Breast Flashcards
(33 cards)
What is the difference between simple, modified radical and radical mastectomy?
Simple (total): mammary tissue and pectoralis fascia
MRM: simple mastectomy + axillary dissection (level I and II)
Radical: Simple + pec minor/majory + ax dissection
What conditions are associated with BRCA 1 and BRCA 2?
BRCA 1: 60% breast, 40% ovarian risk; often triple negative disease
BRCA 2: 40% breast, 20% ovarian; male breast cancer, prostate cancer, pancreatic cancer, stomach, GB and melanoma; usually ER/PR +
What is the screening for BRCA + patients?
MRI @ age 25
Mammogram 30
Ovarian screening 30
Monthly self exam at 18
Biannual clinical breast eval at 25
How do you treat BRCA mutations in men?
Do not need high risk screen or prophylactic mastectomy but may benefit from early prostate exams.
What margins are needed for resection of phylloides tumors and what do these tumors stain positive for?
WLE with 1 cm margins; stain positive for vimectic and actin similar to sarcoma
What is the treatment regimen for inflammatory breast cancer?
Neoadjuvant chemotherapy –> MRM –> radiation to include supra and infraclavicular basins.
DO NOT perform SLNBx bc it will not be accurate
What is the key pathologic feature of LCIS?
Lack of epithelial cadherin expression; More likely to be HER-2 negative but hormone receptor +
When do you do a SLNBx for DCIS? (4)
Size >4 cm
Palpable mass
Mastectomy
Microinvasion
Why do you have to do an axillary dissection with inflammatory breast cancer?
Because lymphatic involvement makes SLNBx unreliable
What cancers are the following associated with:
Li fraumeni
Cowden
AT
Muir-Torre
LF: sarcoma, brain tumors, leukemia, breast, adrenal corticoid
Cowden: Thyroid, endometrial, breast, mucocutaneous
AT: breast, cerebellar, lymphoma, leukemia
Muir-Torre: Skin, GI, GU
Which nerve innervates the serratus anterior?
Long thoracic nerve
*Injury results in winged scapula
Which nerve innervates the latissimus dorsi?
Thoracodorsal
**Injury results in arm weakness and difficulty with adduction
What innervates the pec major and minor?
Medial pectoral nerve
What nerve innervates the pec major only?
Lateral pectoral nerve
What is the most commonly injured nerve in mastectomy?
Intercostobrachial nerve
What is a galactocele?
Breast cysts filled with milk
What is the most aggresive type of DCIS?
Comedo type
*Mastectomy recommended
What margins are needed for DCIS?
> 2 mm; do not need SLNBx unless doing a mastectomy in case the specimen is upstaged
What cancer are women with LCIS most likely to get?
Ductal cancer
Pleomorphic LCIS is most aggresive type
What is the next step if a core needle biopsy result is discordant with imaging findings?
Need excisional bx
What size does a breast mass need to be to be diagnosed on mammogram?
5 mm
What is the location of level I-III lymph nodes?
I: lateral to pec minor
II: beneath pec minor
III: medial to pec minor
**Need to take level I and II for an ax dissection
What is the most important prognostic factor for breast cancer?
Lymph node status
*Bone is most common spot for distant metastasis
What are the T and N staging for breast cancer?
T1: <2
T2: 2-5
T3: 5+
T4: Any size with direct extension to chest wall (not including pec major)
N1: 1-3
N2: 4-9
N3: 10+ or infraclavicular or supraclavicular nodes
