breast Flashcards
anatomy
modified and highly specialized sweat glands
2nd to 6th rib
Axillary tail (of Spence) or process – a small part of breast may extend towards axillary fossa
o 2/3rd of the breast rests on the pectoral fascia covering pectoralis major
o 1/3rd of the breast rests on the fascia covering serratus anterior
suspensory ligament of cooper-support lobules of gland
15-20 lobules
Each lobule is drained by a lactiferous duct – opens independently on the nipple, dilated portion - lactiferous sinus
o The terminal duct lobular unit is the functional milk secretory component of the breast
Ducts & acini are lined by two layers of cells – Luminal epithelial cells (E) & myoepithelial cells (M).
development of breast
o Mammary crests or ridges appear during 4th week
o These crests extend from axillary region to inguinal region
o The crests usually disappear except in the pectoral region
Primary mammary buds Secondary buds lactiferous ducts and their branches
blood supply
branches of
thoraco acromial
lateral thoracic
internal thoracic
• Nerves of the breast
o Anterior and lateral cutaneous branches of 4-6th intercostal nerves
o They convey sensory fibres to the skin of the breast
They also carry sympathetic fibres
• Lymphatic drainage
o Most lymph lateral quadrants axillary lymph nodes
o supraclavicular or inferior cervical nodes
o Lymph from medial quadrants parasternal or to opposite breast
o Sentinel lymph node located via a combination of radiolabelled colloid + dye
benign breast conditions
fibrocystic change
fibroadenoma- circumsribed mobile nodule in reproductive age
Intraductal papilloma
-lactiferous ducts, nipple discharge
Fat necrosis- traumatic injury
♣ Can simulate carcinoma clinically and mammographically
Duct ectasia
-nipple discharge
phyllodes tumour
♣ Fleshy tumour, leaf-like pattern and cysts on cut surface
breast carcinoma
o Affects one in 8 females – 22% of all female cancers
Commonest cause of female cancer death
-mammogram soft tissue opacity, microcalcification
macroscopic-hard lump, fixed mass, tethering to skin, peau d orange sign (dimpling of skin)
risk factors
gender age menstrual history age at first pregnancy radiation family history personal history hormonal treatment genetic factors
Hereditary genes:
BRCA1> BRCA2 70%
TP53 <1%
histo classification
ductal insitu lobular insitu invasive ductal carcinoma special type: tubular mucinous medullary others
insitu
not palpable
lobular-multicentricity and bilaterality
pagets disease of nipple
o Result of intraepithelial spread of intra-ductal carcinoma
o Large pale-staining cells within the epidermis of the nipple
o Limited to the nipple or extend to the areola
o Pain or itching, scaling and redness, mistaken for eczema
o Ulceration, crusting, and serous or bloody discharge
gynaecomastia
hyperthyroidism, cirrhosis of liver, chronic renal failure
screening for breast cancer
30% reduction in mortality
• Mammogram every 3 years for women 50 - 70 years old, registered with GP.
Over 80% (1,406 cases) of cancers detected were invasive, of which over half were less than 15mm in size.
-microcalcifications
diagnostic procedures
triple assessment-sensitive specificity 97 to 100%
clinical exam
radio imaging-US MRI MMG
Fine needle aspiration cytology FNA
mammography and other diagnostic tools
MLO (medio-lateral oblique) view and cranio-caudal view
o Under 35 if: ♣ Strong suspicion of cancer • • Dominant mass • Asymmetry • Architectural distortion • Parenchymal contour • Calcifications ♣ ♣ Family history risk greater than 40% o Radiation dose is 1mSv o Soft tissue mass ♣ ♣ Malignant • irregular, ill defined • spiculated (spikes or points) • dense • distortion of architecture ♣ Benign • smooth or lobulated • normal density • halo MRI high sensitivity poor specificity
Sentinel node sampling
histology
• Estrogen/ Progesterone Receptor (2/3 positive)
•o ER/PR are strong predictors of response to hormonal therapies
o ER/PR negative tumours do not respond
HER-2/neu – associated with poorer prognosis
o predicts response to trastuzumab (Herceptin)
spread
• Local – skin, pectoral muscles
• Lymphatic – axillary and internal mammary nodes
Blood – bone, lungs, liver, brain
