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Surgery > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Borders of the Breast:

A

superior: clavicle
inferior: 6th rib
lateral: lat dorsi
medial: edge of sternum
deep: pec major
superficial: skin

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2
Q

primary lymphatic drainage of the breast

A

axillary nodes

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3
Q

tail of spence:

A

axillary tail of the breast, laterally across anterior axillary fold

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4
Q

other lymphatic drainage of the breast:

A

parasternal nodes

intercostal nodes

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5
Q

categories of axillary lymph nodes:

A

Level I: lateral to pec minor
Level II: deep to pec minor
Level III: medial to pec minor

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6
Q

Nerves to avoid in mastectomy:

A

thoracodorsal nerve
long thoracic nerve
intercostobrachial nerve

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7
Q

vessels to avoid in mastectomy:

A 
axillary vein
perforating arteries (branches 2-4 intercostal arteries)
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8
Q

Staging used for the breast:

A

Tanner (don’t need to know specifics)

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9
Q

common sxs prompt women to get breast exams:

A 
pain
rash/redness/overlying skin changes
nipple discharge/changes
swelling
lumps/mass on self-exam
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10
Q

Types of Mastalgia:

A

cyclical (majority), non-cyclical, extra-mammary

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11
Q

etiology of cyclical mastalgia:

A

effects of hormones: estrogen (ductal); progesterone (stroma); and prolactin (ductal secretion)
-post-menopausal HRT or OCP

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12
Q

when should mastalgia be worked up:

A

persistent, unilateral pain/tenderness

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13
Q

what structure is involved in the p’eau d’orange appearance of breasts?

A

suspensory ligaments of cooper (connect deep to superficial layers)

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14
Q

phases of life that gynecomastia is most common:

A

neonatal
adolescence
senescence
(hormone imbalance)

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15
Q

etiology of extra-mammary mastalgia:

A 
referred pain:
chest wall pain
para/spinal conditions
trauma
biliary, pleural, cardiac
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16
Q

etiology of non-cyclical mastalgia:

A 
large breasts
diet lifestyle
HRT
ductal ectasia
mastitis
abscess
hidradenitis suppurativa
prior breast surgery, pregnancy
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17
Q

suspicious findings on PE:

A

palpable mass
skin changes
bloody nipple discharge

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18
Q

first line tx for mastalgia:

A 
physical support (bras, OTC analgesics, compresses, modify OCP/HRT)
adjuncts/alternatives: reduce caffeine intake, evening primrose oil capsules (gamma linoleic acid)
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19
Q

second line tx for mastalgia:

A

tamoxifen (lower SE, greater risk of coagulation, cataracts)
danazol (androgenic effects)
SE: hot flashes, vaginal dryness, arthralgia, wt gain, deepening voice

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20
Q

MCC breast mass in women 4/5th decade life:

A

fibrocystic disease/changes

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21
Q

fibrocystic mass description:

A

firm, mobile, slightly tender mass, less well-defined borders compared to fibroadenoma
fluid filled
round/ovoid
solitary/multiple
(size/tenderness fluctuate with menstrual cycle)

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22
Q

Dx of simple cysts:

A

ultrasonography

FNA

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23
Q

aspirate of simple cysts:

A

non-bloody, complete cyst collapse

often straw colored/green fluid

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24
Q

Dx of complex cysts:

A 
ultrasound
FNA (if bloody, sent to cytology)
core needle biopsy
mammography
if recurrence x2--> open biopsy indicated
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25
Q

fibroadenoma mass description:

A

typically painless
1-3cm in size
well defined, freely mobile, discrete, firm, rounded mass in breast

26
Q

age of fibrocystic vs fibroadenoma:

A

Fibrocystic: 4th/5th decade of life
Fibroadenoma: young women (teens to 30s)

27
Q

tx options for fibroadenoma:

A

excision
u/s guided cryoablation
vacuum assisted biopsy (outpatient)
observation

28
Q

when is a mammogram indicated?

