Boobies Flashcards
(104 cards)
1
Q
What are the 3 major structures of the breast?
A
skin, subcutaneous tissue, and breast tissue
2
Q
What comprises breast tissue?
A
parenchyma and stroma
3
Q
How many collecting milk ducts open to the nipple?
A
5-10
4
Q
What lies beneath the breast tissue?
A
pectoral fascia
5
Q
What acts as a suspensory system for the breast?
A
Cooper’s ligaments
6
Q
Where does 60% of the breasts blood supply come from?
A
internal mammary (internal thoracic)
7
Q
Where does 30% of the breasts blood supply come from?
A
lateral thoracic
8
Q
Which nodes drain 97% of the breast?
A
Axillary nodes
9
Q
Which nodes drain 3% of the breast?
A
Internal mammary chain
10
Q
What musculature is under the breast?
A
Pectoralis major and minor, serratus anterior, latissimus dorsi
11
Q
What nerves innervate the pecs?
A
Medial and lateral pectoral nerves innervate pecs
12
Q
What nerves run through the axilla?
A
lateral thoracic and thoracodorsal nerves
13
Q
What nerve is sensory to the posterior upper arm and runs through the axilla?
A
Intercostal-brachial cutaneous nerve
14
Q
What genetic mutations cause pts to have a lifetime risk of breast cancer between 50-90%?
A
BRCA 1 or 2
15
Q
What are non-genetic risk factors for breast cancer?
A
Age Personal history of breast cancer History of atypical hyperplasia on biopsy Hx high dose radiation to chest Alcohol and diet Reproductive factors Late age at 1st full term pregnancy (>30), early menarche (55), no full term pregnancy, never breast fed Factors affecting circulating hormones OCP, HRT, obesity
16
Q
What are genetic risk factors for breast cancer?
A
BRCA 1 and BRCA 2
2 or more 1st degree relatives diagnosed at an early age Relative risk > 4.0
One 1st degree relative with breast cancer
Relative risk between 2.1-4.0
17
Q
What is the Gail model for determining breast cancer risk?
A
Combines age, age at 1st MP, age at 1st live birth, number of primary relatives affected, breast bx hx, ethnicity
18
Q
What other cancers is a BRCA positive patient also at risk for?
A
ovarian ca(25-45%)
pancreatic ca
melanoma
prostate ca
19
Q
How is surveillance conducted on BRCA positive patients?
A
exam
mammo
U/S
MRI q 6 mo
20
Q
How is breast cancer prevented in BRCA positive patients?
A
Bilateral prophylactic mastectomy
Bilat salpingo-oophorectomy
tamoxifen
21
Q
Mammography reduces breast cancer mortality by 30% in what age group?
A
50-69
22
Q
At what age should screening mammography begin and how often?
A
Yearly at 40 years
23
Q
Do self breast exams or clinical breasts exams prevent more cancers?
A
Clinical. Studies suggest no improvement in survival for self breast exam
24
Q
What is captured on the mediolateraloblique mammogram?
A
chest wall
tail of Spence
axilla
25
What type of mammograms are ordered for asymptomatic patients yearly after 40?
Screening
26
What type of mammograms are ordered for patients with symptoms?
Diagnostic
27
How do densities show on mammography?
White
28
How does fat show on mammography?
Grey
29
What do microcalcifications indicate on mammography?
Ductal carcinoma in situ
30
What is a BI-RAD lesion staged at 0?
Needs further evaluation
31
What is a BI-RAD lesion staged at 1?
Negative
32
What is a BI-RAD lesion staged at 5?
Highly suggestive of malignancy
33
What is a BI-RAD lesion staged at 6?
Known biopsy proven malignancy
34
What views are included in a screening mammogram?
Cranio-caudal (CC)
| Mediolateraloblique (MLO)
35
What views are included in a diagnostic mammogram?
Anything the radiologist wants, including U/S
36
What is the triad of error for delayed breast cancer diagnosis?
Young age (<45)
Negative mammogram
Self-discovered breast mass
37
When should you order a breast ultrasound?
Any time you order a diagnostic mammogram
38
What are the two phases of the breast exam?
Inspection
| Palpation
39
How should the patient sit for inspection?
Upright with arms relaxed, then raised, pecs contracted with hands on hips
40
What are signs of breast cancer you can find with inspection?
Skin- edema, lesions, retraction, dimpling
| Nipple areolar complex for retraction and discharge
41
How should the patient be positioned for the palpation phase of the breast exam?
Upright and supine
42
What anatomy should be palpated during the clinical breast exam?
Breasts and lymph node basins
43
How much of the breast should be palpated
from clavicle to beyond inframammary crease, and from sternum through axilla
44
What imaging is ordered to diagnose a breast mass?
US and diagnostic mammo
45
What information will FNA not give about a mass?
Invasion
46
What is the usual type of biopsy to diagnose malignancy?
Core needle bx
47
What is an excisional bx?
removal of the entire palpable or imaged abnormality
48
What are characteristic of fibrocystic breasts?
common cause of breast pain, often cyclic
49
What are three benign conditions that could be mistaken for breast cancer?
Fibrocystic breast
Cysts
Fibroadenoma
50
What is a Phyllodes tumor?
usually benign, can enlarge, needs excision with clear margins
51
How is breast pain managed?
Decrease caffeine
Vitamin E
Evening primrose oil
52
What are three prescriptions for breast pain?
danocrine, tamoxifen, bromocriptine
53
When are breast infections most common?
During lactation
54
How are breast infections managed?
