breast

Question 1

breast extends from

Answer 1

2nd to 6th rib and the sternal border to the mid axillary line

circular except the tail of spence

Question 2

what are the strands of connective called that hold the breast upward

Answer 2

cooper’s ligament

Question 3

make up of the breast where milk is produced

Answer 3

lobules

Question 4

what carries breast milk to the tissue

Answer 4

ducts

Question 5

C5-7

what does it do

Answer 5

LONG THORACIC

supplies serrates anterior

medial to the thoracodorsal nerve

Question 6

nerve responsible for sensory to the breast tissue

Answer 6

lateral cutaneous nerve T4

Question 7

injury to the long thoracic causes

Answer 7

winged scapula

Question 8

lymphatics are important because

Answer 8

guide the surgery

usually do core biopsies in radiologist

invasive ductocarcenoma

staging and treatment is based on lymphatics

Question 9

1st lymph node that drains out of the breast

Answer 9

sentinel node
(gatekeeper)
this is the node in which the tumor drains

Question 10

how do they perform a sentinel node in a sentinel node biopsy

Answer 10

radioactive isotope is injected into the breast

as well as blue dye

helps us find the sentinel node

and it is REMOVED

so we usually see two incisions, one where the node biopsy was done and one where the actual mass was taken out

Question 11

this hormone stimulates breast development

Answer 11

estrogen

Question 12

progesterones role in breast development

Answer 12

stimulates breast lobules

Question 13

anti estrogen pill therapy is given to

Answer 13

women at risk of developing breast cancer

and to prevent reoccurrence

Question 14

need to bring pt in within ____ if she says she feels a mass

what should the PCP do

Answer 14

1 week

exam her and document

don’t try to work it up, don’t send for a biopsy

if you feel something send her to a breast center to see a breast surgeon

usually you will get a diagnostic mammo and then send to a center for a biopsy

Question 15

neoadjunctive chemo

Answer 15

given before surgery for triple negative (estrogen, progesterone, HER2 negative)

can completely get rid of that before surgery

the same goes for lymph node involvement

Question 16

screening mammogram

when would you use them and what views are utilized

Answer 16

according to Candice every year after 40? but according to USPS 50-74 EVERY 2 YEARS

craniocaudal
medial lateral oblique

Question 17

what does a diagnostic mammogram involve

Answer 17

special views and usually with an ULS

usually the two regular views

Question 18

how to document mass

Answer 18

mass is a 1 o clock right breast three centimeters from the nipple

Question 19

how to inspect and evaluate a pt who states they have observe a mass

Answer 19

arms above her head

flex pectoralis

sitting up (?) palpate the breast and lymph nodes

make sure the patient is relaxed

how to differentiate a suspicious lymph node from regular: hard fixed, usually 2cm

Question 20

breast pain

Answer 20

not really an emergency

without a mass

if she recently had a mammogram do not order another one if there is nothing else going on

maybe bring her back in a month

try to evaluate if it is around her cycle

Question 21

nipple inversion

Answer 21

very common

document it in her chart

ask her how long this has been going on

if it is new–> get a diagnostic mammogram and send to a specialist

can see this in new weight loss

Question 22

red breast

what is on your ddx

Answer 22

need to have inflammatory breast cancer on your differential

treat with antibiotics and see her back in a week

if not resolved need to work up

Question 23

inflammatory breast cancer

Answer 23

red and inflamed because the cancer is disturbing the lymphatics

swollen
but usually not warm and tender

Question 24

micro calcifications

Answer 24

precancerous signs that can be detected on mammogram

if suspicious biopsy recommended

Question 25

breast implants studies

Answer 25

would still do mammogram maybe a ULS not MRI that is a adjunctive test

Question 26

go to for women <30 with a mass

Answer 26

ULS most women under 30 just have a cyst

Question 27

when to order FNA

Answer 27

usually just for suspicious lymph nodes you do core biopsy for the rest

Question 28

stereotactic core biopsy

Answer 28

this is the x ray guided biopsy that we usually see unless you see a mass on ULS and then you would have a ULS guided core biopsy

Question 29

serum antigen tests associated with breast cancer

Answer 29

15-3 | 27-29

Question 30

most women with breast cancer are diagnosed after age

Answer 30

50 if under that age usually genetic testing is done (referral to cancer genetics)\

Question 31

high risk screening

Answer 31

clinical breast exam every 6 mos Mammogram once a year MRI once a year

Question 32

risk factors for breast cancer

Answer 32

hormone replacement therapy radiation to the chest wall (non Hodgkins lymphoma) obesity (estrogen produced by fat cells) late menopause first pregnancy after 35 infertility and nulliparity alcohol abust 2-5 drinks a day roughly 7 drinks a week for women (liver not making binding proteins for the transport of alcohol)

Question 33

role of receptors in breast cancer

Answer 33

estrogen is most common (75%) progesterone (65%)

Question 34

which receptors do we treat with chemo

Answer 34

HER2 + -herceptin and triple negative -chemo first

Question 35

BRCA1 is associated with

Answer 35

tipple negative breast cancers and pancreatic cancer

Question 36

pancreatic cancer screening

Answer 36

long standing history of low back pain and jaundice no way to screen usually life span is about 6 months after diagnoses

Question 37

BRCA 1 and BRCA 2 treatment

Answer 37

5-10% are genetic mutations can do high risk screening or mastectomy

Question 38

how does breast cancer in men differ

Answer 38

1% incidence usually detected later in life 60-70

Question 39

RF for breast cancer in men

Answer 39

``` testicular cancer klienfelters transgender receiving estrogen therapy hx of family breast cancer gynecomastia liver cirrhosis and alcohol and abuse ``` hx of prostate cancer and BPH with hormone tx of finasteride BRCA1 or BRCA2 (40% breast CA)

Question 40

most common type of breast cancer in men

Answer 40

infiltrating ductal carcinoma

Question 41

most breast cancers in men are

Answer 41

estrogen receptor + (85%) so need to block estrogen

Question 42

evaluation of breast cancer in men

Answer 42

FNA of lymph node core biopsy most will have stage I

Question 43

non invasive breast cancer

Answer 43

DCIS confined to the duct ductal carcinoma in situ usually seen as calcifications can't feel lit remove it surgically radiation pill therapy (Lobular you would not see calcification)

Question 44

invasive breast cancer

Answer 44

can only be defined with core biopsy with microscope has left the duct need to check lymph nodes with sentinel lymph node biopsy

Question 45

paget's

Answer 45

breast disease of the nipple need to do a biopsy (no surg treat with chemo?)

Question 46

presentation of inflammtory breast cancer

Answer 46

(less than 1/3 suspect cellulitis) pain burning red or purple peu de orange signifies lymphatic blockage most malignant

Question 47

lumpectomy vs mastectomy

Answer 47

sub-nipple biopsy take tissue from underneath the nipple.

Question 48

axillary dissection

Answer 48

if a woman has had chemo and at the time of surgery she still has cancer in her lymph node if cancer is still in the lymph node after chemo and during surgery

Question 49

who is at risk of lymphedema

Answer 49

older heavier axillary dissection removed a bunch of lymph nodes and disrupted the lymphatic channels