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Absite Review > The Surgical Review- Breast > Flashcards

The Surgical Review- Breast Flashcards

1
Q

what are the boundaries of the breast?

A

sternum medially, latissimus dorsi laterally, clavicle superiorly, inframammary crease inferiorly

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2
Q

blood supply of the breast?

A
  1. internal mammary

2. lateral thoracic arteries

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3
Q

5 important nerves to identify during mastectomy

A
  1. Lateral pectoral: pectoralis major
  2. Medial pectoral: pectoralis minor
  3. Long thoracic nn: serratus anterior and subscapularis
  4. Thoracodorsal: latissimus dorsi
  5. Intercostobrachial: sensory fibers to the skin of axilla, medial upper arm and lateral breast
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4
Q

What are the BIRADs scores?

A
  1. incomplete, additional imaging needed
  2. negative, routine mammo
  3. benign finding, routing mammo
  4. probably benign, short term fu
  5. suspicious, consider biopsy
  6. highly suggestive of malignancy
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5
Q

what is mondor’s disease?

A

thrombophlebitis of superficial veins of the anterior chest wall and breast
tx: anti-inflammatories and warm compresses

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6
Q

most common cause of bloody nipple discharge?

A

intraductal papilloma

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7
Q

what are the five subtypes of DCIS?

A
  1. Comedo: high grade and necrosis
  2. Cribriform
  3. Micropapilary
  4. Papillary
  5. Solid
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8
Q

what are 4 other less well known subtypes of invasive breast carcinoma?

A
  1. Tubular
  2. Medullary
  3. Mucinous
  4. Metaplastic
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9
Q

what are the major determinants of prognosis in breast cancer?

A

tumor size and lymph node status

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10
Q

what are the most common sites of distant metastasis in breast ca? 5

A
  1. bone
  2. lung
  3. liver
  4. brain
  5. spine
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11
Q

HER2-neu is associated with what 3 factors of prognosis?

A
  1. Increased rate of metastases
  2. Poorer overall survival
  3. Refractoriness to chemotherapy
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12
Q

what is the function of HER2neu

A

tyrosine kinase growth factor receptor

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13
Q

what is the pathogenesis of peak d’orange in inflammatory breast ca?

A

dermal lymphatic congestion with tumor cells

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14
Q

what is the strongest risk factor for male breast cancer?

A

klinefelter syndrome

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15
Q

how do phyllodes tumors metastases and where to?

A

hematogenously

to lung, bone, and abdominal viscera

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16
Q

what 3 veins are most commonly affected in mondors disease?

A
  1. Lateral thoracic vein
  2. thoracoepigastric vein
  3. superficial epigastric vein
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17
Q

what are the three management options when LCIS is discovered?

A
  1. close surveillance
  2. Tamoxifen (shown to reduce breast ca risk)
  3. Bilateral total masties w recon
18
Q

what is the difference in breast ca of BRCA 1 vs BRCA2 mutations?

A

BRCA1 more likely to be poorly differentiated and hormone receptor negative whereas BRCA2 is well differentiated and hormone receptor positive

19
Q

hereditary breast ca accounts for what percentage of all breast cancers?

A

5-10%

20
Q

what accounts for nearly 40% of male breast cancers?

A

BRCA2

21
Q

Increased risk family history of breast cancer includes what? (6)

A
  1. At least 3 first or second degree relatives with breast ca at any age
  2. 2 first degree relatives with breast ca including one who was diagnosed
22
Q

which type of DCIS is assoc w the worse prognosis?

A

comedo

23
Q

which type of cancer stains positive for S-100 antigen?

A

Melanoma

24
Q

which type of invasive breast ca has the most favorable prognosis?

A

tubular

25
Q

neighborhood calcification is a feature characteristic of what?

A

LCIS

26
Q

what defines a women at “high risk” for breast cancer?

A

a women as least 35years of age with a 5yr predicted risk of breast cancer of 1.67% or greater (using the gail model)

27
Q

the primary severe adverse reaction to trastuzumab is?

A

cardiac toxicity: CHF and decreased LVEF

28
Q

what is the most common type of breast lymphoma?

A

B cell: diffuse large B cell lymphoma

29
Q

treatment of breast lymphoma?

A

if low grade/localized: excision

if high grade: CHOP + XRT

30
Q

what is CHOP therapy?

A

Cyclophosphamide, hydroxydoxorubicin, vincristine, prednisone

31
Q

what artery does the long thoracic nerve run with?

A

subscapular artery

32
Q

woman w a teardrop deformity of her breast and rapidly growing mass?

A

phyllodes tumor: careful, they can be confused clinically/radiographically/histologically with fibroadenoma

33
Q

treatment of choice for phyllodes tumor? benign vs malignant?

A

wide local excision with at least 1cm margin for both benign and malignant, rarely go to lymph nodes

34
Q

how do malignant phyllodes tumors spread?

A

hematogenously

35
Q

strongest risk factor for development of angiosarcoma?

A

lymphedema, but can also arise in radiation naiive pts de novo

36
Q

how do you differentiate angiosarcoma from hemangioma?

A

presence of necrosis

37
Q

treatment of angiosarcoma?

A

wide excision to negative margin, no need to do SLNBx

38
Q

what is batson plexus?

A

venules that encircle the vertebrae and course along the spine, path for metastasis of breast and prostate cancer to the spine/spinal cord

39
Q

what is the single most important predictor of 10-20 year survival rates in breast ca?

A

number of axillary lymph nodes involved with metastatic dx

40
Q

what is stewart treves syndrome?

A

deadly malignancy that forms in chronically edematous limbs ie lymphedema after modified radical mastectomy, mets to lungs early on, tx = wide excision and debridement often amputation

41
Q

what is one connective tissue disorder that is NOT a contraindication to breast conserving treatment?

A

Rheumatoid arthritis (SLE and scleroderma are bc they may be exacerbated by radiation therapy)

42
Q

MOA tamoxifen

A

an estrogen agonist but a competitive estrogen antagonist in the breast

Absite Review (30 decks)

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