Management include emptying breast (nurse or pump)
antibiotics
drainage if there is an abscess
It is safe to continue to feed the infant
55
What causes breast infections in non-lactating women?
Smoking
56
What condition must be ruled out with breast infections?
Inflammatory breast cancer (f/u with patient to ensure resolution of sx)
57
How are cysts diagnosed?
Exam, US, FNA
58
What diagnostic procedure is required for solid masses?
Biopsy
59
What do skin changes (peau d'orange, erythema) indicate?
Inflammatory breast cancer
60
What do micro calcifications on mammogram indicate?
Ductal carcinoma in situ
| fibrocystic breast disease (more common)
61
What is a spiculated mass on mammogram indicative of?
Invasive cancer
62
What will be found on ultrasound for breast cancer?
Irregular solid mass
Taller than wide
Shadowing
63
Diagnosis of breast cancer requires what?
Biopsy
64
What type of biopsy will give adequate information for initial treatment decisions?
Image guided core needle bx
65
What are the three disciplines of breast cancer treatment?
Surgery
Radiation
Systemic tx (Chemo or hormone blockade)
66
Surgical options include _________ but not _________.
Radiation, not chemo
67
Breast conserving therapy requires_______.
postoperative radiation
68
What are the goals of breast cancer surgery?
Clear margins
| Adequate staging of the cancer (lymph node status, tumor size)
69
What are the two surgical options for breast cancer?
Breast conserving therapy
| Mastectomy
70
What is included in a lumpectomy?
Lumpectomy and sentinel node
71
When is axillary node dissection necessary?
If more than 2 sentinel nodes are positive
72
What always follows a lumpectomy?
Radiation therapy
73
When is radiation therapy necessary with mastectomy?
Only if tumor >5cm, margins positive, or lymph node is positive (4)
74
Which surgical option has a higher survival rate?
Neither. Both have same survival rates
75
What are the contraindications of breast conservation therapy?
- 2 or more tumors in separate quadrants or diffuse microcalcifications throughout breast or inflammatory breast cancer
- Hx of previous radiation to the chest/breast
- Pregnancy (can’t do radiation)
- Inability to clear margins
- Presence of active autoimmune diseases, esp scleroderma or lupus which can lead to complications from radiation
76
What is the schedule for whole breast radiation?
5 days per week for six weeks
77
What are the side effects of whole breast radiation?
Fatigue, skin changes, low risk of cardiac or pulmonary effects
78
How is mammosite (partial breast irradiation) conducted?
Placement of a balloon catheter into lumpectomy cavity and twice daily radiation for 5 days
79
What is lumpectomy and sentinel node biopsy?
```
Usually an outpatient procedure
Takes 1-2 hours
Requires general anesthetic
Usually leaves 2 separate incisions
Recovery is fairly rapid
```
80
What happens intraoperatively if 3 SNLs are found to be positive?
axillary LN dissection
81
What can be used for reconstruction following mastectomy?
Implants (often by way of tissue expanders)
TRAM flap or latissimus flap using pts own tissue
DIEP flaps (deep inferior epigastric perforators)
82
Describe mastectomy
Requires general anesthetic and overnight hospital stay
SLN bx is usually done in conjunction with mastectomy and will dictate amount of axillary dissection is completed
1-2 drains for 1-2 weeks
Slightly longer operation
Takes a bit longer to recover – more stiff and sore, especially with reconstruction
83
How is chemo used as adjuvant therapy?
In combination with breast conserving therapy in the absence of detectable disease or spread to prevent or delay recurrence
84
How is chemo used as neo-adjuvant therapy?
Treatment given in pre-op setting may shrink the tumor
Provides evidence of whether the chemo will work
May shrink large or fixed tumors to allow clearance of margins and makes BCT more feasible
Complete response found in pathology after neoadjuvant offers good prognosis
85
What is the usual order of tx for breast cancer?
surgery, chemo (if indicated), followed by radiation, then hormone blockade
86
When is neo-adjuvant chemo given?
for inflammatory breast cancer, always followed by postop radiation
87
What drugs are used in hormone blockade?
Tamoxifen and Aromatase inhibitors
88
What is tamoxifen?
Estrogen receptor blocker
89
What are armatase inhibitors
block production of estrogen
90
Who gets adjuvant chemo?
higher risk of recurrence
premenopausal
higher risk tumors (LN positive, larger tumor, ER negative)
Certain oncotypes (genetics of tumors) when uncertain if woman will benefit from chemo
91
What are the risks and side effects of tamoxifen?
uterine cancer, blood clots
| hot flashes
92
What are the benefits of tamoxifen?
Increase bone density and lower cholesterol
93
What types of tumors is tamoxifen used for?
ER positive
94
What is the efficacy of tamoxifen?
Prevents 1 of 2 recurrences
| Prevents 1 of 3 deaths
95
What is irreversible ovarian ablation?
Surgical removal (worthwhile for BRCA +)
96
What is reversible ovarian ablation?
GNRH agonist (Zoladex)
97
What affect does menopause (often chemo-induced) have on breast cancer?
Higher survival
98
What are the sources of estrogen in post-menopausal women?
adrenals and subQ fat
99
What enzyme converts precursors into estrogen?
aromatase
100
What are the names of aromatase inhibitors?
Anastrozole (arimidex), Letrozole (femara), and exemestane (aromasin)
101
What is Her2-neu?
Oncogene that is over expressed in 30% of breast cancers
102
What medication is an antibody to Her2-neu?
Trastuzumab (herceptin)
103
What is herceptin used in combination with?
Chemo
104
What is the risk with herceptin and how is it monitiored?
Heart failure; MUGA scans
