
10
BRCA screening
yearly mammogram and breast MRI starting at age 25
yearly pelvic exam + US, CA-125 starting at age 25
Receptor blocker for Her2/neu + breast cancer
Trastuzumab (Herceptin)
Worse prognosis subtype of ductal cancer
Scirrhotic
More favorable prognosis subtype of ductal cancer
medullary (increased lymphocytes)
Treatment of Ductal Cancer
MRM
Breast conserving + post op XRT
Worse prognosis sybtype of lobulcar cancer
Signet ring cells
Treatment of Lobular cancer
MRM
Breast conserving + post op XRT
Treatment of inflammatory cancer
Neoadjuvant chemo + MRM + adjuvant chemo/XRT
Indication for SLNB
Tumors >1cm w/o clinical nodes
Indication for XRT after mastectomy
advance nodal disease (>4 nodes, N2-N3)
skin/chest wall involvement
+ margins
T3-T4
Who gets chemotherapy
> 1cm + negative nodes
+ nodes
Occult breast cancer
axillary metastases w/ unknown primary
Paget’s disease
scaly skin lesion on nipple, associated w/ DCIS or ductal CA
Spread of phyllodes tumor
hematogenous
Stewart-Treves syndrome
Lymphangiosacroma from chronic lymphedema following axillary dissection **presents w/ dark purple nodule or lesion on arm 5-10 years after surgery
