The Breast

Question 1

Breasts

Answer 1

modified sweat glands specialized to secrete milk

Question 2

What is the main function of breasts?

Answer 2

to produce milk

Question 3

What are the two types of breast tissues?

Answer 3

Glandular tissues - lobular and ducts
Stromal tissues - supporting tissue inclusive of fatty and fibrous connective tissue that give breast its size, shape, and support

Question 4

What are suspensory ligaments?

Answer 4

bands of fibrous tissue extending from skin of breast to the connective tissue covering chest wall muscles

Question 5

What happens to breast structure during puberty?

Answer 5

they enlarge in response to estrogen and progesterone

Question 6

Post-pubertal changes to breast?

Answer 6

proliferation of glandular / fibrous tissue and accumulation of adipose tissue

Question 7

When are the breasts extremely responsive to hormonal stimulation?

Answer 7

during the menstrual cycle, during pregnancy and lactation, and after menopause

Question 8

Menstrual cycle response to hormonal stimulation

Answer 8

cyclic hyperplasia followed by involution

Question 9

Pregnancy and lactation response to hormonal stimulation

Answer 9

hypertrophic glandular and ductal tissues

Question 10

Hormonal stimulation response after menopause

Answer 10

sex hormone levels decline, breasts gradually decrease in size

Question 11

How are lymph vessels of breast related to axillary nodes?

Answer 11

if breast cancer cells reach axillary nodes and continue to grow, nodes swell and cancer is more likely to spread to other organs

Question 12

Abnormalities in breast development

Answer 12

Breast hypertrophy, Gynecomastia

Question 13

Breast hypertrophy

Answer 13

At puberty, one or both breasts overrespond to
hormonal stimulation; true hypertrophy is from overgrowth of fibrous tissue, not glands or fat

Question 14

Gynecomastia

Answer 14

Ductal and fibrous tissue of adolescent male breast
proliferate, affecting one or more breast; from temporary
imbalance of female and male hormones (increase in estrogen) in the male at puberty

Question 15

Fibrocystic disease

Answer 15

benign cystic change in the breast; Focal areas of proliferation of glandular and fibrous tissue; Irregular cyclic response to hormones during menstrual cycle

Question 16

Treatment for Fibrocystic disease

Answer 16

Aspiration of cyst; Surgical excision if no aspiration

Question 17

Breast Carcinoma - Susceptibility Genes

Answer 17

Mutant BRCA1 gene & Mutant BRCA2 gene

Question 18

BRCA1 gene

Answer 18

Increases breast and ovarian carcinoma risk
* Breast cancer risk at 80%
* Ovarian cancer risk is at 20% to 40%
* Large gene with many different mutations

Question 19

BRCA2 gene

Answer 19

• Breast cancer risk at 80%
• Lower ovarian carcinoma risk at 10% to 20%

Question 20

Prognosis of Hormone-Receptor Status of Tumor

Answer 20

*Estrogen receptors (ER) and progesterone receptors (PR) in breast carcinoma
*Hormone-receptor positive tumors are better differentiated with favorable prognosis
*Patients with ER-positive tumors may receive adjuvant hormonal therapy with antiestrogen drug

Question 21

Guide for treatment of Breast Tumor

Answer 21

Tumors with hormone receptors respond to antiestrogen adjuvant therapy

Question 22

Early Stages of Breast Carcinoma

Answer 22

Too small to be detected by breast exam
* Mammogram can identify carcinoma up to 2 years before detection by breast exam

Question 23

Evolution of Breast Carcinoma

Answer 23

Cancer continues to grow, initially in situ; eventually becomes invasive
* Metastasizes to axillary lymph nodes and distant sites
* Problems with late metastases
* Early diagnosis allows prompt treatment and improves the cure rate

Question 24

Mammogram

Answer 24

Suggested for all women starting at age 45 with the option of starting at 40 if desired
* The density of breasts (the ratio of glands and connective tissue to fat) differs from woman to woman as does the degree of benign fibrocystic change
* Mammogram may identify lesions not detected on clinical examination

Question 25

Denser cysts and tumors

Answer 25

White on mammogram

Question 26

Less dense fatty tissue

Answer 26

Dark on mammogram

Question 27

Cysts and benign tumors

Answer 27

Well circumscribed

Question 28

Malignant tumors

Answer 28

Have irregular borders; Frequently contain fine flecks of calcium

Question 29

Clinical Manifestations of Breast Carcinoma

Answer 29

• Lump in breast
• Secondary changes in skin or nipple
• Edema

Question 30

Staging of Breast Carcinoma (TNM)

Answer 30

Stage impacts prognosis
* T: Tumor size
* N: Invasion into nearby
lymph nodes
* M: Invasion of distant
sites (metastases)

Question 31

Breast Carcinoma Treatment: Surgical Resection

Answer 31

Modified radical mastectomy; Partial mastectomy; Lumpectomy

Question 32

Modified radical mastectomy

Answer 32

Also called total mastectomy with axillary lymph node dissection
* Resecting entire breast, axillary tissue with lymph nodes; leaves pectoral muscles
* May be followed by breast reconstruction

Question 33

Partial mastectomy

Answer 33

Removal of only the part of breast with the tumor

Question 34

Lumpectomy

Answer 34

Removal of tumor plus small amount of adjacent breast
tissue
*Axillary lymph nodes removed in both lumpectomy and partial mastectomy followed by radiation to eradicate any remaining carcinoma in the breast

Question 35

Breast Carcinoma Treatment: Adjuvant Therapy

Answer 35

Eradicates any tumor cells that may have spread beyond the breast
* Anticancer drugs (adjuvant chemotherapy)
* Antiestrogen drugs (adjuvant hormonal therapy)

Question 36

Recurrent and Metastatic Carcinoma

Answer 36

May appear many years after original tumor has been resected
* Tumor no longer curable, treatment is to control growth, relieve symptoms, and improve quality of life

Question 37

Methods of Treatment for Metastatic Carcinoma

Answer 37

Hormone-receptor positive tumor
* Premenopausal: Antiestrogen drugs
* Postmenopausal: Aromatase inhibitor drugs
Hormone-receptor negative tumor
* Use of targeted therapies such as kinase inhibitors
HER-2 positive tumor
* Anti-HER-2 antibodies
Bone modifying drugs
* Stabilize bone loss
* Reduces recurrence of bone metastasis

Question 38

Methods of Treatment for Metastatic Carcinoma Depend on a few factors

Answer 38

Methods of treatment depend on the following factors
* Hormone-receptor status of tumor
* Age of patient
* Time that elapsed from initial treatment to appearance of metastasis
* Pre- and postmenopausal, hormone-receptor positive tumor: Use
antiestrogen drugs