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Reproductive system > Breasts > Flashcards

Breasts Flashcards

1
Q

what is the blood supply of the breast?

A

arterial and venous;

branches of internal thoracic, intercostal and axillary arteries

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2
Q

what is the lymph drainage of the breast?

A

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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3
Q

what is the nerve supply of the breast?

A

anterior and lateral branches of the intercostal nerves

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4
Q

from what ribs does the breast extend?

A

2nd/3rd to the 6th rib

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5
Q

what fascia does the breast lie on?

A

2/3rds pectoral fascia of pectorals muscle

1/3rd fascia from serrates anterior

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6
Q

what cell type lines the alveoli?

A

luminal epithelial cells + myoepithelial cells

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7
Q

what cell type lines the ducts?

A

luminal epithelial cells + myoepthelial cells

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8
Q

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

A

fatty change from glandular tissue

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9
Q

what type of tissue is the nipple made of?

A

collagenous dense connective tissue

smooth muscle and elastic fibres

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10
Q

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

A

dense fibrocollangenous

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11
Q

what type of tissue is the intralobular tissue?

A

loose fibrocollagenous

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12
Q

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

A

breast: amastia
nipple: athelia

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13
Q

what is colostrum ?

A

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

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14
Q

name 4 benign tumours of the breast.

A

duct papillomas
fibroadenomas
adenomas
connective tissue tumours

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15
Q

what is pagets disease of the nipple ?

A

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

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16
Q

what is pagets disease of the nipple associated with?

A

ductal or invasive carcinoma

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17
Q

what differs carcinoma in situ from invasive carcinoma?

A

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

18
Q

what are the presentations of breast cancer?

A 
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
19
Q

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

A

Mammogram
FNA cytology
Fine needle core biopsy

20
Q

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

A 
FBC and U&E's
LFT (liver mets)
Ca (bone mets)
P02 (lung mets)
CXR (invasion to surrounding structures + lung mets)
21
Q

what staging classification is used for breast cancer?

A

TNM staging

22
Q

what is defined as T1-T4 breast cancer?

A

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

23
Q

what are the treatment options for breast cancer?

A

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

24
Q

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

A

HER 2 positive

monoclonal antibody against HER 2

25
Q

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

A

ER ve+

blocks the oestrogen receptor

26
Q

what is the mode of action of tamoxifen and arimidex?

A

tamoxifen - blocks oestrogen receptor

arimidex (aromatase inhibitor) - inhibits ER synthesis

27
Q

name 2 aromatase inhibitors.

A

arimidex

letrozole

28
Q

what factors increase risk of recurrence from breast cancer?

A 
tumour size
nodal involvement
steroid receptor status (ER/PR negative)
HER 2 positive 
lymphovascular invasion
29
Q

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

A

axillary node clearance surgery
or
radiotherapy

30
Q

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

A

sentinel lymph node

31
Q

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

A

no treatment to the axilla

32
Q

what are the complications of axillary treatment?

A 
sensory disturbance (intercostobrachial nerve)
decreased ROM of shoulder joint
lymphedema 
vascular damage 
nerve damage 
radiation induced sarcoma
33
Q

when are women screened for breast cancer?

A

every 3 years between the age of 50-70 years

34
Q

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

A

mammogram every year for 3-10 years

35
Q

what are the risk factors for breast cancer?

A 
FHx breast cancer
- BRCA 1 &amp; 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
36
Q

what features on mammogram are suggestive of breast cancer?

A

microcalcifications

soft tissue opacification

37
Q

what is the survival rate for cancer?

A

5 year survival 65%

38
Q

what factor is the main determinant of estimated survival?

A

nodal involvement

39
Q

what are the modes of spread for breast cancer?

A

local
lymphatic
blood

40
Q

where does breast cancer spread?

A

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

41
Q

what 2 main pathological types of breast cancer?

A

ductal cell

lobular

42
Q

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

A

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

Reproductive system (31 decks)

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