Breast Disease: Cancer And Benign Flashcards
What is the leading cancer in women?
Breast cancer
What are the most common types of epithelial tumors in breast cancer?
Ducts or lobules
How is breast cancer typically diagnosed?
By biopsy
What is the common presentation of breast cancer?
Asymptomatic mass discovered during examination or screening mammography
What are the common treatment options for breast cancer?
Surgical excision, radiation therapy, chemotherapy, endocrine therapy
Name common sites of metastasis for breast cancer.
Lung cancer, skin melanoma, bone metastases, pleura, liver, colorectal cancer, ovarian, adrenal gland and pcnreas.
What is the leading cause of cancer death in women?
Breast cancer
List three risk factors for breast cancer.
- Age between 65 to 74
- Black women
- Family history
Gene mutation of BRCA1 and BRCA2, with BRCA1 having a greater risk. - use of oral contraceptives
*early period or alte menopause - first child over 35
*radiation therapy to chest
*smoking and alcohol use
What gene mutations are associated with a higher risk of breast cancer?
BRCA1 and BRCA2
-> prophylactic bilateral mastectomy should be offered
What is the risk reduction percentage of breast cancer with prophylactic bilateral mastectomy in women with BRCA mutation?
90%
What are the hisotlgoical types of breast cancer?
invasive ductal caricnoma
Invasive lobular
Ductal adenocarcinoma
Lobular caricnoma in situ
Mucinous
Tubular
Medullary
What is the most common hisotlogical subtype of breast cancer?
- Invasive ductal carcinoma is the most common type, beginning in the milk duct and invading the fatty tissue of the breast
What does DCIS stand for?
Ductal adenocarcinoma in situ neoplastic epithelial lesions that are confined to the breast ducts, detected only by mammography. Biospy will show cellular atypical and hyperchromatic nuclei involving the ducts but not extending past the basementmebran.DCIS accounts for approximately 20% of breast cancers and increases the risk of developing invasive breast cancer.
How are patients with DCIS treated?
Patients with DCIS are often treated with daily oral tamoxifen. There will be necrosis in advanced DCIS, with white/yellow debris in breast tissue.
What is Paget disease of the nipple?
DCIS whichwhich extends into the SKIN over the nipple and areola, characterises are an eczematous or psoriaform lesion and may have characteristic malignant Paget cells in the epidermis or cancer cells migrating to the nipple.
What is the presentation of paget disease of nipple?
It presents initially with eczema-like changes to the nipple and areola with crusty inflamed rash, bloody nipple discharge and nipple retraction/inversion and a non-healing skin lump. Most common in post menopausal women.
What is the most common type of invasive breast cancer?
Invasive ductal carcinoma
What are the features of lobular caricnoma?
Lobular carcinoma in situ (LCIS) is often multifocal and is bilateral and incudes classic and pleomorphic (cells are larger and more atypical). Includes classic and pleomorphic LCIS.
What is classic LCIS?
Classic LCIS is not malignant but increases risk of developing invasive carcinoma in either breast. This nonpalpable lesion is usually suspected based on calcifications or a mass on mammography or ultrasonography and is diagnosed with biopsy.
What is pleomorphic LCIS?
Pleomorphic LCIS behaves more like DCIS; it should be excised to negative margins
What are the feature of medullary caricnoma?
Medullary carcinoma is aggressive and poorly differentiated, seen more commonly in BRCA mutant and younger patients.
True or False: Triple negative breast cancer has the worst prognosis.
True As hormonal therapy is ineffective
What is the preferred therapy for premenopausal women with ER+ breast cancer?
Tamoxifen or ovarian suppression combined with aromatase inhibitor
What is the preferred therapy for postmenopausal women?
aromatase inhibitor
What characterizes inflammatory breast cancer?
Fast-growing, aggressive cancer that blocks lymphatic vessels. a result, the breast appears inflamed, and the skin appears thickened with erythema and nipple discharge, resembling orange peel (peau d’orange). Usually, inflammatory breast cancer spreads to the axillary lymph nodes.
