The Breast Flashcards
Breasts
modified sweat glands specialized to secrete milk
What is the main function of breasts?
to produce milk
What are the two types of breast tissues?
Glandular tissues - lobular and ducts
Stromal tissues - supporting tissue inclusive of fatty and fibrous connective tissue that give breast its size, shape, and support
What are suspensory ligaments?
bands of fibrous tissue extending from skin of breast to the connective tissue covering chest wall muscles
What happens to breast structure during puberty?
they enlarge in response to estrogen and progesterone
Post-pubertal changes to breast?
proliferation of glandular / fibrous tissue and accumulation of adipose tissue
When are the breasts extremely responsive to hormonal stimulation?
during the menstrual cycle, during pregnancy and lactation, and after menopause
Menstrual cycle response to hormonal stimulation
cyclic hyperplasia followed by involution
Pregnancy and lactation response to hormonal stimulation
hypertrophic glandular and ductal tissues
Hormonal stimulation response after menopause
sex hormone levels decline, breasts gradually decrease in size
How are lymph vessels of breast related to axillary nodes?
if breast cancer cells reach axillary nodes and continue to grow, nodes swell and cancer is more likely to spread to other organs
Abnormalities in breast development
Breast hypertrophy, Gynecomastia
Breast hypertrophy
At puberty, one or both breasts overrespond to
hormonal stimulation; true hypertrophy is from overgrowth of fibrous tissue, not glands or fat
Gynecomastia
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
Fibrocystic disease
benign cystic change in the breast; Focal areas of proliferation of glandular and fibrous tissue; Irregular cyclic response to hormones during menstrual cycle
Treatment for Fibrocystic disease
Aspiration of cyst; Surgical excision if no aspiration
Breast Carcinoma - Susceptibility Genes
Mutant BRCA1 gene & Mutant BRCA2 gene
BRCA1 gene
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
BRCA2 gene
- Breast cancer risk at 80%
- Lower ovarian carcinoma risk at 10% to 20%
Prognosis of Hormone-Receptor Status of Tumor
*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
Guide for treatment of Breast Tumor
Tumors with hormone receptors respond to antiestrogen adjuvant therapy
Early Stages of Breast Carcinoma
Too small to be detected by breast exam
* Mammogram can identify carcinoma up to 2 years before detection by breast exam
Evolution of Breast Carcinoma
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
Mammogram
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
Denser cysts and tumors
White on mammogram
Less dense fatty tissue
Dark on mammogram
Cysts and benign tumors
Well circumscribed
Malignant tumors
Have irregular borders; Frequently contain fine flecks of calcium
Clinical Manifestations of Breast Carcinoma
- Lump in breast
- Secondary changes in skin or nipple
- Edema
Staging of Breast Carcinoma (TNM)
Stage impacts prognosis
* T: Tumor size
* N: Invasion into nearby
lymph nodes
* M: Invasion of distant
sites (metastases)
Breast Carcinoma Treatment: Surgical Resection
Modified radical mastectomy; Partial mastectomy; Lumpectomy
Modified radical mastectomy
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
Partial mastectomy
Removal of only the part of breast with the tumor
Lumpectomy
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
Breast Carcinoma Treatment: Adjuvant Therapy
Eradicates any tumor cells that may have spread beyond the breast
* Anticancer drugs (adjuvant chemotherapy)
* Antiestrogen drugs (adjuvant hormonal therapy)
Recurrent and Metastatic Carcinoma
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
Methods of Treatment for Metastatic Carcinoma
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
Methods of Treatment for Metastatic Carcinoma Depend on a few factors
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
