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Flashcards in Breast Deck (35):
1

What is the functional unit of a breast?

Lobules that contain terminal ducts. This is where milk is produced. Ductules and ducts convey milk to the nipple.

2

Lymphatic drainage of the breast is through which nodes?

Axillary, mammary, central nodes

3

How are nodes characterized (level 1, etc)

Based on relation to pec minor
level 1 nodes are lateral to pec minor
level 2 nodes are beneath it
level 3 nodes are medial to it

4

What ligaments support the breast?

Cooper's ligaments

5

What nerves are in the axilla, and what do they innervate?

Thoracodorsal nerve- motor fn to lat. dorsi (dmg = weakness in shoulder abduction)
LTN- motor fn to serr. anterior (dmg = winged scapula)

6

List the kinds of benign breast lesions

simple cysts
fibroadenomas
papillomas
fibrocystic dz - group including firm nodular lesions, cysts, epithelial hyperplasia

7

Are phyllodes tumors malignant or benign?

They have "low malignant potential"

8

Most common malignant lesions of the breast

lobular carcinoma
ductal carcinoma (most common)
these can be non-invasive/in situ (don't penetrate the BM) or can be invasive (do penetrate BM)

9

What is inflammatory breast cancer?

Tumor invades the lymphatic channels.
May have warmth/tenderness at site of cancer.
Erythema and skin excoriation- peau d'orange

10

Paget's dz

Tumor cells invade the epidermal layer of skin
Can have nipple or areolar excoriation

11

Risk factors for breast ca

age
hx of BC in 1st degree relative
atypical hyperplasia
personal hx of BC
LCIS (lobular carcinoma in situ)

12

Most common tumor in young women?

Fibroadenoma

13

Most common cause of bloody nipple discharge?

Intraductal papilloma (benign)

14

Most common breast malignancy?

Ductal carcinoma

15

Constitutional sx of cancer

weight loss
nausea
malaise
bone pain (if skeletal mets)

16

Fibroadenoma physEx characteristics

well-circumscribed
mobile

17

Concerning signs on physEx

breast asymmetry
dimpling or retractions
excoriation or edema of skin
^all are extremely sensitive for malignancy
also, firmness and indistinct borders
may have lymphadenopathy, bloody discharge

18

Mammogram characteristics susp for malignancy

Densities w irreg margins
Spiculated lesions (spiky)
Microcalcifications
Rodlike/branching patterns
Changes from prev mammogram

19

Dx eval for non-palpable abnormalities on mammogram

Needle-directed biopsy- place a needle at the lesion using mammography, then surgeon uses needle to locate lesion

20

Dx eval for palpable masses

FNA, aspirate sent to cytology.

21

If a palpable mass is aspirated, what characteristics make malignancy unlikely

If all of these criteria are present, unlikely:
mass completely disappears after aspiration
it doesn't return
fluid is hemoccult-negative
if these criteria are NOT met, need to do a biopsy

22

Lumpectomy

removal of lesion w negative margins

23

mastectomy

removal of all breast tsu on the affected side

24

axillary node dissection

removal of all level 1 and level 2 nodes (lateral and beneath pec minor)

25

Modified radical mastectomy

mastectomy + ax node dissection

26

Sentinel node biopsy

inject blue dye/radioactive sulfur colloid around tumor, wait for it to go to lymph nodes.dissect only the lymph node that is blue/radioactive and send it to path.
if it's positive for ca, go back later a dissect the other ax lymph nodes

27

What is DCIS? and Rx?

ductal carcinoma in situ
PRE-malignant lesion.
2 rx options:
local excision w neg margins + radiation
mastectomy without radiation

28

What is LCIS? and Rx?

lobular carcinoma in situ
a "condition" not a lesion- pts have incrsd risk of ca but can be in either breast, unrelated to lesion biopsied.
2 rx options:
careful follow-up (physEx, mammography)
bilateral prophylactic mastectomy (more extreme, only in selected cases)

29

Rx for Stage I or II breast ca

surgical removal of tumor w negative margins, assess regional lymph nodes (sentinel node biopsy)
can do lumpectomy or mastectomy.
if mastectomy, add radiation

30

Indications that favor mastectomy for Stg I or II

multiple tumors
prior radiation
large lesions
positive lumpectomy margins.
if choosing mastectomy, add radiation.

31

Rx for Stage III or IV

Surgical resection for local control plus rad or chemo, since surgery only treats local, known.

32

Endocrine therapy for BC

if tumor expresses estrogen receptor- has 30% chance of responding to endo therapy. if it also expresses progesterone receptor, the probability increases to 70%.

33

How do aromatase inhibitors work?

They prevent the production of estrone and estradiol.
They are generally better than tamoxifen.

34

Chemo regimens

CMF: cyclophosphamide, methotrexate, 5-fluorouracil
AC: doxorubicin and cyclophosphamide
Tamoxifen

35

Pgx of BC based on staging

5 year dz-free survival:
stg 1 80%
stg 2 60%
stg 3 20%
stg 4 unlikely
presence of estrogen and progesterone receptors improves survival rates.