What are the features of metastatic breast cancer on clinical examination?
- Fixation of the mass to the chest wall
- Satellite nodules or ulcers in the skin
- Matted or fixed axillary lymph nodes
- supraclavicular or infraclavicular lymphadenopathy
What are the clinical features of breast cancer on examination?
Overlying skin changes, nipple discharge, edema, peau d’orange, and ulceration. An unexplained axillary mass in women over 30, unexplained breast mass in patients aged over 20
What is the Criteria for a 2-week wait for breast cancer evaluation for age over 30 with what condition?
Unexplained breast lump with or without pain
OR
skin changes suggestive of breast cancer or an unexplained lump in the axilla
What is the criteria for 2 week wait in over 50s?
Age 50 or more with nipple discharge, retraction or other changes
What is the role of imaging in breast cancer diagnosis?
To guide biopsy and assess for lesions . The excised specimen should be x-rayed and compared with prebiopsy mammogram to determine whether all of the lesion has been removed.
If the original lesion contained microcalcifications, mammography is repeated when the breast is no longer tender, usually 6 to 12 weeks after biopsy, to check for residual microcalcifications.
What does triple testing for breast cancer involve?
- Clinical examination
- Imaging with ultrasound or mammogram
- Core needle Excision biopsy as fine needle has a high rate of false negatives
When is mammogram not useful?
Mammography is of limited utility in patients with dense breasts, in younger patients, and in those who cannot tolerate the breast compression that is required. Breast ultrasound or magnetic resonance imaging (MRI) with contrast may be utilized in such cases.
When is MRI used?
MRI is the most sensitive, but time consuming and expensive. Indicated for axillary lymph node disease, dense breast tissue, evaluating invasive lobular carcinoma and an occult primary malignancy, Paget disease, multifocal or bilateral cancers
to assess the tumour size if breast-conserving surgery is being considered for invasive lobular cancer.
What is recommended for breast cancer diagnosed at age ≤ 50 years?
Genetic testing
Triple negative breast cancer
Male breast cancer
Aiding decisions about use of PARP inhibitors or olaparib
What are the components of the NICE guidelines for breast cancer evaluation?
- Pre-treatment ultrasound evaluation of axilla
- MRI for invasive breast cancer assessment
What tool estimates prognsois of invasive breast cancer?
PREDICT toool
it is less effective women under30 with ER-positive breast cancer, women aged 70and over and women with tumours larger than 50mm.
What is the initial adjuvant endocrine therapy for postmenopausal women with ER-positive invasive breast cancer?
Aromatase inhibitor
->Offer tamoxifen to women who are at low risk of disease recurrence, or if aromatase inhibitors are not tolerated or are contraindicated
What is the initial adjuvant endocrine therapy for men?
tamoxifeon
-> also given to premenopausal women
How are the lymph nodes assessed?
pre-operative axillary ultrasound prior to surgery. Progress to sentinel biopsy and if positive, do axillary node clearance, which can cause arm lymphoedema and functional arm impairment.
What is a breast conserving surgery?
Breast conserving surgery is a wide local excision for solitary tumour or small tumour under 4cm in a large breast. It involves determining the size of the tumor and the required margins (based on the tumor’s size relative to the volume of the breast), then surgically removing the tumor with its margins.
This incudes quadrantectomy (removing a quarter of the breast tissue) or a wide excision.
When is breast-conserving surgery contraindicated?
It is contraindicated for large tumors, chest wall or skin involvement, multifocal disease, inability to receive radiation, and large tumor size to breast size ratio.
What is a lumpectomy?
Lumpectomy, a wide loca excision for small tumours localised to a breast region.
What are the surgical options for breast cancer treatment?
- Lumpectomy
- Mastectomy
- Skin-sparing mastectomy
- Nipple-sparing mastectomy
What is a skin sparing mastectomy?
Spares the pectoral muscles and enough skin to cover the wound, making breast reconstruction much easier, and spares axillary lymph nodes
What is a simple mastectomy?
