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Surgical Recall > SR 56 - Breast > Flashcards

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
Q

Breast exam recommendations?

A

Self-exam monthly
20-40yo - physician exam every 2-3 years
>40yo - physician exam yearly

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26
Q

Mammogram recommendations?

A

Baseline mammogram 35-40yo
Biyearly 40-50yo
Yearly >50yo

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27
Q

What is the classic picture of breast canc on mammogram?

A

Spiculated mass

28
Q

Indications for a breast biopsy?

A

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
Q

What is a ‘radial scar’ seen on mammogram?

A

Spiculated mass with central lucency, +/- microcalcifications
Associated with Tubular carcinoma

30
Q

When do you proceed to open biopsy for a breast cyst?

A
  • Second cyst recurrence
  • Bloody fluid in cyst
  • Palpable mass after aspiration
31
Q

Preop staging workup for patient with breast cancer?

A 
Bilateral mammogram
CXR
LFTs
Serum calcium, alkaline phosphate
Other tests based on symptoms
32
Q

Breast cancer - Stage I

A

Tumor

33
Q

Breast cancer - Stage IIA

A

Tumor

34
Q

Breast cancer - Stage IIB

A 
Tumor 2-5cm 
Mobile axillary node
OR
Tumor >5cm 
No nodes
35
Q

Breast cancer - Stage IIIA

A 
Tumor >5cm
Mobile axillary node
OR
Any sized tumor
Fixed axillary nodes
No metastases
36
Q

Breast cancer - Stage IIIB

A 
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
Q

Breast cancer - Stage IIIC

A

Any size tumor
NO distant mets
Positive - supraclavicular, infraclavicular, internal mammary LN

38
Q

Breast cancer - Stage IV

A

Distant mets

Including ipsilateral supraclavicular nodes

39
Q

Common sites of metastases in breast cancer?

A 
LN
Lung/pleura
Liver
Bone 
Brain
40
Q

Major treatment options for breast cancer?

A

Modified radical mastectomy
Lumpectomy and radiation + sentinel LN dissection

+/- postop chemotherapy or Tamoxifen

41
Q

Indications for radiation after a modified radial mastectomy?

A 
Stage IIIA/B
Pectoral muscle/fascia invasion
Positive internal mammary LN
Positive surgical margins
>4 positive axillary LN postmenopausal
42
Q

What carcinomas are candidates for breast-conserving therapy?

A

Stage I/II

43
Q

Treatment for inflammatory carcinoma of the breast?

A

Chemo first

Then radiation and/or mastectomy

44
Q

What is a modified radical mastectomy?

A

Breast, axillary nodes (level Ii, I) and nipple-areolar complex are removed
Pectoralis msucles are NOT removed
Drains in axilla and chest wall

45
Q

When do you remove drains after axillary dissection?

A
46
Q

Common options for breast reconstruction?

A

Transverse Rectus Abdominis Myocutaneous flap (TRAM flap)
Implant
Latissimus dorsi flap

47
Q

AE of Tamoxifen?

A 
Endometrial cancer
DVT, PE
Cataracts
Hot flashes
Mood swings
48
Q

Chemotherapy for breast cancer?

A

CMF - Cyclophosphamide, Methotrexate, 5-Flurouracil

CAF - Cyclophosphamide, Adriamycin, 5-Fluorouracil

49
Q

When do you use Tamoxifen?

A

ER +

Postmenopausal ER -

50
Q

What make a high risk tumor?

A 
>1cm in size
Lymphatic/vascular invasion
High nuclear grade
High S phase
ER negative
HER-2/neu overexpression
51
Q

Most common cause of bloody nipple discharge in a young woman?

A

Intraductal papilloma

52
Q

Most common breast tumor in patients younger than 30yo?

A

Fibroadenoma

53
Q

Define paget’s disease of the breast

A

Scaling rash/dermatitis of the nipple

Due to invasion of skin by cells from a ductal carcinoma

54
Q

Risk factors for male breast cancer?

A 
>65yo
Increased estrogens
Radiation
Gynecomastia from increased estrogen
Estrogen therapy
Klinefelter's syndrome (XXY)
BRCA2 carrier
55
Q

What is the most common cause of green, straw-colored or brown nipple discharge?

A

Fibrocystic disease

56
Q

What is the most common cause of breast mass after breast trauma?

A

Fat necrosis

57
Q

What is Mondor’s disease?

A

Thrombophlebitis of superficial breast veins

58
Q

What must be ruled out with sponatneous galactorrhea (+/- amenorrhea)?

A

Prolactinoma

Pregnancy test and prolactin level

59
Q

What is cystosarcoma phyllodes

A

Mesenchymal tumor arising from breast lobar tissue

Most are benign

60
Q

What is a fibroadenoma?

A

Benign tumor of breast consisting of stromal overgrowth
Collagen arranged in swirls

Solid, mobile, well-circumscribed round breast mass,

61
Q

What is fibrocystic disease?

A

Common benign breast condition consisting of fibrous, rubbery and chystic changes in breast
Varies with menstrual cycle

62
Q

What is the treatment of fibrocystic disease?

A

Stop caffiene
Pain meds (NSAIDS)
Vit E, primrose oil
Danzol and OCP

63
Q

What is mastitis? When does it occur?

A

Superficial infection of the breast

Associated with breast-feeding

64
Q

Bacteria associated with mastitis?

A

Staph aureus

65
Q

Causes of a breast abscess?

A

Mammary ductal ectasis (stenosis of duct)

Mastitis

66
Q

Causes of male gynecomastia?

A 
Medications
Illicit drugs (marijuana)
Liver failure
Increased estrogen
Decreased testosterone

Surgical Recall (32 decks)

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