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SR 56 - Breast Flashcards

1
Q

What are the boundaries of the axialla?

A

Superior - axillary vein
Posterior - Long thoracic nerve
Lateral - Latissimus dorsi muscle
Medial boundary - Pectoral minor muscle (lateral, deep or medial to)

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2
Q

What four nerves are at risk during an axillary dissection?

A

Long thoracic nerve
Thoracodorsal nerve
Medial pectoral nerve
Lateral pectoral nerve

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3
Q

Location of and muscle innervated?

Long thoracic nerve

A

Lateral chest wall in midaxillary line on serratus anterior muscle
Innervates serratus anterior muscle

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4
Q

Location of and muscle innervated?

Thoracodorsal nerve

A

Lateral to long thoracic ner on lattisimus dorsi muscle

Innervates lattisimus dorsi muscle

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5
Q

Location of and muscle innervated?

Medial pectoral nerve

A

Runs laterl to or through th pectoral minor muscle; latearl to lateral pectoral nerve
Inervates pectoral minor and major

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6
Q

Location of and muscle innervated?

Lateral pectoral nerve

A

Medial to medial pectoral nerve

Innervates pectoral major

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7
Q

What deformity do you get if you cut the long thoracic nerve?

A

Winged scapula

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8
Q

Name of the cutaneous nerve the crosses the axilla in a transverse fashion?

A

Intercostobrachial nerve

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9
Q

What is the large vein that akrs the upper limit of the axilla?

A

Axillary vein

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10
Q

Lymphatic drainage of the breast?

A

Lateral - axillary LN

Medial - parasternal LN that run with internal mammary artery

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11
Q

What are the levels of axillary LN?

A 
Level I (low) - lateral to pectoral minor
Level II (middle) - deep to pectoral minor
Level III (high) - medial to pectoral minor
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12
Q

What are Rotter’s nodes?

A

Between the pectoralis major and minr muscles

Only removed if tehy are enlarged or feel suspicious intraoperatively

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13
Q

suspensory breast ligaments?

A

Cooper’s ligaments

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14
Q

What is the tail of Spence?

A

Breast tissue that tapers into the axilla

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15
Q

Which hornome is mainly responsible for breast milk production?

A

Prolactin

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16
Q

Triad of error for misdiagnosed breast cancer?

A

Age

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17
Q

History risk factors for breast cancer?

A

Nulliparity
Age at menarch 55yo
Cancer of the breast (self or family)
Pregnancy with first child >30yo

NAACP

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18
Q

Physical/anatomic risk factors for breast cancer?

A 
Cancer in the breast
Hyperplasia
Atypical hyperplasa
Female
Elderly
DCIS

LCIS
Inherited genes
Papilloma
Scloering adenosis

CHAFED LIPS

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19
Q

Possible symtoms of breast cancer?

A 
No symptoms
Mass in breast
(Pain)
Nipple discharge
Local edema
Nipple retraction
Dimple
Nipple rash
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20
Q

Why does skin retraction occur in breast cancer?

A

Tumor involvement of Cooper’s ligaments and subsequent traction on ligaments pull skin inwards

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21
Q

What are the signs of breast cancer?

A 
Mass (1cm is smallest palpable)
Dimple
Nipple rash
Edema
Axillary/supraclavicular nodes
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22
Q

Different types of invasive breast cancer?

A 
Infiltrating ductal carcinoma (75%)
Medullary carcinoma (15%)
Infiltrating lobular carcinoma (5%)
Tubular carcinoma (2%)
Mucinous carcinoma (cooloid) (1%)
Inflammatory breast cancer (1%)
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23
Q

Most common type of invasive breast cacner?

A

Infiltrating ductal carcinoma

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24
Q

DDx of a breast mass?