Spares the pectoral muscles and axillary lymph nodes and physically performed for tumours over 5cm
What is a modified radical mastectomy?
Spares the pectoral muscles and removes some axillary lymph nodes
What is a radical mastectomy?
Removes axillary lymph nodes and the pectoral muscles, rarely done unless cancer has invaded pectoral muscle
What is the chemotherapy regime for breast cancer composed of?
FEC-D
* 5-fluorouracil
* Epirubicin
* Cyclophosphamide
* Docetaxel
Given prior to surgery to shrink primary tumour or post surgery if lymph node involvement is present
What are some poor prognostic factors for breast cancer?
- Advancing age
- Being male
- Stage III or IV
- Tumor size
- Tumor grade
- Hormone receptor-negative tumors
When is radiation therapy indicated after mastectomy?
- The primary tumor is ≥ 5 cm.
- Axillary nodes are involved.
- Margins are positive for cancer in resected tissue.
It can be delivered with catheter devises or brachytherapy, where the source is placed inside or next to the area requiring treatment.
What are potential complications of surgery for breast cancer?
- Venous thromboembolism
- Lymphoedema
- Pain
What ar the complications of radiotherapy?
*Cardiac toxicity, with atherosclerosis of coronary artery
*Pneumonitis, with inflammatio of the lung tissue that is greater risk with the use of paclitaxel.
*Breast fibrosis, with breakfast shrinkage, hardening, pain and poor wound healing
*Lymphoedema
*Brachial plexopathy, causing hand and arm paresthesia, weakness, and pain in the affected arm and shoulder. Onset is typically 8 to 12 months after treatment
*Secondary malignancy for lung, oesophageal cancers and sarcoma
What is the purpose of axillary lymph node evaluation during mastectomy?
To determine the spread of cancer
What is sentinel lymph node biopsy (SLNB)?
A procedure to locate the first lymph nodes that cancer cells are likely to spread to. It involves a blue dye and/or radioactive colloid injected around the breast, and a gamma probe is used to locate the nodes the tracer drains into.
It is used to stage the axilla where there is no evidence of lymph node involvement on ultrasound and negative needle biopsy. All people having mastectomy for DCIS should have SLNB. If there are cancer cells present, ALND is indicated.
SLNB has ≥ 95% sensitivity for axillary node involvement.
What treatment is indicated for high-risk patients post-mastectomy?
Radiation therapy
What are the complications of radiotherapy?
- Cardiac toxicity
- Pneumonitis
- Breast fibrosis
- Lymphoedema
- Brachial plexopathy
- Secondary malignancy
What is the role of bisphosphonates in breast cancer management?
To reduce the risk of bone metastasis But there is a risk of osteonecrosis of jaw
What is breast-conserving surgery?
A surgical procedure to remove the tumor with its margins
What is the indication for whole-breast radiotherapy?
For those with breast-conserving surgery with clear margins
What does the PREDICT tool estimate?
Prognosis for invasive breast cancer
What is the significance of a non-palpable axillary lymphadenopathy?
Indicates need for pre-operative axillary ultrasound prior to surgery
What is the main adverse effect associated with axillary node dissection (ND)?
Lymphoedema
Lymphoedema is a common complication, especially with excessive removal of nodes.
Which factors increase the risk of lymphedema in patients undergoing axillary dissection?
- High preoperative BMI
- Significant weight gain during and after treatment
- Prior trauma to shoulder
- Use of radiotherapy to axillary node
These factors contribute to the likelihood of developing lymphedema.
What is the preferred surgical approach for axillary node evaluation in breast cancer?
Sentinel lymph node biopsy (SLNB)
SLNB is preferred due to lower risk of lymphedema compared to routine axillary lymph node dissection (ALND).
What is the significance of lobular carcinoma in situ in terms of breast cancer risk?
Invasive cancer is equally likely to develop in either breast
Bilateral mastectomy is the only way to eliminate the risk for these patients.
Define locally advanced breast cancer.
