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My own copies of absite stuff > breast questions > Flashcards

breast questions Flashcards

1
Q

Levels of axillary LN

A

1- lateral to pec minor
2 - underneath pec minor
3 - medial to pec minor

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2
Q

Important nerves

A 
1 - long thoracic - 
2 - Intercostal brachial nerve **** MC 
3 - Thoracodorsal nerve 
4 - medial pectoral nerve -  
5 - lateral pectoral nerve
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3
Q

Intercostal brachial nerve

A

provides sensation to medial arm

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4
Q

Thoracodorsal nerve

A

lattisimus dorsi - weak arm adduction

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5
Q

medial pectoral nerve

A

pec major and minor (MM, cap M)

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6
Q

lateral pectoral nerve

A

pec minor only

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7
Q

Blood supply

A 
Intermal mammary


Intercostal 

Thoracoacromial 

Lateral thoracic artery 

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8
Q

BiRADs

A 
1 - normal — routine screening 
2 - benign — same as above 
3 - decrease interval to 6 months to repeat imaging 
4 - bx and further tissue analysis 
5 - same as above 
6 - confirmed diagnosis 
0 - not enough info
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9
Q

Nipple discharge

A

3 % later diagnosis with cancer if < 40 year old
> 60, 33% Cancer risk
— bloody, spontaneous discharge, persistent after a week, unilateral
— mammography, ductal fluid cytology, duct excision to look at underlying pathology

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10
Q

MC cause of bloody discharge

A

Intraductal papilloma

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11
Q

If cyst on US

A

Bloody or recurrent, send for cytology

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12
Q

Phyllodes tumor

A

Malignant potential, wide local excision with 1 cm margin. If > 5 mitosis per hpf, higher risk, rarely goes to node. So may not need LN excision

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13
Q

Radial scar

A

Sclerosis proliferations - mammography appearance can show calcifications, only small increased risk of cancer, need to bx to rule out

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14
Q

MC organism in abscess

A

Gram + staph

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15
Q

Hereditary disorder increase risk

A 
BRACA 1/2- 10-20 fold, 30-60% chance of having this by age 60 
Le freumani - p53 
Cowden syndrome -p10 
Putzjieger-stk11 
Chd1 - gastric cancer
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16
Q

Gail model

A 
Women risk of developing breast cancer within 5 year and life time 
age 

Age at menarche 

Time of first child born 

Family hx of breast cancer 

Number fo breast bx 

Number of bx showing atypical hyperplasia 

Race and ethnicity 

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17
Q

DCIS tx

A

Lumpectomy with radiation and hormonal therapy if hormone receptor +, tamoxifen for 5 years; if post menopause aromatase inhibitors

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18
Q

Mastectomy

A

Multi quadrant disease, large lesion, contraindication to pst op radiation need sentinel LN bx, to 25% may show invasive pathology

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19
Q

Margins for DCIS

A

1-2 mm margin spreads along the basement membrane can be contiguous

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20
Q

Invasive ductal margins

A

Only need negative ink

21
Q

Canceling for post radiation

A

Radiation in breast conservation - decreased risk of recurrence by 50%, but no difference than mastectomy in overall survival
Mastectomy

Overall survival is the same, there is increased risk of recurrence in breast conservation, adding radiation decreases risk by 50%

22
Q

LCIS

A

Not a premalignant lesion, but it increases risk of cancer in both breast, need excisions bx

23
Q

Tx LCIS

A

Wire localized excision to rule out
+ margin: surgically complete, don’t need negative margins
— risk of developing ductal cancer half percent risk increased per year, but could consider hormonal therapy

24
Q

Invasive cancer - staging

A 
T0 
T1: 0-2 cm 
T2: 2-5 
T3: >5 
T4 Invasion of wall- pec major is not considered chest wall

N1:1-3
N2: 4-9
N3: 10 or supra or infraclavicular staging

M1: distal mets

25
Q

Staging

A

Stage 1: T1N0M0: - small tumor and no nodes
Stage 2: T3N0, T2N1 - Larger tumor or minor nodal involvement
Stage 3a- T4N0, T3N2 - local invasion or more modes
Stage 3b-T3N2
Stage 3c - clavicular nodes, any T but N3 disease
Stage 4: distal mets

26
Q

Treatment 1-2 stage

A

Surgery and adjuvant chemo and rads- breast conservation therapy, whole breast radiation survival equivalent of mastectomy
Contradiction: radiation after, if no candidates pregnant multi centric disease, + pathologic margins after re-excisions, previous radiation or active connective tissue or greater than 5 cm

27
Q

3a

A

Locally advanced operatively tumor, surgery first or neoadjuvant for downstaging

28
Q

3b/3c

A

Locally advance inoperative,y neadjuvant first and surgery if they respond

29
Q

4

A

Primary chemo

30
Q

Surgical axillary staging

A

Invasive tumor, need SLN bx .

31
Q

z11 trial

A

Comparing patients with small tumors and small amount axillary disease to wether they need axillary dissection or radiation can treat axilla adequate.
Patients > 18 age, < 5 cm (T2 or less), < 3 + LN (N1) breast conservation therapy w/ whole breast radiation. RTC.
1 group: if + SLN, got axillary dissection (morbid procedure)
2 group: whole breast radiation which treats the axilla
— no difference in local recurrence, overall survival 6.3 years

32
Q

axillary dissection

A

clinically + nodes confirmed by FNA or core needle bx, - level 1-2 for breast cancer . Or SLN that were not identified

33
Q

Chemo

A

> 1 cm , + node, tripple neg nodes (ER,PR,HER2)
— TAC (taximes, peripheral neuropathy), adreomycin (doxorubicin ,cardiomyopathy cyclophosphamide, hemorrhagic cystitis give MESNA)

34
Q

Neoadjuvant for

A

Locally advanced, N2/N3, too large relative to rest of breast

35
Q

Radiotherapy

A

Whole breast decreased local recurrence and survival , give after chemo. If LN>4, infraclavicular, supraclavicular radaiotn to inter

36
Q

85-90 yo cancer breast

A

If > 70 , negative margins after lumpectomy ER+TN1, may not need radiation and just hormonal therapy

37
Q

Radiation after mastectomy

A

If + axillary LN, tumors > 5cm ,+ margins

38
Q

All positives

A

5 years of tamoxifen

39
Q

HER 2

A

Transtuzumab for HER 2 for 1 year

40
Q

Inflammatory breast cancer r

A

Rapid diffuse involvement of entire breast, skin changes from lymphatic invasion T4, at least stage 3 b

41
Q

Pagets disease

A

Scaling and ulceration of nipple, concerning for malignancy. HER2+, HR -,

42
Q

Breast cancer in pregnancy

A

1st- modified radical mastectomy because can’t undergo radiation
2nd - can do breast conservation, SLN and modified isotope dosing , chemo can be given, after delivery will undergo radiation

43
Q

Dominant breast mass next

A

Bilateral mammography and Us depending on age

44
Q

MC site mets

A

Lung, brain, bone, liver

45
Q

.1mm lesion of isolated cell deposits

A

Not considered mets

46
Q

BRACA 1/2

A

Breast and ovarian , high in 1 40%,

47
Q

Tamoxifen risks

A

Thromboembolism, uterine Cancer

48
Q

Tender palpable cord

A

Superficial thrombophlebitis - given NSAIDs, mammography and all the other screening.

49
Q

Stuart treves syndrome

A

Lesion many years after axillary dissection - lyphangiosarcoma

My own copies of absite stuff (12 decks)

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