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cape cod surgery > breast questions > Flashcards

breast questions Flashcards

1
Q

What are the 6 borders of the breast?

A 
Superior=clavical
Lateral=latissmis dorsi
Medial=sternum
Inferior=rectus abdominus
Anterior=subcutaneous fat
Posterior=Pec major
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2
Q

What are Cooper’s Ligaments?

A

White suspensory ligaments of the breast

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3
Q

Name of the breast suspensory ligaments?

A

Cooper’s Ligaments

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4
Q

Where and what is areola?

A

Small circular area of pigmented skin surrounding the nipple

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5
Q

Name of the opening of the areola?

A

Nipple

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6
Q

Which lymph nodes receive 3/4 of the breast lymph?

A

Axillary

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7
Q

4 different types of breast cancer?

A
  1. DCIS
  2. Ductal invasive carcinoma
  3. LCIS (lobular carcinoma in situ)
  4. Lobular invasive carcinoma
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8
Q

What does DCIS stand for?

A

Ductal Carcinoma in situ

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9
Q

What does DCIS mean about the carcinoma?

A

It has not invaded past the basement membrane

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10
Q

Which lymph node can breast carcinoma easily spread to?

A

Axillary lymph nodes

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11
Q

Where are Level I lymph nodes

A

Inferior lateral to pec minor muscle

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12
Q

Where are Level II lymph nodes?

A

Deep to the pec minor

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13
Q

Where are Level III lymph nodes?

A

Superior-medial the pec minor muscle

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14
Q

5 types of mastectomies?

A
  1. Radical mastectomy
  2. Modified radical
  3. Simple mastectomy mastectomy
  4. Subcutaneous mastectomy
  5. Lumpectomy
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15
Q

What is removed in a Modified Radical Mastectomy?

A

Simple mastectomy plus removal of Lymph Noes level 1 and 2

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16
Q

What is removed in a Simple Mastectomy?

A

Skin, breast tissue, subcutaneous fat, and cooper’s ligaments

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20
Q

Describe Radical Mastectomy (hint: 3 parts)

A
  1. Simple mastectomy
  2. Removal of pac major and minor
  3. Removal of Lymph Nodes levels I, II, and III
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21
Q

Who gets a Subcutaneous Mastectomy?

A

Males

22
Q

3 risks of PT with BRCA gene?

A
  1. Breast cancer
  2. Ovarian cancer
  3. Recurrence
23
Q

Normally perform a lymphnode biopsy after mastectomy for DCIS?

A

No. In situ and not invaded past basement membrane.

24
Q

What is Sentinel Node?

A

First node where lymph drains to

25
Q

Purpose of Sentinel Node biopsy?

A

Staging of carcinoma

26
Q

What happens to mapping of the lymphatic drainage after simple mastectomy?

A

Mapping destroyed so sentinel node biopsy not useful

27
Q

Is there a mass with DCIS?

A

No

28
Q

How are lymph nodes detected? (hint: 2 things)

A
  1. Technecium-99

2. Isosulfan blue dye or methylene blue due

29
Q

Where is isosulfan blue dye injected?

A

Subareolar/paraareolar area

30
Q

Why is isosulfan blue injecte into the subareolar/paraareolar area?

A

Where lymph drainage follows and stains the lymphatic map

31
Q

How does Tc-99 detect lymph nodes?

A

Probe detecting concentration of Tc-99 will emit number around 20,000

32
Q

How long to hold Tc-99 probe on LN?

A

10 seconds

33
Q

What does Tc-99 emit that the probe picks up?

A

Gamma rays

34
Q

How to determine which lymph nodes to take out?

A

All LNs that have 10% of highest number (highest 20,000 take nodes 2000)

35
Q

How many LNs normally removed?

A

About 20

36
Q

Name of pathology quick test for presence of cancer in LN?

A

Touch Prep. Done during surgery.

37
Q

What to do it Touch Prep is positive for cancer?

A

Remove all axillary LNs

38
Q

2 main complications of complete axillary LN removal?

A
  1. Lympheema

2. Brachial plexus neuropathy

39
Q

Why palpate axilla after sentinel node biopsy?

A

Find nodes not detected by probe

40
Q

Why would LNs not be detected by probe?

A

Brease tumor can cause lymphatic blockage and prevent Tc-99 and blue dye from draining into entire breast

41
Q

Med class of breast cancer meds?

A

Estrogen receptors

42
Q

Which estrogen receptor is better for younger women?

A

Tamoxifen

43
Q

Which estrogen receptor is better for older women?

A

Raloxifen

44
Q

What type of inhibitors are preferred in older women?

A

Aromatase inhibitors

45
Q

Lumpectomy aka?

A

Breast Conserving Therapy

46
Q

2 CIs to Breast Conserving Therapy?

A
  1. Multicentric disease (cancer located in more than 1 quarant, diffuse microcalcification on mammogram)
  2. Prior radiation (due to prior tissue damage)
47
Q

5 relative CIs to Breast Conserving Therapy?

A
  1. CREST syndrome
  2. SLE
  3. Preggers
  4. Large tumor in relation to breast
  5. Persistent + margins s/p re-excision

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