Tumors larger than 5cm or clinically positive lymph nodes
These patients typically receive neoadjuvant therapy and adjuvant radiotherapy.
What is axillary web syndrome?
Development of fibrotic bands in the axilla after axillary lymph node dissection. It occurs within weeks to months after surgery, causing a sensation of tightness and pulling I h chest area, restricted shoulder movement and pain. Treatment is physical therapy and stretching exercises.
It causes tightness, restricted shoulder movement, and pain.
What is the criteria for SLNB and ALND?
Most surgeons now first do SLNB unless biopsy of clinically suspect nodes detected cancer; risk of lymphedema is less with SLNB. Routine use of ALND is not justified because the main value of lymph node removal is diagnostic, not therapeutic, and SLNB has ≥ 95% sensitivity for axillary node involvement.
What is ALND?
Axillary lymph node evaluation extensive procedure that involves removal of as many axillary nodes as possible; adverse effects, particularly lymphoedema, are common especially with excessive removal of the nodes.
hWhat are the two types of reconstructive procedures for breast surgery?
- Prosthetic reconstruction: Placement of a silicone or saline implant, sometimes after a tissue expander is used
- Autologous reconstruction:
Autologous reconstruction can involve muscle flap transfer or muscle-free flap transfer.
What is autologous reconstruction?
Muscle flap transfer (using the latissimus dorsi, gluteus maximus, or the lower rectus abdominis) or muscle-free flap transfer
Immediate mastectomy can be performed in the same operation as a mastectomy, to maintain breast shape, and reduce rate of tissue breakdown. Delayed reconstruction occurs after mastectomy and reduced rate of capsular contracture (scar layer arid implant that can be painful)
What is tamoxifen and its primary use?
A selective estrogen receptor modulator used to reduce breast cancer mortality in ER-positive tumors
It can induce menopausal symptoms but reduces contralateral breast cancer incidence.
What are the off target effects of tamoxifen?
Tamoxifen can induce or exacerbate menopausal symptoms but reduces incidence of contralateral breast cancer and lowers serum cholesterol. Tamoxifen increases bone density in postmenopausal women and may reduce risk of fractures and ischemic heart disease. However, it significantly increases risk of developing endometrial cancer and thromboembolism
What are aromatase inhibitors and their role in breast cancer treatment?
(anastrozole, exemestane, letrozole) Medications that block peripheral estrogen production in postmenopausal women. More effective than tamoxifen, these medications are becoming the preferred treatment for early-stage hormone receptor–positive cancer in postmenopausal patients
They are more effective than tamoxifen for early-stage hormone receptor-positive cancer.
What is the preferred therapy for premenopausal women with ER+ breast cancer?
Tamoxifen or ovarian suppression (usually with leuprolide, a GnRH agonist) combined with an aromatase inhibitor
For postmenopausal women, an aromatase inhibitor is preferred.
What medication is used for BRCA1 mutation?
Olaparib is used in patients with germline BRCA1 and double ortriple negative cancer. It inhibits PARP (poly ADP-ribose polymerases) responsible for DNA transcription and DNA repair and in cancer cells with BRCA mutations, BRCA is ineffective for homologous recombination and causes genomic stability and apoptosis cell death.
What are the side effects of hormone therapies used for breast cancer?
- Hot flushes
- Vaginal dryness
- Menstrual changes
- Fatigue
- Mood changes
- Osteoporosis
These side effects can significantly impact quality of life.
What is the significance of HER2 overexpression in breast cancer?
It indicates the use of monoclonal anti-HER2 treatment such as trastuzumab
Trastuzumab has a risk of cardiotoxicity.
What is the risk of trastuzumab?
trastuzuma has a risk of cardio toxicity by blocking HER2 action on cardiomyocyte, which can decrease left ventricular systolic function.
What does a DEXA scan assess in breast cancer patients?
Bone density
It is particularly important for those on aromatase inhibitor treatment.
What is the prognosis for stage 0 and stage 1 breast cancer?
100% 5-year survival rate
Prognosis decreases with higher stages of cancer.
