breast questions Flashcards
What are the 6 borders of the breast?
Superior=clavical Lateral=latissmis dorsi Medial=sternum Inferior=rectus abdominus Anterior=subcutaneous fat Posterior=Pec major
What are Cooper’s Ligaments?
White suspensory ligaments of the breast
Name of the breast suspensory ligaments?
Cooper’s Ligaments
Where and what is areola?
Small circular area of pigmented skin surrounding the nipple
Name of the opening of the areola?
Nipple
Which lymph nodes receive 3/4 of the breast lymph?
Axillary
4 different types of breast cancer?
- DCIS
- Ductal invasive carcinoma
- LCIS (lobular carcinoma in situ)
- Lobular invasive carcinoma
What does DCIS stand for?
Ductal Carcinoma in situ
What does DCIS mean about the carcinoma?
It has not invaded past the basement membrane
Which lymph node can breast carcinoma easily spread to?
Axillary lymph nodes
Where are Level I lymph nodes
Inferior lateral to pec minor muscle
Where are Level II lymph nodes?
Deep to the pec minor
Where are Level III lymph nodes?
Superior-medial the pec minor muscle
5 types of mastectomies?
- Radical mastectomy
- Modified radical
- Simple mastectomy mastectomy
- Subcutaneous mastectomy
- Lumpectomy
What is removed in a Modified Radical Mastectomy?
Simple mastectomy plus removal of Lymph Noes level 1 and 2
What is removed in a Simple Mastectomy?
Skin, breast tissue, subcutaneous fat, and cooper’s ligaments
Describe Radical Mastectomy (hint: 3 parts)
- Simple mastectomy
- Removal of pac major and minor
- Removal of Lymph Nodes levels I, II, and III
Who gets a Subcutaneous Mastectomy?
Males
3 risks of PT with BRCA gene?
- Breast cancer
- Ovarian cancer
- Recurrence
Normally perform a lymphnode biopsy after mastectomy for DCIS?
No. In situ and not invaded past basement membrane.
What is Sentinel Node?
First node where lymph drains to
Purpose of Sentinel Node biopsy?
Staging of carcinoma
What happens to mapping of the lymphatic drainage after simple mastectomy?
Mapping destroyed so sentinel node biopsy not useful
Is there a mass with DCIS?
No
How are lymph nodes detected? (hint: 2 things)
- Technecium-99
2. Isosulfan blue dye or methylene blue due
Where is isosulfan blue dye injected?
Subareolar/paraareolar area
Why is isosulfan blue injecte into the subareolar/paraareolar area?
Where lymph drainage follows and stains the lymphatic map
How does Tc-99 detect lymph nodes?
Probe detecting concentration of Tc-99 will emit number around 20,000
How long to hold Tc-99 probe on LN?
10 seconds
What does Tc-99 emit that the probe picks up?
Gamma rays
How to determine which lymph nodes to take out?
All LNs that have 10% of highest number (highest 20,000 take nodes 2000)
How many LNs normally removed?
About 20
Name of pathology quick test for presence of cancer in LN?
Touch Prep. Done during surgery.
What to do it Touch Prep is positive for cancer?
Remove all axillary LNs
2 main complications of complete axillary LN removal?
- Lympheema
2. Brachial plexus neuropathy
Why palpate axilla after sentinel node biopsy?
Find nodes not detected by probe
Why would LNs not be detected by probe?
Brease tumor can cause lymphatic blockage and prevent Tc-99 and blue dye from draining into entire breast
Med class of breast cancer meds?
Estrogen receptors
Which estrogen receptor is better for younger women?
Tamoxifen
Which estrogen receptor is better for older women?
Raloxifen
What type of inhibitors are preferred in older women?
Aromatase inhibitors
Lumpectomy aka?
Breast Conserving Therapy
2 CIs to Breast Conserving Therapy?
- Multicentric disease (cancer located in more than 1 quarant, diffuse microcalcification on mammogram)
- Prior radiation (due to prior tissue damage)
5 relative CIs to Breast Conserving Therapy?
- CREST syndrome
- SLE
- Preggers
- Large tumor in relation to breast
- Persistent + margins s/p re-excision
