Chapter 36 WS Flashcards
how many lymph nodes are in each axilla
10 - 38
_______ are located caudal and lateral of the pectoralis minor and are the most superficial lymph nodes in the axilla. They often represent the first station of drainage from breast
level I lymph nodes
_________ are located beneath the muscle.
level II lymph nodes
___________ are located cranial and medial to the pectoralis minor.
Level III lymph nodes
infraclavicular lymph nodes
At what level nodes is the sentinel node most commonly found?
Levels I and II
List a minimum of 4 physical signs of a locally advanced breast cancer.
a. Enlarged or matted axillary or supraclavicular lymph nodes
b. Abnormal breast contours
c. Nipple discharge or retraction
d. Palpable mass with or without fixation to the chest wall or involvement of the skin
e. In addition, skin findings, sucah as erythema, thickening, peau d’orange, and ulcerations.
What are the two views used in a routine screening mammogram?
Craniocaudal and mediolateral oblique
What is the difference between a screening mammogram and a diagnostic mammogram?
A screening mammogram is performed in a patient with no clinical symptoms of breast cancer; a diagnostic mammogram is performed in a patient who presents with clinical suspicion.
Which one of these types of breast cancer has a higher frequency of bilateral breast involvement (Invasive lobular carcinomas or Invasive ductal carcinoma
invasive lobular carcinomas
Invasive lobular carcinomas are mostly __________________. (ER +or ER-)
ER +
____________________ (Black Women, White women) are at higher risk for developing triple negative breast cancer than _______________________ (black women, white women)
black women
white women
List three contraindications to breast-conserving surgery
a. Multicentric disease with 2 or more primary tumors in separate quadrants of the breast such that they cannot be encompassed in a single excision.
b. Diffuse malignant microcalcifications on mammography
c. Persistent positive resection margins after multiple attempts of re-excision
List three indications for mastectomy for patients.
- Patients who are not candidates for breast-conserving therapy
- Patients who prefer mastectomy
- For prophylactic purposes in extremely high-risk populations
What is removed in a Radical mastectomy?
the breast with overlying skin, the pectoralis muscles, and all the axillary lymph nodes
What is removed in a modified radical mastectomy
the breast and the underlying fascia together with removal of the level I and II axillary lymph nodes.
what is removed in a total mastectomy
The entire breast without removal of level I and II lymph nodes
Eighty-five percent of lymphatic drainage from the breast goes to which lymph nodes
axillary lymph nodes
What level nodes are removed in an axillary dissection?
Levels I and II
advantages of immediate breast reconstruction
The streamline of surgical procedures (mastectomy and reconstructive surgery), which decreases the overall surgical time and also provides benefits in preserving the normal body image in women.
disadvantages of immediate breast reconstruction
The potential heightened post-reconstruction complications from adjuvant chemotherapy and radiation therapy.
advantages of delayed breast reconstruction
Allows for the completion of adjuvant treatments, and therefore may limit the immediate post-reconstruction complications.
disadvantages of delayed breast reconstruction
Limited reconstructive options because of tissue fibrosis after radiation therapy or chemotherapy
What endocrine therapy drug is given to premenopausal women after chemotherapy who have ER+ breast cancer? And how long will this drug be taken?
tamoxifen; 5 years
What are the advantages of treating the breast with the patient in the prone position
Minimizes lung and/or heart tissue in the treatment field as the breast falls away from the chest wall.
what patients should not be treated in the prone position?
Women with small breast or with breast implants. If the chest wall needs to be included in the treatment field. If regional lymph nodes need to be treated.
During simulation of the whole breast, the radiation oncologist may place wire at the borders of the possible treatment field. Indicate where these wires are to be placed.
medially at the mid-sternum, laterally at the level of mid-axilla, superiorly at the level of clavicular head, and inferiorly approximately 2 cm below the inframammary fold.
What are the two most important critical structures to consider in the design of breast radiation treatments?
lung and heart
DIBH is used when treating the _______________ (left or right) breast in order to minimize dose to which critical structure.
left; heart
Whole breast tangent field border: superior, at the most cephalad of the following points:
- superior extent of the palpable breast tissue
- edge of the head of the clavicle
Whole breast tangent field border: inferior
- 2 cm below the inframammary fold or 2 cm below lower edge of the breast
Whole breast tangent field border: medial
- at midline of patinet, as determined with palpation of suprasternal notch and xiphoid process
- exclusion of contralateral breast in the treatmnet field is important
Whole breast tangent field border: lateral
- midaxillary line or 2 cm beyond breast tissue
Whole breast tangent field border: anterior
- flash to include entire breast
Whole breast tangent field border: posterior
- include the chest wall; this often may include 1 to 2 cm posterior to edge of the ribcage
What is the relationship between estrogen and breast cancer?
Increased estrogen levels increase the risk of breast cancer.
The removal of the entire lesion.
excisional biopsy
Similar to a fine needle biopsy but using a larger gauge needle to aspirate a core of tissue from the breast mass. The pathologist then examines the tissue histologically. It offers a more definitive histologic diagnosis compared with Fine needle biopsy
core needle biopsy
Using a small-gauge needle attached to a syringe where blood or tissue is collected from a suspicious tissue in the breast. This material is prepared on slides for cytologic evaluation. Can also be used with ultrasound guidance to confirm the disease status in the axilla
fine needle biopsy
Explain what DCIS is:
Ductal carcinoma in situ.
It is confined to the preexisting duct system of the breast without penetration of the basement membrane and invasion of surrounding tissues on microscopic examination.
What are the two most common types of invasive breast cancers?
Invasive ductal carcinoma (also called infiltrating ductal carcinoma) and Invasive lobular carcinoma
What age group has the worst prognosis for breast cancer?
younger age (under 35 in age)
What are triple-negative breast cancers?
Breast cancers that are ER negative(estrogen receptor), PR negative (Progesterone receptor), and HER2 negative (human epidermal growth factor receptor 2). Triple negative breast cancers are more aggressive than breast cancers with positive receptors because there is a lack of targeted treatment. For example, if the cancer grows in the presence of estrogen, then the cancer can be targeted with anti- estrogen treatment therapy.
Explain what a sentinel node biopsy is and how is it used in the diagnoses of breast cancer.
A blue dye, radioactive substance is injected near the tumor site. The tracer enters the lymphatic channels and flows to the lymph nodes that are first in line to receive the drainage from the tumor. The node is then more easily identified by the surgeon so it can be removed and examined for cancer cells. If there are no cancer cells present, an axillary lymph node dissection may not be necessary. For patients with 3 or more nodes, axillary dissection is generally recommended.
Explain what BRCA1 and BRCA2 are and their relationship to Breast cancer
BRCA1 and BRCA2 are tumor suppresser genes that repair damaged DNA to help prevent malignant tumors. Sometimes these genes become mutated and do not function properly. Gene mutations of the BRCA1 and BRCA2 are inherited. Women with these mutations are at a very high risk of development of breast cancer. Risk is 60% by age 70 if carrier of the BRCA1 gene mutation and 55% risk if carrier of BRCA2 gene mutation. Also increase risk for men.
In patients with BRCA1 and BRCA2 mutations, Prophylactic mastectomies reduce the risk of development of breast cancer by __________ percent.
more than 90%