What is the indication for adjuvant chemotherapy?
larger tumours
Which chemotherapy agents are used?
capecitabine, doxorubicin(including its liposomal formulation), gemcitabine, the taxanes paclitaxeland docetaxel, and vinorelbine
What is an issue with doxorubicin?
Doxorubicin increases risk of cardiac arrythmias and myoperciarditis.
What is the action of capecitabine?
inhibits thymidine syntehsis
What is paclitaxel associated with?
lung fibrosis
What is the therapy for HER2 positive breast cancer?
Biological therapy involves trastuzumab for HER2 positive patients
What is the biological therapy for HER2 negative and hormone positive breast cancer?
Abermaciclib for HER2-negative hormone positive breast cancer
What is the biological therapy for triple negative breast caner?
Pembrolizumab for triple negative breast anger
How are lymph nodes assessed in breast cancer?
N1: Mobile ipsilateral axillary nodes
* N2: Fixed/matted ipsilateral axillary nodes
* N3a: Ipsilateral infraclavicular nodes
*N3b: Ipsilateral mammary nodes
*N3c: Ipsilateralsupraclavicular nodes
What is the prognosis for different stages of breast cancer?
Prognosis for stage 0 and stage 1 have a 100% 5 year survival
Stage 2 and 3 have 93% and 72%. Stage 4 has 22% positive prognosis.
What are the long term complications of breast cancer treatment?
Altered or loss of sensation in chest area, Early menopausal symptoms and fertility loss, Hair loss and memory loss, Vaginal dryness, Hormonal therapy will cause hot flashes, fatigue and nausea, Impotence in males, Radiation will cause pain, fatigue, nausea and hair loss.
What is the breast cancer screening programme?
NHS breast cancer screening programme offers a mammogram (X-ray) every 3 years to women between 50 and 70 to detect cancer. It is quic and cost-effective but has low sensitivity and specificity and may be painful.
What is lymphoedema?
Lymphoedema is chronic impaired lymphatic drainage after removal of axillary lymph nodes, with excess protein rich fluid in the arm and increases risk of infection.
What is the management of lymphoedema?
Conservative management is decongestive therapy with manual lymphatic drainage, compression bandages and exercises. Surgery involves removing excess skin, underlying tissue for debunking, liposuction of affected limb and restoring flow around affected area with lymphaticovenular anastomosis to provide a direct route of lymph into the bloodstream.
What are the principles of cancer screening?
the condition should be an important health problem
* there should be a recognisable latent or early symptomatic stage
* the natural history of the condition, including development from latent to declared disease, should be adequately understood
* there should be an accepted treatment for patients with recognised disease
* there should be a suitable test or examination that has a high level of accuracy
* the test should be acceptable to the population
* there should be an agreed policy on whom to treat as patients
* facilities for diagnosis and treatment should be available
* the cost of screening (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole, and
What is fibroadenoma of breast?
Fibroadenoma of the breast: painless unilateral lump that is solid, occur in most commonly between 14 years old to 35 years old, with highest incidence in women in their 20s and shrink after menopause.
What are the features of fibroadenoma?
They have a marble-like mass with high mobility and encapsulated and overlying skin is normal. It arises from sensitivity to oestrogen, growing during pregnancy and shrinking during menopause causing excessive division of a single lobule. Those taking oral contrrracepties have higher risk. It has a clear border and a rubbery consistency.
What is the classification of fibroadenoma?
Classification is simple which are 1-3 cm and complex that are larger with popcorn calcifications and associated with breast cancer risk. Giant fibroadenoma is greater than 5cm.
How are fibroadenoma managed?
On mammogram, it has a distinct area from breast tissue with round and smooth edges and may have popcorn calcifications.. Diagnosis is with triple therapy but ultrasound is ideal as women under age 40 will have higher breast density. Surgery can be indicated if it is greater than 3cm and has rapid growth, with lumpectomy, vacuum-assisted excision biopsy or excsional biopsy. Cryoablation may be performed.
What are phyllodes?
