6: Axilla and breast

Question 1

Function of cervico-axillary canal

Answer 1

Allows nerves and blood vessels to pass between neck and upper limb

Question 2

What are the boundaries of the axilla

Answer 2

Apex, medial wall, lateral wall

Question 3

Location of apex of axilla

Answer 3

Between clavicle, scapula and lateral border of first rib

Question 4

What does medial wall of axilla consist of

Answer 4

Ribs 1-4, intercostal muscles, slips serratus anterior

Question 5

What does lateral wall of axilla consist of

Answer 5

Intertubercular sulcus of humerus, anterior axillary fold, anterior axillary fold

Question 6

Muscles of anterior axillary fold

Answer 6

Pectoralis major, minor and subclavius

Question 7

Muscles of posterior axillary fold

Answer 7

Subscapularis, teres major, latissimus dorsi

Question 8

Contents of axilla

Answer 8

Axillary artery and its 6 branches
Axillary vein and its tributaries
Brachial plexus
Lateral branches of intercostal nerves
Lymph nodes

Question 9

Polymastia

Answer 9

Additional breasts

Question 10

Polythelia

Answer 10

Additional nipples

Question 11

Position of breast

Answer 11

Anterior thoracic wall
Overlies ribs 2-6 along midclavicular line
Overlies pectoral muscles and serratus anterior
Extends from lateral border of sternum to mid axillary line

Question 12

Portion of breast extending into axillary fossa

Answer 12

Axillary Process/ Tail of Spence

Question 13

Space that separates breast and pectoral muscles

Answer 13

Retromammary space

Question 14

Innervation of breast

Answer 14

Anterior and lateral cutaneous branches of intercostal nerves 2-6 pass through deep pectoral fascia to reach the breast and carry sensory and sympathetic fibres

Question 15

Function of sensory fibers

Answer 15

Carry sensory signals back to spinal cord and brain

Question 16

Function of sympathetic fibers

Answer 16

Carry signals from brain and spinal cord to control blood vessels and smooth muscles

Question 17

Arterial supply to breast superiorly

Answer 17

Branches of the thoracoacromial artery (second part of axillary artery )

Question 18

Arterial supply to breast inferolaterally

Answer 18

Branches of the intercostal artery
(part of descending aorta)

Question 19

Arterial supply to breast medially

Answer 19

Branches of the internal thoracic artery
(part of subclavian artery)

Question 20

Arterial supply to breast laterally

Answer 20

Branches of the lateral thoracic artery
(part of axillary artery)

Question 21

Breast changes during lactation

Answer 21

1)prolactin is released from anterior pituitary gland
2) alveoli within mammary lobules produce milk
3) milk travels via lactiferous ducts to lactiferous sinus for storage
4) feeding harvests milk stored in the lactiferous sinuses

Question 22

What are the axillary lymph nodes (3)

Answer 22

Pectoral nodes, subscapular nodes, humeral nodes

Question 23

What does the pectoral nodes drain

Answer 23

Superior 1/2 of anterior thorax

Question 24

What does the subscapular nodes drain

Answer 24

Medial wall, posterior fold and axillary process of the breast

Question 25

What does the humeral nodes drain

Answer 25

Majority of the upper limb

Question 26

What do the central nodes drain

Answer 26

Pectoral nodes, subscapular nodes, humeral nodes AKA axillary nodes

Question 27

What do the apical nodes drain

Answer 27

Central nodes

Question 28

~75% drains to the.....

Answer 28

Axillary lymph nodes

Question 29

~25% drains medially to the....

Answer 29

Parasternal lymph nodes

Question 30

Small amount drains to.....

Answer 30

Deep cervical and supraclavicular or lymph abdominal nodes

Question 31

How is breast cancer diagnosed

Answer 31

1) clinical history and examination 2) imaging 3) biopsy

Question 32

Lumpectomy

Answer 32

Removal of suspicious lump

Question 33

Mastectomy

Answer 33

Removal of breast

Question 34

Axillary clearance

Answer 34

Removal of lymph nodes from axilla to prevent lymphogenous spread of cancer

Question 35

Potential consequences of axillary clearance (2)

Answer 35

Lymphoedema of upper limb Long thoracic nerve involvement (winging of scapula)

Question 36

It patients have a genetic suspectibility to breast cancer they may get a

Answer 36

Prophylactic mastectomy

Question 37

Gene mutations that may cause breast cancer

Answer 37

BRCA1 and BRCA2

Question 38

Peau d'Orange symptoms

Answer 38

Lymphoedema within breast -increases size Tightening of cooper's ligaments - dimpling at attachment site

Question 39

Consequences of p'eau d'Orange

Answer 39

Mastitis + inflammatory breast cancer