Mammary glands - vasculature, nerves, lymph, breast cancer

Question 1

what is the arterial supply to the medial aspect of the breast via?

Answer 1

via the internal thoracic artery, a branch of the subclavian artery

Question 2

what is the internal thoracic artery a branch of?

Answer 2

the subclavian artery

Question 3

where does the lateral part of the breast receive blood from?

Answer 3

4 vessels:
Lateral thoracic and thoracoacromial branches
Lateral mammary branches
Mammary branch

Question 4

what do the veins of the breast correspond with?

Answer 4

The veins of the breast correspond with the arteries

Question 5

where do the veins of the breast drain into?

Answer 5

the axillary and internal thoracic veins

Question 6

where does the Lateral thoracic and thoracoacromial branches originate from?

Answer 6

originate from the axillary artery

Question 7

where does the lateral mammary branches originate from?

Answer 7

originate from the posterior intercostal arteries (derived from the aorta)

Question 8

what do the lateral mammary branches supply?

Answer 8

They supply the lateral aspect of the breast in the 2nd 3rd and 4th intercostal spaces

Question 9

where does the mammary branch originate from?

Answer 9

the anterior intercostal artery

Question 10

why is lymphatic drainage of the breasts of great clinical importance?

Answer 10

due to its role in the metastasis of breast cancer cells

Question 11

how many groups of lymph nodes receive lymph from breast tissue are what are they?

Answer 11

three groups:
the axillary nodes (75%),
parasternal nodes (20%),
posterior intercostal nodes (5%)

Question 12

does the skin of the breast receive lymphatic drainage?

Answer 12

YES

Question 13

where does the skin drain into?

Answer 13

drains to the axillary, inferior deep cervical and infraclavicular nodes

Question 14

where does the nipple and areola drain into?

Answer 14

drains to the subareolar lymphatic plexus

Question 15

what is the breast innervated by?

Answer 15

the anterior and lateral cutaneous branches of the 4th to 6th intercostal nerves

Question 16

what do the the anterior and lateral cutaneous branches of the 4th to 6th intercostal nerves contain?

Answer 16

These nerves contain both sensory and autonomic nerve fibres

Question 17

what is the function of the autonomic fibres of the anterior and lateral cutaneous branches of the 4th-6th intercostal nerves?

Answer 17

the autonomic fibres regulate smooth muscle and blood vessel tone

Question 18

are the nerves involved in the control of secretion of milk?

Answer 18

NO

Question 19

what is the secretion of milk regulated by?

Answer 19

the hormone prolactin

Question 20

where is the hormone prolactin secreted from?

Answer 20

anterior pituitary gland

Question 21

which type of cancer is the most common to be diagnosed in the UK?

Answer 21

Breast cancer

Question 22

what is the death rate of breast cancer like?

Answer 22

After lung cancer it has the second highest death rate

Question 23

which gender is breast cancer more common in?

Answer 23

women

Question 24

what are common presentations associated with breast cancer due to?

Answer 24

due to blockages of the lymphatic drainage - excess lymph builds up in the subcutaneous tissue

Question 25

what happens if there is excess lymph build up in subcutaneous tissue?

Answer 25

resulting in clinical features such as nipple deviation and retraction, and prominent skin between small dimpled pores (peau d’orange)

Question 26

what are larger dimples generally cause by?

Answer 26

cancerous invasions and fibrosis

Question 27

what does cancerous invasions and fibrosis lead to?

Answer 27

This causes traction of the suspensory ligaments, causing them to shorten

Question 28

where does metastasis of breast cancer commonly occur through?

Answer 28

the lymph nodes

Question 29

which lymph nodes are most likely to be involved?

Answer 29

the axillary lymph nodes

Question 30

what happens to the axillary lymph nodes?

Answer 30

They become stony hard and fixed

Question 31

following invasion of the lymph nodes, where can the cancer spread?

Answer 31

to distant places such as the liver, lungs, bones and ovary

Question 32

how to assess a suspected breast cancer?

Answer 32

a triple assessment is carried out

Question 33

what does a triple assessment involve?

Answer 33

involves clinical examination, imaging using a mammogram and ultrasound scan and finally a biopsy

Question 34

which system is used for breast cancer staging?

Answer 34

the I-IV system or the Tumour Node Metastasis (TNM) system

Question 35

what is the recommended treatment option for breast cancer?

Answer 35

Surgical treatment with adjuvant radiotherapy is the recommended treatment option

Question 36

what is the purpose of the surgical treatment?

Answer 36

The operation is local and aims to remove only the affected tissue area

Question 37

what is the next best option when the operation doesn’t work?

Answer 37

Failing this it is considered that a mastectomy is the best option

Question 38

what is known to improve survival rates?

Answer 38

Adjuvant chemotherapy