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Repro > Breast > Flashcards

Breast Flashcards

1
Q

Name part of the breast that extends to the axillary fossa

A

Axillary tail of spence

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2
Q

What determines breast size and shape?

A

Genetics, race and diet

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3
Q

Vertical and transverse relations of breast

A

Extends 2/3rd to 6th rib vertically

Sternum to midaxillary line

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4
Q

The breast rests on top of what tissue

A

Deep pectoral fascia

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5
Q

Function of retromammary space

A

Aid in pectoral movement

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6
Q

What does the pectoral fascia cover?

A

Pectoralis major

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7
Q

Two thirds of the breast lies on pectoral fascia. Where does the other third lie?

A

Fascia of serratus anterior

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8
Q

What attaches the breast tissue to the dermis?

A

Suspensory ligaments of Cooper

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9
Q

What type of tissue is the nipple made up of?

A

Collagenous, dense connective tissue
Elastic fibres
Bands of smooth muscle

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10
Q

Approximate position of the nipple

A

4th ICS

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11
Q

Dermatome of the Nipple

A

T4

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12
Q

What is the areola?

A

Skin covering containing sweat and sebaceous glands

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13
Q

Purpose of sebaceous secretions of areola

A

Protective lubricant

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14
Q

How many lobules are there in one breast?

A

Around 15-20

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15
Q

What structures drain the lobules of the breast?

A

Lactiferous ducts

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16
Q

Name the dilated portion of the lactiferous ducts

A

Lactiferous sinus

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17
Q

How is the breast divided for anatomical and pathological descriptipon?

A

Quadrants
Superolateral/medial
Inferolateral/medial

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18
Q

When does breast development begin?

A

4th week

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19
Q

Where do mammary crests extend from in initial breast development?

A

Axilla to inguinal region

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20
Q

Where do mammary crests persist after development?

A

Pectoral region

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21
Q

The mammary crest gives rise ot which structures in breast development?

A

Primary mammary bud

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22
Q

From what structure do lactiferous ducts and branches originate?

A

Secondary mammary buds

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23
Q

What is polymastia?

A

Extra breast

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24
Q

What is plythelia?

A

Extra nipple

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25
Q

What is athelia and amastia?

A

Absence of nipple and breast

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26
Q

What is the blood supply to the breast?

A

Thoracoacromial artery
Internal mammary artery
Lateral thoracic artery

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27
Q

Nerve supply to the breast

A

Sensory fibres from anterior and lateral cutaneous branches of 4-6th intercostal nerves
Sympathetic supply to blood vessels and smooth muscle

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28
Q

From which quadrant is the majority of breast lymphatic drainage?

A

Lateral quadrant to axillary nodes

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29
Q

To where does lymph from medial parts of the breast drain to?

A

Parasternal nodes or opposite breast

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30
Q

Other lymph nodes in addition to axillary that provide drainage in the breast

A

Supraclavicular

Inferior cervical

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31
Q

What investigation can be used to gauge metastasis in the breast?

A

Sentinel lymph node biopsy

-Radiolabelled colloid detection to map lymph drainage

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32
Q

What type of tissue surrounds the lobules in the breast?

A

Dense fibrocollagenous connective tissue

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33
Q

What type of tissue is intralobular breast tissue?

A

Loose connective tissue

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34
Q

What is the milk secretory component in breast tissue?

A

Terminal lobular duct

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35
Q

Which types of cells line the ducts and acini in the breast?

A

Luminal epithelial cells and myoepithelial cells

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36
Q

What structures are absent in the neonatal breast?

A

Alveoli

Do contain lactiferous ducts

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37
Q

What changes occur in the breast during puberty?

A

Branching of lactiferous ducts
Granular polyhedral cells (alveoli)
Adipocytes fill with lipids

38
Q

What changes occur in the breast post menopause?

A

Atrophy of of lobules and ducts

Replacement of glandular tissue with fatty tissue

39
Q

What changes occur in the breast during pregnancy?

A

Enlarged lobles
Dilated acini
Epithelium - cuboidal to low columnar
Colostrum available few days after birth

40
Q

What does colostrum contain?

A

Protein rich fluid with antibodies

41
Q

What changes occur in the breast during lactation?

A

Acini distended with milk

Thinner septa

42
Q

What reflex triggers milk production?

A

Neurohormonal when child suckling

Prostanglandin and oxytocin driven

43
Q

Diagnostic investigations in breast

A

History and examination
Imaging - Mammography and Ultrasound
Cytology - FNA and core biospy

44
Q

Breast cancer accounts for what percentage of cancers in women?

A

20 percent

45
Q

Types of benign breast tumours

A 
Fibroadenoma (most common)
Duct papillomas
Adenomas
Connective tissue tumours
Phyllodes tumour
46
Q

Which type of breast cancer is Paget’s disease associated with?

A

Ductal or invasive carcinoma

47
Q

At what age are women offered breast cancer screening in Scotland?

A

50-74

Every 3 years

48
Q

What standard views are taken in mammography?

A

Mediolateral oblique

Craniocaudal

49
Q

What additional views may be utilised in mammography?

A 
Coned
Magnification view
True lateral
Extended CC
Eclund
50
Q

What factors indicate need for earlier screening in patients?