A 
Fibrocystic disease of the breast
Fibroadenoma
Intraductal papilloma
Ductal ectasia
Fat necrosis
Abscess
Radial scar
Simple cyst
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25
Breast exam recommendations?
Self-exam monthly 20-40yo - physician exam every 2-3 years >40yo - physician exam yearly
26
Mammogram recommendations?
Baseline mammogram 35-40yo Biyearly 40-50yo Yearly >50yo
27
What is the classic picture of breast canc on mammogram?
Spiculated mass
28
Indications for a breast biopsy?
Persistent mass after aspiration Solid mass Blood in cyst aspirate Suspicious lesion by mammography, US, MRI Bloody nipple discharge Ulcer or dermatitis of nipple Patient's concern of persistent breast abnormality
29
What is a ‘radial scar’ seen on mammogram?
Spiculated mass with central lucency, +/- microcalcifications Associated with Tubular carcinoma
30
When do you proceed to open biopsy for a breast cyst?
- Second cyst recurrence - Bloody fluid in cyst - Palpable mass after aspiration
31
Preop staging workup for patient with breast cancer?
``` Bilateral mammogram CXR LFTs Serum calcium, alkaline phosphate Other tests based on symptoms ```
32
Breast cancer - Stage I
Tumor
33
Breast cancer - Stage IIA
Tumor
34
Breast cancer - Stage IIB
``` Tumor 2-5cm Mobile axillary node OR Tumor >5cm No nodes ```
35
Breast cancer - Stage IIIA
``` Tumor >5cm Mobile axillary node OR Any sized tumor Fixed axillary nodes No metastases ```
36
Breast cancer - Stage IIIB
``` Peau d'orange OR Chest wall invasioin/fixation OR Inflammatory cancer OR Breast skin ulceration OR Breast skin satellite metastases OR Any tumor + ipsilateral internal mammary LN ```
37
Breast cancer - Stage IIIC
Any size tumor NO distant mets Positive - supraclavicular, infraclavicular, internal mammary LN
38
Breast cancer - Stage IV
Distant mets | Including ipsilateral supraclavicular nodes
39
Common sites of metastases in breast cancer?
``` LN Lung/pleura Liver Bone Brain ```
40
Major treatment options for breast cancer?
Modified radical mastectomy Lumpectomy and radiation + sentinel LN dissection +/- postop chemotherapy or Tamoxifen
41
Indications for radiation after a modified radial mastectomy?
``` Stage IIIA/B Pectoral muscle/fascia invasion Positive internal mammary LN Positive surgical margins >4 positive axillary LN postmenopausal ```
42
What carcinomas are candidates for breast-conserving therapy?
Stage I/II
43
Treatment for inflammatory carcinoma of the breast?
Chemo first | Then radiation and/or mastectomy
44
What is a modified radical mastectomy?
Breast, axillary nodes (level Ii, I) and nipple-areolar complex are removed Pectoralis msucles are NOT removed Drains in axilla and chest wall
45
When do you remove drains after axillary dissection?
46
Common options for breast reconstruction?
Transverse Rectus Abdominis Myocutaneous flap (TRAM flap) Implant Latissimus dorsi flap
47
AE of Tamoxifen?
``` Endometrial cancer DVT, PE Cataracts Hot flashes Mood swings ```
48
Chemotherapy for breast cancer?
CMF - Cyclophosphamide, Methotrexate, 5-Flurouracil | CAF - Cyclophosphamide, Adriamycin, 5-Fluorouracil
49
When do you use Tamoxifen?
ER + | Postmenopausal ER -
50
What make a high risk tumor?
``` >1cm in size Lymphatic/vascular invasion High nuclear grade High S phase ER negative HER-2/neu overexpression ```
51
Most common cause of bloody nipple discharge in a young woman?
Intraductal papilloma
52
Most common breast tumor in patients younger than 30yo?
Fibroadenoma
53
Define paget's disease of the breast
Scaling rash/dermatitis of the nipple | Due to invasion of skin by cells from a ductal carcinoma
54
Risk factors for male breast cancer?
``` >65yo Increased estrogens Radiation Gynecomastia from increased estrogen Estrogen therapy Klinefelter's syndrome (XXY) BRCA2 carrier ```
55
What is the most common cause of green, straw-colored or brown nipple discharge?
Fibrocystic disease
56
What is the most common cause of breast mass after breast trauma?
Fat necrosis
57
What is Mondor's disease?
Thrombophlebitis of superficial breast veins
58
What must be ruled out with sponatneous galactorrhea (+/- amenorrhea)?
Prolactinoma | Pregnancy test and prolactin level
59
What is cystosarcoma phyllodes
Mesenchymal tumor arising from breast lobar tissue | Most are benign
60
What is a fibroadenoma?
Benign tumor of breast consisting of stromal overgrowth Collagen arranged in swirls Solid, mobile, well-circumscribed round breast mass,
61
What is fibrocystic disease?
Common benign breast condition consisting of fibrous, rubbery and chystic changes in breast Varies with menstrual cycle
62
What is the treatment of fibrocystic disease?
Stop caffiene Pain meds (NSAIDS) Vit E, primrose oil Danzol and OCP
63
What is mastitis? When does it occur?
Superficial infection of the breast | Associated with breast-feeding
64
Bacteria associated with mastitis?
Staph aureus
65
Causes of a breast abscess?
Mammary ductal ectasis (stenosis of duct) | Mastitis
66
Causes of male gynecomastia?
``` Medications Illicit drugs (marijuana) Liver failure Increased estrogen Decreased testosterone ```

Surgical Recall (32 decks)

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