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Flashcards in Breast Deck (12)
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1

Breast cancer incidence

1 in 8 lifetime for women

2% of women less than 30 get breast cancer

2

Risk factors for breast cancer

Nulliparity

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

3

Breast cancer symptoms

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

4

Workup for breast cancer

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

Biopsy
- 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

5

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

6

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

7

Malignant breast changes

Invasive ductal carcinoma = #1

Invasive lobular

Inflammatory = most lethal

Paget's = nipple changes with discharge

8

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

9

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 +

10

Where do breast mets go?

LN

Lung

Liver

Bones

Brain

11

Levels of axillary nodes

Level 1 = lateral to pec minor

Level 2 = deep to pec minor

Level 3 = medial ro pec minor

12

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