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DVS Part II Breast > Surgical Recall - Ch. 56 Breast > Flashcards

Surgical Recall - Ch. 56 Breast Flashcards

1
Q

Anatomy

  1. What are Rotter’s nodes?
  2. What is the mammary “milk line”?
  3. What is the “tail of Spence”?
  4. Which hormone is mainly responsible for breast milk production?
A
  1. Nodes between pectoralis major and minor muscles; not usually removed unless they are enlarged or feel suspicious intraoperatively
  2. Embryological line from shoulder to thigh where “supernumerary” breast aerolar and/or nipples can be found
  3. “Tail” of brast tissue that tapers into axilla
  4. Prolactin
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2
Q

Breast Cancer

  1. What option exists to decrease the risk of breast cancer in women with BRCA?
  2. What is the “TRIAD OF ERROR” for misdiagnosed breast cancer?
  3. What are the physical/anatomic risk factors for breast cancer?
A

Breast Cancer

  1. What option exists to decrease the risk of breast cancer in women with BRCA? Prophylactic bilateral mastectomy
  2. What is the “TRIAD OF ERROR” for misdiagnosed breast cancer?
    1. Age < 45 yrs
    2. Self-diagnosed mass
    3. Negative mammogram
  3. What are the physical/anatomic risk factors for breast cancer?
    1. Cancer in the breast
    2. Hyperplasia (2x)
    3. Atypical hyperplasia (5x)
    4. Female
    5. Elderly
    6. DCIS
    7. LCIS
    8. Inherited genes (BRCA I & II)
    9. Papilloma (1.5x)
    10. Sclerosing adenosis (1.5x)
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3
Q

Breast Cancer

  1. What are the different types of invasive breast cancer (6)?
  2. What is the most common type of breast cancer?
  3. What are the screening recommendations for breast cancer:
    1. Breast exam recommendations?
    2. Mammograms?
  4. Why is mammography more useful diagnostic tool in older women than in younger?
A
  1. Invasive types:
    1. IDC (75%)
    2. Medullary (15%)
    3. ILC (5%)
    4. Tubular (2%)
    5. Mucinous (1%)
    6. Inflammatory (1%)
  2. IDC
  3. Screening recommendations:
    1. Breast exam: Self-exam monthly; ages 20-40: breast exam every 2-3 years by a physician; >40 years: annual exam
    2. Mammograms: Baseline mammogram between 35 and 40; mammogram every year > 50
  4. Breast tissue undergoes fatty replacement with age, making masses more visible; younger women have more fibrous tissue, which makes mammograms harder to interpret
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4
Q

Breast Cancer

  1. What is the classic picture of breast cancer on mammogram?
  2. Wich option is best to evaluate a breast mass in a woman younger than 30 years?
  3. What is obtained first, the mammogram or the biopsy?
  4. What would be suspicious mammographic findings?
A
  1. Spiculated mass
  2. Breast U/S
  3. Mammogram is obtained first; otherwise, tissue extraction (core or open) may alter the mammographic findings (FNA may be done prior to mammogram b/c the fine needle usually will not affect the mammographic findings)
  4. Mass, microcalcifications, stellate/spiculated mass
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5
Q

Breast Cancer

  1. What is the “workup” for a breast mass?
  2. How do you proceed if the mass appears to be a cyst?
  3. What is the pre-op staging workup in a pt with breast cancer?
A
  1. Workup:
    1. Clinical breast exam
    2. Mammogram or breast U/S
    3. FNA, core biopsy, or open biopsy
  2. Aspirate cyst
  3. Pre-op staging workup:
    1. Bilateral mammogram (cancer in one breast is a risk factor for cancer in the contralateral breast!)
    2. CXR (check for lung mets)
    3. LFTs (check for liver mets)
    4. Serum calcium level, AP (if these tests indicate bone mets, proceed to bone scan)
    5. Head CT (if pt has focal neurologic deficit to look for brain mets)
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6
Q

Breast Cancer

  1. What breast carcinomas are candidates for lumpectomy and radiation (breast-conserving therapy)?
  2. What is the treatment of inflammatory carcinoma of the breast?
  3. What is a sentinel node biopsy?
  4. Can tamoxifen prevent breast cancer?
  5. What are the side effects of tamoxifen?
A
  1. Stage I and stage II (tumors < 5 cm)
  2. Chemo first! Then often followed by radiation, mastectomy, or both!
  3. Instead of removing all the axillary lymph nodes, the primary draining or “sentinel” lymph node is removed
  4. Yes! Reduce risk by 50%
  5. Endometrial cancer (2.5x relative risk), DVT, PE, cataracts, hot flashes
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7
Q

Fibrocystic Change

  1. What is it?
  2. What are the signs/symptoms?
  3. How it is diagnosed?
  4. Treatment for symptomatic fibrocystic disease?
  5. What is done if the pt has a breast cyst?
A

Fibrocystic change

  1. Common benign breast condition consisting of fibrous and cystic changes
  2. Breast pain or tenderness that varies with menstrual cycle
    1. Multiple, diffuse nodulocystic masses (CORDLIKE THICKENING)
    2. No nipple discharge
  3. Through breast exam, history, and aspirated cysts (usually green fluid)
  4. STOP CAFFEINE; pain meds (NSAIDS), vitamin E
  5. Needle drainage: if aspirate is bloody, open biopsy… if aspirate is green, follow pt closely
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8
Q

Miscellaneous

  1. What is the most common cause of bloody nipple discharge in a young woman?
  2. What is the most common breast tumor in pts younger than 30 years?
  3. What is Paget’s disease of the breast?
  4. What are the common options for breast reconstruction after a mastectomy?
A
  1. Intraductal papilloma
  2. Fibroadenoma
  3. Scaling rash/dermatitis of the nipple caused by invasion of skin by cells from a ductal carcinoma
  4. Saline implant / TRAM flap
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9
Q

Benign Breast Disease

  1. What is the most common cause of green, or brown nipple discharge?
  2. What is the most common cause of breast mass after breast trauma?
  3. What is Mondor’s disease?
  4. What must be r/o with spontaneous galactorrhea?
A
  1. Fibrocystic disease
  2. Fat necrosis
  3. Thrombophlebitis of superficial breast veins
  4. Prolactinoma (check pregnancy test and prolactin level)
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10
Q

What is the major difference in the subsequent development of invasive breast cancer with DCIS and LCIS?

A

LCIS cancer develops in either breast; DCIS cancer develops in the ipsilateral breast

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11
Q

Incisional biopsy of a breast mass in a 35 y/o woman demonstrates cystosarcoma phyllodes at the time of frozen section. Which of the following is the most appropriate mgmt strategy for this lesion?

a. Wide local excision with a rim of normal tissue
b. Lumpectomy and axillary lymphadenopathy
c. Modified radical mastectomy
d. Excision and post-op radiotherapy

A

a. Wide local excision with a rim of normal tissue

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DVS Part II Breast (5 decks)

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