A

age >30 and palpable breast mass

29
Q

risk factors for breast cancer >4.0:

A 
female
age (65+)
BRCA1 or BRCA2
personal hx breast cancer
high breast tissue density
biopsy confirmed hyperplasia
30
Q

Breast cancer can be broadly categorized based on:

A

estrogen and progesterone receptivity

HER2 recetpor

31
Q

tx for hormone receptor positive breast cancer:

A

selective estrogen receptor modulators (SERMS- tamoxifen; premeno)
or aromatase inhibitors (anastrozole; post meno)

32
Q

triple negative breast cancer

A

ER neg
PR neg
HER2 neg
(hardest to treat, not responsive to drugs)

33
Q

most common type of breast cancer:

A

invasive/infiltrative ductal carcinoma (80%)

most are hormone R positive and HER2 negative
tx: tamoxifen

34
Q

multicentricity vs multifocality:

A

multicentric: separate quadrants of the same breast
multifocality: lesions in same quadrant of breast (separated by normal tissue)

35
Q

two main types of invasive breast cancer:

A

ductal (MC)

lobular

36
Q

type of breast cancer that presents as “microcalcifications” on mammogram:

A

ductal cancer in situ (DCIS)

37
Q

what is unique about LCIS and DCIS?

A

they can invade the ipsilateral breast (MC in DCIS)

38
Q

MC presentation of breast cancer:

A

single, nontender, immobile mass
MC in upper outer quadrant
(may present on routine mammogram w/o palpable mass)

39
Q

Dx of solid mass in postmenopausal woman

A

cancer until proven otherwise!

40
Q

Best screening tool for breast cancer:

A

mammogram (starting at age 45)

41
Q

benign ultrasound findings:

A

well-demarcated borders
“posterior enlargement”
absence of internal echoes (cysts)

42
Q

suspicious ultrasound findings:

A

poorly demarcated borders
“posterior shadowing”
heterogenous internal echoes
“taller than wide” orientation

43
Q

when is MRI preferred for dx:

A 
dense breast tissue
scars
implants
h/o breast cancer or contralateral dz
women w/ BRCA1/2 mutations
44
Q

standard views for mammograms:

A 
medio lateral oblique (MLO)
craniocaudal view (CC)
45
Q

definitive dx of breast cancer:

A

tissue sampling:
needle-biopsied (may need u/s or radiological guidance)
excisional biopsy (needle vs seed- localized lumpectomy)

46
Q

Breast cancer staging:

A

Tumor
Nodes
Mets: commonly to lymph nodes, lungs, liver, bones, brain

47
Q

most important factor in prognosis:

A

axillary lymph node status (estrogen receptor close second)

48
Q

indications for chemo:

A

node positive disease

tumors >1cm

49
Q

neoadjuvant therapy:

A

preop therapy
may make surgery easier/ reduce need for surgery
useful in early stage disease and HER positive or triple neg

50
Q

adjuvant therapy:

A

post surgery

depends on tumor characteristics

51
Q

neo/adjuvant therapy:

A

endocrine, biologic, or cytotoxic medications

52
Q

main surgery options:

A

lumpectomy + radiation
or mastectomy
(same recurrence rates)

53
Q

simple/total mastectomy:

A

removes entire breast and pec major fascia

skin or nipple sparing

54
Q

modified radical (Patey) mastectomy:

A

simple mastectomy and axillary dissection (levels I-III)

55
Q

radical (halsted) mastectomy:

A

removes entire breast, overlying skin, pec major/minor muscles, entire axillary contents

56
Q

lumpectomy:

A

(aka wide excision, segmental or partial mastectomy)

excision of malignancy with circumferential margins and microscopically nl tissue

57
Q

breast reconstruction implant options:

A

prosthetic implant

or autologous tissue (lat dosri or rectus abdominis)

58
Q

timing of breast reconstruction:

A

immediate or delayed

*fun fact: insurance MUST cover

59
Q

when is a sentinel lymph node biopsy indicated:

A

early breast cancer

clinical and radiographic node NEGATIVE disease

60
Q

when is an axillary lymph node dissection indicated:

A

presence of positive sentinel lymph node

clinically positive axilla

61
Q

most common complications of breast surgery:

A 
bleeding 
infection
seroma
deformity
(flap necrosis less common)
62
Q

complication of axillary lymph node dissection:

A

lymphedema

decreased ROM, injury to intercostobrachial nerve

Surgery (2 decks)

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