Breasts Flashcards
what is the blood supply of the breast?
arterial and venous;
branches of internal thoracic, intercostal and axillary arteries
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)
what is the nerve supply of the breast?
anterior and lateral branches of the intercostal nerves
from what ribs does the breast extend?
2nd/3rd to the 6th rib
what fascia does the breast lie on?
2/3rds pectoral fascia of pectorals muscle
1/3rd fascia from serrates anterior
what cell type lines the alveoli?
luminal epithelial cells + myoepithelial cells
what cell type lines the ducts?
luminal epithelial cells + myoepthelial cells
what is the main change in the breast tissue in post menopausal women?
fatty change from glandular tissue
what type of tissue is the nipple made of?
collagenous dense connective tissue
smooth muscle and elastic fibres
what type of tissue is found in the septa (interlobular) ?
dense fibrocollangenous
what type of tissue is the intralobular tissue?
loose fibrocollagenous
what is the condition called if someone has no nipple(s) or breast(s) ?
breast: amastia
nipple: athelia
what is colostrum ?
protein and antibody rich milk available a few days after birth (first milk produced by the mother)
name 4 benign tumours of the breast.
duct papillomas
fibroadenomas
adenomas
connective tissue tumours
what is pagets disease of the nipple ?
erosion of the nipple resembling eczema associated with ductal or invasive carcinoma
what is pagets disease of the nipple associated with?
ductal or invasive carcinoma
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&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
