Breast Doc Flashcards
Which ribs does breast tissue extend from
Ribs 2-6
Where does breast tissue sit in relation to the pec major
Sits on top of the deep fascia that covers pec major and serratus anterior
What is the retromammary space
The space between the fascia (covering pec major) and breast tissue
What are the three main arteries supplying the breast tissue
Internal mammary
Posterior intercostal
Lateral thoracic
Give an outline of the path that most lymph takes from the breast
Majority of lymphatic will drain to ipsilateral axillary node then to supra-clavicular nodes then to thoracic duct
Apart from the ipsilateral axillary nodes, what 3 other groups of nodes receive lymph from the breast tissue
Parasternal
Abdominal
Nodes of contralateral breast
What is the basic functional secretory unit of breast tissue
Terminal Duct Lobular Unit (TDLU) –> site of milk production
What is the largest of the ducts, which connect the nipple and acini, called
Lactiferous duct
What happens to the lactiferous ducts just before they reach the nipple
Expansion of ducts called the lactiferous sinus –> storage site for milk
What special epithelium is lines the ducts and what is its function
Myoepithelium –> contracts in response to oxytocin
The nipple is the only place in the body where sebaceous glands do what
Open up directly to the skin
What kind of epithelium is the nipple composed of
highly pigmented keratinised epithelium
What is the difference in tissue composition of the breasts in young adults and older adults
Young –> higher proportion of glandular tissue compared to adipose tissue
Older –> loss of glandular tissue and replacement with adipose tissue
What happens to the breast tissue in pregnancy
The glandular tissue proliferates in response to oestrogen and progesterone
What makes up the triple assessment that is offered to all women who attend the breast clinic
Clinical: history and examination
Radiological: mammography +/- ultrasound
Cyto-pathology: cytology or biopsy
During breast examination, which three arm positions should you get the patient to hold
Resting on thighs
Above head
Hands on hips
What is the general rule of thumb on when to use ultrasound or mammography to visualise breast tissue
> 40 y/o –> Mammography
<40 y/o –> Ultrasound
On a mammogram, what colour is fat and what colour is glandular tissue
Fat –> grey
Glandular tissue –> white
A popcorn shaped calcification on mammogram suggests what pathology
Fibroadenoma
A rod shaped calcification on mammogram suggests what pathology
Duct ectasia
Which benign breast disease is associated with a seatbelt injury and what drug can be associated with it as well
Fat necrosis
Warfarin therapy
How is fat necrosis managed
Analgesia
can spontaneously resolve
Which benign breast disease is strongly associated with smoking and how does it present
Duct ectasia
Pain and nipple discharge
How is duct ectasia managed
Duct excision
What pathology presents as multiple lumps within breast and cyclical mastalgia
Fibrocystic change
Blue domed cysts filled with pale fluid is suggestive of which disease
Fibrocystic change
Which breast disease will present as a painless, firm and mobile mass and what classic appearance will it have on ultrasound
Fibroadenoma
Breast mouse on USS
Young women of which ethnicity are prone to fibroadenomas and how is it treated
Afro-caribbean
Excise if unsure
What is Mondor’s disease
Thrombophlebitis of the subcutaneous veins of the chest well and breast
Which two benign breast conditions can be described as biphasic
Phyllodes tumour
Fibroadenoma
When is the peak incidence for breast cancer
60-70
Describe the breast cancer screening program
50-70
Mammogram every 3 years
What is the most common type of breast cancer
Carcinoma
What are the two most common pre-cursors for breast carcinoma
Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS)
What are the three receptors that a breast cancer can express
Estrogen
Progesterone
HER 2
What is the best combination of receptor expression of a breast cancer, in terms of prognosis
ER positive
PR positive
HER 2 negative
What is the worst combination of receptor expression of a breast cancer, in terms of prognosis
Triple negative
Which three lifestyle factors are risks for breast cancer
Obesity
Alcohol
Smoking
Which form of contraception increases your risk of breast cancer
COCP
What is Paget’s Disease of the Nipple
High grade DCIS extending along ducts to reach the epidermis of the nipple
What is the most common finding on mammogram which is almost pathognomonic for DCIS
Micro-calcification
Where does DCIS typically arise from
Arises in TDLU
What are the two types of Lobular in situ neoplasia and what is the difference between them
Atypical Lobular Hyperplasia (ALH) <50% of lobule involved
Lobular Carcinoma in situ (LCIS) >50% of lobule involved
What are the two surgical options available for someone with breast cancer
Wide Local Excision + radiotherapy
Radical mastectomy + radiotherapy
In general how small must the breast cancer be in order to be excised by Wide Local Excision instead of mastectomy
<4cm
Tumours can be shrank prior to surgery using drugs; what is this process called
Neo-Adjuvant chemotherapy
Which anti-oestrogen therapies can be given for an ER positive tumour
Tamoxifen
Aromatase inhibitors(Letrozole)
GnRH antagonists - (Goserilin)
What is the main risk of using tamoxifen and how does this risk arise
Endometrial cancer
tamoxifen acts as an anti-oestrogen agent in breast tissue but like an oestrogen in the uterus
What kind of drug is Trastuzamab and how can it be used in breast cancer therapy
Monoclonal antibody against HER2 (use in HER 2 + tumours)
Also called herceptin
