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Surgery > Breast Disease > Flashcards

Breast Disease Flashcards

1
Q

the breast lies in

A

subcutaneous tissue of the anterior thoracic wall

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2
Q

extent of the breast base

A

sternal edge to mid-axillary line from 2nd to 6th ribs

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3
Q

the breast overlies

A

pectoralis major, overlapping into serrates and to a small extent, supper rectus and external oblique

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4
Q

axillary tail

A

small part of the outer quadrant that is prolonged toward the axilla

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5
Q

blood supply of breasts

A

mainly lateral thoracic artery
also internal thoracic, posterior intercostal arteries (perforating branches) and thoracic-acromial artery
all arterial supply forms an anastomosing network

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6
Q

venous drainage of breasts

A

circus areolar venous plexus and glandular tissue venous plexus to internal thoracic and axillary veins

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7
Q

lymph drainage

A

subareolar plexus communicated with breast lymphatics
75% drains to axillary nodes
25% to parasternal nodes
occasional drainage to intraclavicular

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8
Q

lactiferous ducts

A

about 15-20
each drains a lobe of the breast
each has a dilated sinus at its terminal portion in the nipple

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9
Q

areola

A

pigmented skin with smooth muscle
contraction causes nipple erection

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10
Q

the skin of the areola

A

large sebaceous glands, sweat glands and areolar glands are present
areolar glands form small elevations

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11
Q

areolar glands

A

form small elevations called tubercles of Montgomery

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12
Q

ligaments of Cooper

A

fibrous strands connecting dermis of skin to ducts and fascia
cancers may attach to these fibres which is what causes dimpling

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13
Q

how is paeu d’orange created

A

the appearance of orange peel
cancer obstructs dermal lymphatics causing appearance

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14
Q

crucial points to ask on history

A

history of the symptom
reproductive history (menarche, menopause, pregnancies, lactation, HRT, OCP, age of first full term pregnancy)
previous breast exams
smoking, alcohol, injectables
family Hx

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15
Q

when to use MRI

A

for high risk screening and complex cases only

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16
Q

types of benign breast disease

A

hormonal benign breast change
fibroadenomas
inflammation
cysts
papillomas
fat necrosis
screen detected lesions

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17
Q

some screen detected lesions

A

radial scars - benign
atypical ductal hyperplasia - increased risk of cancer
LCIS or lobular neoplasia - risk lesion

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18
Q

mammography density

A

women with extensive mammography density are 4-6 times more likely to develop breast cancer than women of the same age with little or no mammography density

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19
Q

people with first degree relatives who ha breast cancer

A

2-3x higher risk
higher is relatives has premenopausal onset/bilateral breast cancer

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20
Q

people with second degree relatives who had breast cancer

A

not increased
?? except paternal aunts

21
Q

people with multiple affected family members

A

absolute risk approaches 50%

22
Q

if women have BRCA1 or BRCA2

A

45% lifetime risk ovarian cancer

23
Q

other genes increasing risk of breast cancer

A

TP53
PALB2
PTEN
CHEK2 associated with moderate increase

24
Q

signs and symptoms of breast cancer

A

lump or lumpiness in the breast or axilla, especially if its only on one breast
breast lump and pain
changes in nipple appearance eg. retraction, scaliness, inversion, redness
discharge from nipple
breast pain, particularly localised with or without cyclic variation
change in shape or appearance of breast eg. dimpling, redness

25
Q

triple test includes

A
  1. clinical examination
  2. imaging (mammography and/or ultrasound
  3. non-excision biopsy (FNA and/or core biopsy)

if any of the triple tests results are abnormal, refer to breast assessment clinic

26
Q

national breast cancer screening program

A

women between the ages of 50-74 years are invited every two years for free mammograms
women ages 40-49 and 75 and over are also eligible to receive free mammograms

27
Q

Ductal carcinoma in situ

A

more morphologically heterogenous
discrete spaces filled with malignant cells, rarely single subtypes
as lesions grow, the centre tends to necroses, undergoing coagulation and calcifying towards the nipple (segmental calcifications)

28
Q

four subtypes of DCIS

A

papillary, cribriform, solid and comedo

29
Q

invasive ductal cancer

A

grows as a cohesive mass with mammography abnormalities
usually a palpable lump
most common

30
Q

3 subtypes of invasive ductal cancer

A

infiltrating
mutinous
colloid

31
Q

invasive lobular cancer

A

permeates in single file
escapes physical examination and early detection on mammography
variable prognosis

32
Q

breast cancer mets

A

advanced, metastatic stage 4 breast cancer
aim of treatment of distant mets is usually palliative

33
Q

common places for breast cancer to go

A

lung
bone
liver
brain

34
Q

breast conservation surgery

A

survival is the same as mastectomy
aims for better cosmetic outcome
WILL need radiotherapy
once more than 30% of breast needs to be removed, cosmetic outcome is worse

35
Q

oncoplastic surgery

A

breast reshaping
reduction techniques
volume replacement
augmentation or reduction contralateral side

36
Q

radiotherapy

A

usually even after breast conserving surgery
or to chest wall after mastectomy

37
Q

chemotherapy

A

mainly anthracycline and taxmen containing regimens
neo-adjuvnant therapy

38
Q

hormone blocking therapy

A

tamoxifen
aromatase inhibitors
ovarian function suppression

39
Q

targeted therapy

A

Herceptin and pertuzumab for HER2 over expressing tumours
CDK4/6 inhibitor for ER+ tumours

40
Q

treatment for ER+ slow growing cancers

A

hormone therapy

41
Q

treatment for ER+ fast growing cancers

A

hormone therapy plus chemo

42
Q

treatment for HER2+ breast cancer

A

chemo
Herceptin (Trastuzumab)
hormone therapy (if ER+ as well)

43
Q

treatment for triple negative breast cancer

A

chemo

44
Q

molecular profiling for breast cancer

A

analysis of multiple genes to develop an individual signature prognostic indicators so may suggest whether chemo is needed

45
Q

oncotype DX

A

tests for 21 genes
predicts risk of cancer recurrence and likely benefit of chemotherapy in lymph node negative breast cancer

46
Q

what is used for anti-HER2 therapy

A

Herceptin

47
Q

tamoxifen

A

selective oestrogen receptor modulator
used in pre and post menopausal women

48
Q

aromatase inhibitors

A

eg. anastrazole and letrozole block oestrogen production in liver and fat
only for post menopausal women

49
Q

side effects of hormonal therapy

A

hot flushes
joint pains and stiffness
mood disturbance
sexual dysfunction

Surgery (18 decks)

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