Phyllodes tumours are rare fibroepithelial neoplasm of the breast which arise from the stroma, affecting women in their 40s or 50s. It is a rapidly growing smooth and hard palpable breast mass which can cause ulcers in later stages but rarely metastasises.
What is a phyllodes tumour?
Phyllodes tumours are rare fibroepithelial neoplasm of the breast which arise from the stroma, affecting women in their 40s or 50s. It is a rapidly growing smooth and hard palpable breast mass which can cause ulcers in later stages but rarely metastasises.
What is an Intraductal papilloma?
Intraductal papilloma is a wart-like tumour within the milk ducts of the breast causing spontaneous clear/bloody nipple discharge. The most typical duct affected is the central duct and affects females of all ages but more common in women aged 40-50. It is typically asymptomatic. Predisposing factors are contraceptiveuse, hormone replacement therapy, increased lifetime estrogen exposure from early period or late menopause, and family history
What are the features of fat necrosis?
Fat necrosis may occur following chest trauma, with localised inflammation, pain and tenderness and calcification. If there is a mass, it will be firm or hard irregular lump with a clear margin and overlying skin trauma. Management is convservative with analgesia.
What is mammary Ductal ectasia?
Mammary duct ectasia is when milk ducts under the nipple widen and thicken more than 2mm causing bloackage and fluid build up with intermittent nipple discharge and tenderness. Nipple discharge may be green, brown or bloody and there may be inflammation around the nipple, breast mass below the areola and nipple inversion or retraction GH. Mainly seen in perimenopausal women 45 to 55 and more common in smokers, higher BMI, lactation history and coffee consumption.
How is mammary Ductal ectasia diagnosed?
Ultrasound is ideal for women under 40 and mammogram for women over 40. Ductal graphs can be used in combination to visualise the ducts and core needle biospy may be necessary.
Management is conservative with analgesia, surgical management with microdochectomy to remove the ducts, total duct excision. There
What is fibrocystic breast disease?
Fibrocystic breast disease is the most common benign disease where breasts are “lumpy and doughy” with symptom as worsening during luteal phase of menstruation because it is driven by osteogenesis and progesterone. There is a risk of glandular tissue undergoing hyperplasia and developing cysts, fibroadenomas and mastitis. It is mobile in the chest and presents with bilateral lumpy with a rubbery texture and there usually isn’t any discomfort. It is an oval shape with a well-defined margin and nipple discharge. To manage this,
What is the management of fibrocystic breast disease?
Risks factors is age approaching menopause, nulliparity, late onset menopause, use of oestrogen replacement therapy and late age at first brith.
Metformin is a supportive treatment method with soft and well-fitting bra method and pain relief with aspirin and ibuprofen. Typically self resolves after menopause
What are lipomas?
Lipomas are benign subcutaneous adipocyte tumours that are soft and painless and mobile, with a slippage sign at the edge of the tumour. If large enough, can cause bronchial obstruction. Complete surgical ejection is reccomended.
What are breast cysts?
Breast cysts are rounded smooth and fluid filled lumps which can be tender, typically enveloping in 30 to 50 year olds. Cause of breast cysts is overgrowth of glandular and connective tissue, leading to blocked breast ducts and subsequent fluid accumulation.
What is the typical management for breast cysts?
Ultrasound is ideal over mammography to identify this. Management includes fine needle aspiration but further cysts may occur and there may be local oedema and haematoma and small risk of mastitis and breast abscess and risk of tumour seeding if there is an underlying malignancy..
Further cysts may occur, and ultrasound is preferred for identification.
What is a radial scar?
Radial scar is a lesion less than 1cm which can appear as breast cancer on mammogram, where there is an area of hardened tissue with central scarring surrounded by proliferating glandular tissue. Complex sclerosing l It is a proliferative breast lesion with an idiopathic process which may be related to inflammation and ischaemia that can co-occur with scloerisng ductal hyperplasia.
What is the management of radical scar?
Management is surgical excision, vacuum-assisted biopsy to enable tissue sampling. There is no breast
What is cyclical mastalgia?