A

Family history

Past radiation exposure

51
Q

How is cancer assessed in a mammogram?

A 
Mass
Assymetry
Architectural distortion
Calcifications
Skin changes
52
Q

What type of tumour appears as ‘popcorn calcification’ in a mammogram?

A

Calcified fibroadenoma - benign

53
Q

What investigation can distinguish solid mass from cyst?

A

Ultrasound

54
Q

What investigation is first line for ?breast cancer in under 40s?

A

Ultrasound - no radiation

55
Q

How will benign breast tumours apear on ultrasound?

A

Smooth, oval shape

Acoustic enhancement

56
Q

How can malignant tumours be differentiated from benign on ultrasound?

A

Irregular outline
Interrupts architecture
Acoustic shadowing
Anterior halo

57
Q

What is the indication for MRI in breast cancer diagnosis?

A

Indeterminate diagnosis following triple therapy
Breast implants
Recurring disease
Screening high risk women

58
Q

Curative treatment for cysts in breast

A

Aspiration

59
Q

When would cystic fluid be kept for sample on aspiration?

A

If blood stained or residual mass after aspiration

60
Q

Complications of aspiration

A 
Pain
Haematoma
Fainting
Infection
Pneumothorax
61
Q

What 3 conditions can nipple discharge be indicative of?

A

Duct ectasia
Intraduct papilloma
Intraduct carcinoma

62
Q

Risk factors for breast cancer

A 
Age
Previous breast cancer
Previous radiation exposure
Family history - genetic BRCA 1 or 2
First pregnancy at later age
HRT
OCP
Alcohol
Weight
Early menarche
Late menopause
63
Q

Symptoms of breast cancer

A 
Palpable mass
Mastalgia - persistent unilateral pain
Nipple discharge
Nipple changes
Change in size or shape of breast
Lymphoedema - swellling in axilla
Dimpling of breast skin
64
Q

What investigations can be used in staging of breast cancer?

A

Bloods - FBC, U&Es, LFTs. Calcium and phosphate

Chest and abdominal X ray

65
Q

Factors indicating greater risk of recurrence of breast cancer

A

Nottingham Porgnostic Index
Steroid receptor status
HER 2 status
Lymphovascular invasion

66
Q

Preventative therapy for breast cancer recurrence

A

Local radiotherapy

Systemic - hormonal, chemotherapy, targeted immunotherapy

67
Q

Complications of radiotherapy

A 
Skin reaction - telangiectasis
Radiation pneumonitis
Cutaneous radionecrosis
Osteonecrosis
Angiosarcoma
68
Q

In which group of patients with breast cancer would hormonal therapy be used?

A

Oestrogen receptor positive

69
Q

Mechanism of action of tamoxifen

A

Blocks oestrogen receptor

70
Q

Dose recommended of tamoxifen

A

20mg daily 5-10 years

71
Q

Side effects of tamoxifen

A

Thromboembolic events

Increased risk of uterine carcinoma

72
Q

In which group of patients is aromatase inhibitors recommended for breast cancer treatment?

A

Postmenopausal

73
Q

Examples of aromatase inhibitor medication

A

Arimidex, Letrozole

74
Q

Recommended course of aromatase inhibitors

A

Daily for 5 years

75
Q

Mechanism of action of aromatase inhibitors

A

Blocks oestrogen synthesis

76
Q

Side effect of aromatase inhibitor use

A

Osteoporosis

77
Q

What type of medication is trastuzumab?

A

Herceptin

Monoclonal antibody against HER 2 receptors

78
Q

What must be monitored during immunotherapy treatment?

A

Heart function

Cardiotoxicity is common side effect

79
Q

Indications for breast conserving treatment

A

Localised operable disease

No evidence of metastasis

80
Q

Most common breast conserving treatment

A

Wide Local Excision

81
Q

What is removed in a mastectomy?

A

All of the tissue in the affected breast along with portion of overlying skin

82
Q

Indication for mastectomy

A 
Multifocal disease
High tumour to breast tisue ratio
Disease recurrence
Patient choice
Risk reducing cases
83
Q

Why is axillary surgery also performed alongside WLE and masectomies?

A

To assess nodal status and remove any nodal disease

84
Q

Two examples of axillary surgery

A

Sentinel node biopsy

Axillary node clearance

85
Q

Complications of axillary node clearance

A

Paraesthesia
Seroma formation
Lymphoedema

86
Q

Factors that can indicate need to consider risk reducing breast surgery

A

Strong family history of breast and ovarian cancer
BRCA 1, BRCA 2, PTEN or TP53
Previous history of breast cancer

87
Q

Examples of oncoplastic treatment and surgical reconstructive techniques

A

Therapeutic mammoplasty

Flap formation

88
Q

Types of flap formation

A

Latissimus dorsi
Transverse Rectus Abdominis flap (TRAM)
Deep Inferior Epigastric Perforator Flap (DIEP)

89
Q

What is involved in therapeutic mammoplasty?

A

WLE and breast reduction

Smaller, uplifted breast with nipple and areola preserved

90
Q

What is the advantage of DIEP, over TRAM and Latissimus Dorsi Flap formation?

A

No reduction in abdominal strength

Repro (12 decks)

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