Breasts Flashcards by Billie jo stephen

what is the blood supply of the breast?

arterial and venous;

branches of internal thoracic, intercostal and axillary arteries

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what is the lymph drainage of the breast?

medial quadrants: pectoral group of lymph nodes or the other breast
lateral quadrant: axillary group of lymph nodes (75% of lymph drainage)

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what is the nerve supply of the breast?

anterior and lateral branches of the intercostal nerves

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from what ribs does the breast extend?

2nd/3rd to the 6th rib

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what fascia does the breast lie on?

2/3rds pectoral fascia of pectorals muscle

1/3rd fascia from serrates anterior

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what cell type lines the alveoli?

luminal epithelial cells + myoepithelial cells

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what cell type lines the ducts?

luminal epithelial cells + myoepthelial cells

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what is the main change in the breast tissue in post menopausal women?

fatty change from glandular tissue

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what type of tissue is the nipple made of?

collagenous dense connective tissue

smooth muscle and elastic fibres

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what type of tissue is found in the septa (interlobular) ?

dense fibrocollangenous

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what type of tissue is the intralobular tissue?

loose fibrocollagenous

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what is the condition called if someone has no nipple(s) or breast(s) ?

breast: amastia
nipple: athelia

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what is colostrum ?

protein and antibody rich milk available a few days after birth (first milk produced by the mother)

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name 4 benign tumours of the breast.

duct papillomas
fibroadenomas
adenomas
connective tissue tumours

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what is pagets disease of the nipple ?

erosion of the nipple resembling eczema associated with ductal or invasive carcinoma

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what is pagets disease of the nipple associated with?

ductal or invasive carcinoma

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what differs carcinoma in situ from invasive carcinoma?

CIS doesn’t form a palpable tumour
they are typically less than 2 cm
they have not penetrated the basement membrane

what are the presentations of breast cancer?

accidental on screening
lump - hard, immobile, tethered to the skin, painless 
skin changes
changes in breast size / shape 
peau d'orange 
eczema of the nipple (pages)
nipple discharge 
unilateral mastalgia 
lymphadenopathy

what investigations would you carry out if you suspected breast cancer?

Mammogram
FNA cytology
Fine needle core biopsy

what investigations would you carry out in order to stage the breast cancer ?

FBC and U&amp;E's
LFT (liver mets)
Ca (bone mets)
P02 (lung mets)
CXR (invasion to surrounding structures + lung mets)

what staging classification is used for breast cancer?

TNM staging

what is defined as T1-T4 breast cancer?

T1 < 2cm
T2 2-5cm
T3 > 5cm
T4 - involving/invading other structures

what are the treatment options for breast cancer?

surgery: masectomy or wide local excision
chemotherapy - systemic recurrence
radiotherapy - local recurrence
hormone therapy - HER2 ve+ & ER/PR ve+

in what patients can tratzumab be used for treatment and how?

HER 2 positive

monoclonal antibody against HER 2

in what patients can tamoxifen be used for treatment and how?

ER ve+ | blocks the oestrogen receptor

what is the mode of action of tamoxifen and arimidex?

tamoxifen - blocks oestrogen receptor | arimidex (aromatase inhibitor) - inhibits ER synthesis

name 2 aromatase inhibitors.

arimidex | letrozole

what factors increase risk of recurrence from breast cancer?

``` tumour size nodal involvement steroid receptor status (ER/PR negative) HER 2 positive lymphovascular invasion ```

what are the treatment options if the breast cancer has spread to the axilla?

axillary node clearance surgery or radiotherapy

what is the name of the node which the cancer spreads to first?

sentinel lymph node

what treatment is given if the sentinel lymph node biopsy is negative?

no treatment to the axilla

what are the complications of axillary treatment?

``` sensory disturbance (intercostobrachial nerve) decreased ROM of shoulder joint lymphedema vascular damage nerve damage radiation induced sarcoma ```

when are women screened for breast cancer?

every 3 years between the age of 50-70 years

what follow up protocol is used for people with previous breast cancer?

mammogram every year for 3-10 years

what are the risk factors for breast cancer?

``` FHx breast cancer - BRCA 1 & 2, PTEN, TP53 previous history of breast cancer increasing age late age of 1st pregnancy / nuliparity early menarche / late menopause radiation (treatment for Hodgkin's lymphoma) hormone involvement lack of exercise obesity smoking ```

what features on mammogram are suggestive of breast cancer?

microcalcifications | soft tissue opacification

what is the survival rate for cancer?

5 year survival 65%

what factor is the main determinant of estimated survival?

nodal involvement

what are the modes of spread for breast cancer?

local lymphatic blood

where does breast cancer spread?

local - opposite breast, surrounding structures i.e. chest wall, skin, pectoral muscles lymphatic - axillary, internal mammary, pectoral blood - liver, lung, brain, bone

what 2 main pathological types of breast cancer?

ductal cell | lobular

why may a core biopsy be needed instead of just doing a FNA cytology?

FNA only takes cells but the core biopsy is required to determine if there is any invasion, if it is ER/PR/HER 2 positive as it is assessing the tissue instead of just cells