GS1 Structure of the Breast

Question 1

Breast cancer spreads by?

Answer 1

Breast cancer spreads by:

a) Direct invasion e.g. to the skin, to pectoralis major or minor or to serratus anterior.
b) Lymphatic system to axillary and supraclavicular nodes
c) Blood (haematogenic) via intercostal veins to the vertebral venous plexus to ventral bodies

Question 2

Lymph drainage of nipple, areola and breast lobules?

Answer 2

To sub areolar lymphatic plexus

Question 3

What are the main axillary nodes?

Answer 3

Pectoral (ant)
Humeral (lat)
Subscapular (post)
Central
Apical

Question 4

Middle breast lymph drainage?

Answer 4

To axillary nodes but also to..

To parasternal nodes

Question 5

Inferior breast lymph drainage?

Answer 5

To axillary nodes but also to..

to abdominal nodes

Question 6

What are the different levels of the apical nodes?

Answer 6

Level I (13 nodes): Lies lateral to pectoralis minor
Level II (5 nodes): Lie posterior  to pectoralis minor
Level III (2 nodes): Lie medial to pectoralis minor

Question 7

What are the main methods to investigate metastatic spread of tumour to axillary nodes?

Answer 7

Axillary clearance
Axillary node sampling
Sentinel lymph node biopsy (SLNB)

Question 8

What is axillary clearance?

Answer 8

Removal of all axillary nodes followed by pathological examination of removed nodes.
Complications: Shoulder movement difficulties due to nerve damage, infection, numbness and lymphoedema

Question 9

What is axillary node sampling?

Answer 9

Removal of four level I nodes from the lower axilla.

If tumour is found, the followed by axillary clearance or radiotherapy.

Question 10

What is SLNB?

Answer 10

Sentinel lymph node biopsy
Uses a radioactive tracer (technetium-99m) and a blue dye. Prior to surgery, breast tissue around a tumour is injected with a small amount of radioactive fluid which migrates to the sentinel node. During surgery a blue dye is injected into breast tissue close to the tumour. This will track to the sentinel node.
Sentinel node is detected using a radiation detection probe.

Question 11

Common sites of metastases of breast cancer?

Answer 11

Bones, lungs and liver

also to brain and adrenals

Question 12

Most common breast cancers?

Answer 12

Originate in epithelial tissue.
Adenocarcinomas- Carcinomas as they orginate from epithelial tissues, adeno because of glandular components.
Most originate in terminal ducts , forms DCIS and LCIS.

Question 13

NHS breast screening programme provides…

Answer 13

Free breast screening every 3 years for all women in the UK aged 50+.

Question 14

What are the boundaries of the base of the breast?

Answer 14

2nd to 6th ribs

Lateral border of the sternum to midaxillary line

Question 15

What muscle underlie the base of the breast?

Answer 15

Pec major

Serratus anterior

Question 16

Which group of axillary nodes are most commonly involved in metastatic spread of breast cancer?

Answer 16

Anterior

Question 17

What hormone is involved in the development of the breast at puberty?

Answer 17

Oestrogen produced by ovarian follicles

Question 18

Explain the arrangement of glandular tissue and how the ducts combine to drain the gland and deliver milk to the baby.

Answer 18

15– 20 lobesare arranged radialy around the nipple.Each lobe isdrained by a lactiferou sdu ct w hich opensdirectly on to the su rface ofthe nipple.

Question 19

Which hormones are involved in milk secretion and delivery to the baby?

Answer 19

Oxytocin: From post pituitary, stimulated by the suckling of the baby. Causes the milk to be ejected from the lactiferous ducts
Prolactin: From ant pituitary stimulates the secretion of milk by the glandular tissue of the breast

Question 20

Where is the breast is cancer most likely to develop?

Answer 20

Upper, outer quadrant