Lecture 7.2 - Breasts and Regional Lymphatic System

Question 1

What is the tail of spence?

Answer 1

A palpable triangle of breast tissue that extends towards the axillary region

Question 2

Where does 75% of lymphatic fluid in the breast drain to?

Answer 2

Axillary nodes

Question 3

Which four lymph nodes drain the breasts?

Answer 3

1. Lateral axilla
2. Central axilla
3. Subscapular (Posterior axilla)
4. Pectoral (Anterior axilla)

Question 4

How do the breasts of older females change with age?

Answer 4

Estrogen and progesterone decrease after menopause –> Glandular tissue atrophy + decreased axilla hair.

Atrophy of fat leads to a decrease in breast size and elasticity. An overall decrease in breast size leads to more prominent inner structures and more palpable lactiferous ducts.

Question 5

Which two genes predispose a person to breast cancer?

Answer 5

BRCA1
BRCA2

Question 6

What are urgent findings in a breast examination?

Answer 6

Unexplained discharge or bleeding from nipples
open sores, ulceration, and non-traumatic lesions
Breast mass in patient with previous breast cancer

Question 7

What is mastalgia?

Answer 7

Breast pain

Question 8

What is galactorrhea and when is it normal?

Answer 8

Discharge (milk) from nipples - normal only if pregnant or breastfeeding

Question 9

In what positions should breast retraction be inspected for in?

Answer 9

1. With arms above head
2. With hands on hips
3. With palms pressed together
4. Leaning forward (used only with larger chested women)

Question 10

On what line could a supernumerary nipple be found?

Answer 10

Anywhere along the embryonic milk line

Question 11

How should the axilla be palpated during a breast examination?

Answer 11

With opposite hand, following anterior, posterior, and mid-axillary line, and then down the underside of the arm.

Feel for any abnormalities or masses

Question 12

What is the best tool for risk assessment of breast cancer?

Answer 12

Asking the right history questions

Question 13

What are the characteristics of a breast cancer mass?

Answer 13

Solitary, unilateral, nontender mass.
Mass should be solid, hard, dense, and fixed to underlying tissues or skin. It will have irregular borders and be poorly delineated.

advanced changes include firm axillary nodes, dimpling, nipple retraction, poor skin retraction with movement, elevation, and discharge.