Recurrent bilateral diffuse breast tenderness occurring in the luteal phase, most prevalent i peri and post menopausal women. There may be breast lumpiness due to fibrocystic changs and Ductal ectasia. Management is pain relief
It is prevalent in peri- and postmenopausal women.
What is the primary cause of puerperal mastitis?
Lactation in postpartum women There will be localised pain, tenderness, redness and heat in a unilateral breast one week post partum with systemic symptoms like fever, rigours, myalgia, fatigue, nausea and headache.
Symptoms include localized pain, tenderness, and systemic symptoms like fever.
What are the risk factors for puerparal mastitis?
Risk factor for Puertas mastitis is having breast implants, shaving around the nipple, injury to nipple, weaning, infant preference for one breast or difficulty feeding.
What is the classification of fibroadenomas?
- Simple (1-3 cm)
- Complex (larger with popcorn calcifications)
- Giant (greater than 5 cm)
Complex fibroadenomas are associated with breast cancer risk.
What is the definition of a breast abscess?
Localized infection in the breast, often as a complication of mastitis
It may require drainage and antibiotic therapy.
What are the common symptoms of intraductal papilloma?
Spontaneous clear or bloody nipple discharge
It is typically asymptomatic and affects women of all ages.
What is the primary management for mastitis?
Analgesia, warm and cold compresses
For abscesses, radical drainage may be required. Antibiotics are indicated if fever is present or symptoms last more than 12-24 hours.
What antibiotics are commonly used for mastitis?
Flucloxacillin, clindamycin for penicillin allergy
If the condition does not improve, intravenous antibiotic with vancomycin is indicated.
What are the complications of mastitis?
Breast abscess, recurrence
there is risk of candida of nipple after antibiotic course, where thee is painful itchy nipples with flaky cracked skin around areola
In puerperal mastitis, there is a risk of candida of the nipple after an antibiotic course.
What characterizes congestive mastitis?
Bilateral breast fullness, heaviness, and pain without fever or systemic symptoms.
What are the symptoms of a breast abscess?
Severe pain, fluctuating mass, localized heat, redness, and fever.
What is the functional unit of the breast?
Lobules.
What are Cooper’s ligaments?
Thick fibrous strands that attach the breast to the pectoralis major muscle.
Which hormone drives ductal development in the breast?
Oestrogen.
Which hormone drives lobule development in the breast?
Progesterone.
What is the primary blood supply to the breast?
Internal mammary artery
A branch of the subclavian artery.
List the branches of the axillary artery supplying the breast.
- Superior thoracic artery
- Acromiothoracic artery
- Lateral thoracic artery.
What are the primary veins involved in the venous drainage of the breast?
- Internal Mammary vein
- Axillary vein
- Intercostal vein.
What is the source of spread of breast disease ?
bastion plexus: The source of spread in breast disease where breast cancer cells spread via posterior intercostal vein to paravertebral plexus.
What lymph nodes drain the majority of the breast?
Axillary lymph nodes anterior, posterior, lateral, central and apical. Internal mammary nodes and supraclavicular nodes drain the breast.
This is where the majority of breast cancer spreads, likely the sentinel lymph node.
Which lymph nodes drain the most medial aspects of the breast?
Parasternal lymph nodes.
What are the two types of lymphatics that drain breast tissue?
- Superficial lymphatics (for skin over breast excluding nipple and areola)
- Deep lymphatics (drain nipple, areola, and breast parenchyma).
What is the Beg classification used for?
Lymphatic classification of lymph node spread based on proximity to pectoralis major.
Describe Level I of the Beg classification.
Anterior, posterior, and lateral lymph nodes which are lateral to the pectoralis major.
Describe Level II of the Beg classification.
Central lymph nodes and Rotter’s lymph nodes (between pectoralis major and minor).
Describe Level III of the Beg classification.
Apical lymph nodes (Halstead group) which are medial to pectoralis major.
What causes scapula winging?
Damage to the long thoracic nerve supplying serratus anterior.
