breast cancer

Question 1

blood supply of the breast

Answer 1

Two major sources:

• Internal mammary
• Lateral thoracic artery

Acromiothoracic and intercostals

Question 2

lymphatic drainage of the breast

Answer 2

75% to axillary LNs
Internal Mammary LNs
Lymphatics to contralateral breast
To rectus sheath & reach subperitoneal and subhepatic plexus

Question 3

presenting symptoms

Answer 3

Lump

Pain

Nipple discharge

Nipple Retraction

Change in breast shape/ appearance

Skin changes

Question 4

breast lump

Answer 4

Tenderness
Site
Size
Skin above the lump
Composition
Fixity
To skin or deeper structures
Mobility

Question 5

differential diagnosis of lump

Answer 5

Asymmetrical Dense glandular tissue
Cyst
Inflammatory/abscess
Fibroadenoma/Hamartoma
Phyllodes
Cancer

Question 6

nipple discharge

Answer 6

Symptom history
Colour
Spontaneous
Uniductal/ multiductal
Medications
Smoking

Question 7

nipple discharge- colour

Answer 7

Blood stained: Papilloma, DCIS, Paget’s

Green/Brown: Duct ectasia

Clear: Hormonal, Duct Hyperplasia, Ca

Milky: Post lactational/ Prolactinoma

Purulent: Superficial/ Central abscess

Question 8

triple assessment

Answer 8

History/examination

Imaging: Mammogram/USS/MRI

Tissue biopsy: FNAC/Core/VAB/punch Bx

Question 9

mutations

Answer 9

BRCA 1
Risk of breast Ca is 55-65%, risk of ovarian Ca 40% by 70yrs

BRCA 2
Risk of breast Ca 45% and ovarian Ca 11-17% by 70 yrs.

Li Fraumeni syndrome ( P 53 )

Question 10

hormonal risk factors

Answer 10

Hormonal Factors
 levels of estrogen risk
Early age at menarche
Late age at menopause
Nulliparity
Late age at first child-birth
Obesity