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Flashcards in Breast Deck (12)
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Breast cancer incidence

1 in 8 lifetime for women

2% of women less than 30 get breast cancer


Risk factors for breast cancer


Age at menarche (55)

Cancer of breast (self or family)

Pregnancy of first child > 30

Benign biopsy of breast is risk factor for breast cancer


Breast cancer symptoms

No symptoms, mass, pain (most are painless), nipple discharge, edema, nipple retraction, dimple, nipple rash


Workup for breast cancer

Mammogram - look for mass, microcalcifications, stellate/speculated mass

- FNA (can't tell invasive vs in situ), core (can be rad guided) and excisional

U/S good for cysts

CXR (for lung mets)

LFTs (for liver mets)

Labs: Calcium, alk phos (both change with bone mets)

Check for estrogen and progesterone receptors to assess adjuvant treatment


Benign breast changes

Fibrocystic changes = rubbery and cystic changes in breast, varies with menstrual cycle

Fibroadenoma = collagen in swirls, most common in young women
- Phyllodes is variant that can be malignant

Intraductal papilloma = most common cause of bloody nipple discharge


Premalignant breast changes

DCIS (may progress to malignancy) - 1cm perform lumpectomy with 1cm margins + radiation OR total mastectomy

LCIS - incidental on bx. Seen as risk factor for breast cancer, always monitor other breast


Malignant breast changes

Invasive ductal carcinoma = #1

Invasive lobular

Inflammatory = most lethal

Paget's = nipple changes with discharge


Breast cancer staging

1 = tumor 5cm N0

3A = > 5cm tumor with mobile nodes OR any size with fixed axillary nodes

3B = Any tumor with ipsilateral internal mammary nodes OR peu d'orange OR chest wall invasion OR inflammatory cancer OR breast skin ulceration

4 = distant mets


Breast cancer treatment

1) Lumpectomy, axillary node dissection OR sentinal node w/radiation - stage 1 and 2

contraindicated if had previous radiation, +margins, extensive DCIS --- Do mastectomy

2) Modified radical mastectomy: breast, axillary nodes (II and I), nipple removed, place drains

Radical = take breast, pec major and minor, axillary nodes

Simple = entire breast removed but nodes left in place

3) Chemo - generally offered to women with stage 2 or more who are premenopausal
- role of neoadjuvant is good if want to conserve breast but must stage before beginning therapy to appreciate disease extent

4) Antiestrogen treatment - given for 5 years to people who are receptor +


Where do breast mets go?







Levels of axillary nodes

Level 1 = lateral to pec minor

Level 2 = deep to pec minor

Level 3 = medial ro pec minor


Nerves that can be injured during breast surgery

Long thoracic nerve - innervates serratus anterior (winged scapula)

Thoracodorsal nerve - innervates lats

Medial pectoral nerve - innervates pec minor and major

Lateral pectoral nerve - innervates pec major