Breast Flashcards
Nerve supply
Branches of intercostal nerves from T4-T6.
Arterial supply
Internal mammary (thoracic) artery
External mammary artery (laterally)
Anterior intercostal arteries
Thoraco-acromial artery
Venous drainage
Superficial venous plexus to subclavian, axillary and intercostal veins
Lymphatic drainage
70% Axillary nodes
Internal mammary chain
Other lymphatic sites such as deep cervical and supraclavicular fossa (later in disease)
The breast itself lies on a layer of pectoral fascia and the following muscles:
- Pectoralis major
- Serratus anterior
- External oblique
Most likely to form microcalcifications
Comdeo DCIS
Ductal carcinoma in situ
Sub types include;
comedo, cribriform, micropapillary and solid
High nuclear grade DCIS is associated with more malignant characteristics
loss of p53, increased erbB2 expression
Multifocal lesions, large and high nuclear grade lesions will usually require mastectomy
Lobular carcinoma in situ
Much rarer than DCIS
Does not form microcalcifications
Usually single growth pattern
When an invasive component is found it is less likely to be associated with axillary nodal metastasis than with invasive foci found within DCIS
Low-grade LCIS is usually treated by monitoring rather than excision
Radiotherapy is given to all patients who have
undergone breast conserving surgery.
Mastectomy
Multifocal tumour
central tumour
large and small breasts
DCIS greater than 4 centimetres
Risks of axillary node clearance
development of lymphedema
increased risk of cellulitis and frozen shoulder
Chemotherapy for..
Patients with grade 3 lesions
Axillary nodal disease
Downstaging advanced lesions to facilitate breast conserving surgery
Tamoxifen is used and works as a ..
Increased risk of..
Effect on bone
partial oestrogen receptor agonist
association with endometrial cancer and VTE
Bone agonist - increases bone density
FEC regime is
most commonly used (Fluorouracil, epirubicin and cyclophosphamide).
Taxanes are commonly used in high risk patients and in this setting a regime of
docetaxal, doxorubicin and cyclophosphamide
MRI scanning may be beneficial in
screening younger patients with a family history
patients with lobular cancers who are being considered for breast-conserving surgery.
Were there are specific concerns about a breast implant, rather than a lump
Axillary sentinel lymph node biopsy – damage to
intercostobrachial nerves (Level 1)
Axillary node level 2 clearance, damage to:
Axillary node clearance: clavipectoral facial division, damage to thoracodorsal nerve (Level 2)– careful for lat dorsi flap!
Inferior breast lesion + axillary lymphadenopathy
FNAC first
Nipple + peri-areolar erythema
Nipple + peri-areolar erythema – pagets disease – most a/w IDC
IDC with -ve nodes
just radiotherapy
Soft lump – grey and gelatinous
mucinous carcinoma
Dystrophic calcification
Pseudocapsule/membrane surrounding the implants, it has a coarse granular appearance – fibrosis + calcification
Ductal ectasia is..
Highest risk factor…
If troublesome…
slit nipple retraction + cheese = smoking highest risk factor
If troublesome – Hadfields procedure (total duct excision)
US Cyst appearance
Halo, smooth outline aspirate large painful ones only
Ovarian CA risk larger in..
BRCA 1>2
New lumps in opposite breast
New lumps in opposite breast – invasive lobular carcinoma
Post-surgery
Redivac closed suction polypropolene system
HER2 Receptor Target:
Trustuzumab
Lytic lesions – high P() of..
Lytic lesions – high P() peritrochanteric # (prostate mets are sclerotic not lytic)
Linear, branching microcalcification with coarse granules
Comedo type DCIS
Grade 3 IDC with axillary node mets
chemo after mastectomy + ANC
Post implant infection
Staph Epidermidis – biofilm, remove implant
88yo, ER +ve give…
Letrozole
L3 Node Brisk Haemorrhage
L3 Node Brisk Haemorrhage – Thoracoacromial artery
Duct papilloma
sually present with nipple discharge
Large papillomas may present with a mass
Microdochectomy
