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Flashcards in SR 56 - Breast Deck (66):
1

What are the boundaries of the axialla?

Superior - axillary vein
Posterior - Long thoracic nerve
Lateral - Latissimus dorsi muscle
Medial boundary - Pectoral minor muscle (lateral, deep or medial to)

2

What four nerves are at risk during an axillary dissection?

Long thoracic nerve
Thoracodorsal nerve
Medial pectoral nerve
Lateral pectoral nerve

3

Location of and muscle innervated?
Long thoracic nerve

Lateral chest wall in midaxillary line on serratus anterior muscle
Innervates serratus anterior muscle

4

Location of and muscle innervated?
Thoracodorsal nerve

Lateral to long thoracic ner on lattisimus dorsi muscle
Innervates lattisimus dorsi muscle

5

Location of and muscle innervated?
Medial pectoral nerve

Runs laterl to or through th pectoral minor muscle; latearl to lateral pectoral nerve
Inervates pectoral minor and major

6

Location of and muscle innervated?
Lateral pectoral nerve

Medial to medial pectoral nerve
Innervates pectoral major

7

What deformity do you get if you cut the long thoracic nerve?

Winged scapula

8

Name of the cutaneous nerve the crosses the axilla in a transverse fashion?

Intercostobrachial nerve

9

What is the large vein that akrs the upper limit of the axilla?

Axillary vein

10

Lymphatic drainage of the breast?

Lateral - axillary LN
Medial - parasternal LN that run with internal mammary artery

11

What are the levels of axillary LN?

Level I (low) - lateral to pectoral minor
Level II (middle) - deep to pectoral minor
Level III (high) - medial to pectoral minor

12

What are Rotter's nodes?

Between the pectoralis major and minr muscles
Only removed if tehy are enlarged or feel suspicious intraoperatively

13

suspensory breast ligaments?

Cooper's ligaments

14

What is the tail of Spence?

Breast tissue that tapers into the axilla

15

Which hornome is mainly responsible for breast milk production?

Prolactin

16

Triad of error for misdiagnosed breast cancer?

Age

17

History risk factors for breast cancer?

Nulliparity
Age at menarch 55yo
Cancer of the breast (self or family)
Pregnancy with first child >30yo

NAACP

18

Physical/anatomic risk factors for breast cancer?

Cancer in the breast
Hyperplasia
Atypical hyperplasa
Female
Elderly
DCIS

LCIS
Inherited genes
Papilloma
Scloering adenosis

CHAFED LIPS

19

Possible symtoms of breast cancer?

No symptoms
Mass in breast
(Pain)
Nipple discharge
Local edema
Nipple retraction
Dimple
Nipple rash

20

Why does skin retraction occur in breast cancer?

Tumor involvement of Cooper's ligaments and subsequent traction on ligaments pull skin inwards

21

What are the signs of breast cancer?

Mass (1cm is smallest palpable)
Dimple
Nipple rash
Edema
Axillary/supraclavicular nodes

22

Different types of invasive breast cancer?

Infiltrating ductal carcinoma (75%)
Medullary carcinoma (15%)
Infiltrating lobular carcinoma (5%)
Tubular carcinoma (2%)
Mucinous carcinoma (cooloid) (1%)
Inflammatory breast cancer (1%)

23

Most common type of invasive breast cacner?

Infiltrating ductal carcinoma

24

DDx of a breast mass?

Fibrocystic disease of the breast
Fibroadenoma
Intraductal papilloma
Ductal ectasia
Fat necrosis
Abscess
Radial scar
Simple cyst

25

Breast exam recommendations?

Self-exam monthly
20-40yo - physician exam every 2-3 years
>40yo - physician exam yearly

26

Mammogram recommendations?

Baseline mammogram 35-40yo
Biyearly 40-50yo
Yearly >50yo

27

What is the classic picture of breast canc on mammogram?

Spiculated mass

28

Indications for a breast biopsy?

Persistent mass after aspiration
Solid mass
Blood in cyst aspirate
Suspicious lesion by mammography, US, MRI
Bloody nipple discharge
Ulcer or dermatitis of nipple
Patient's concern of persistent breast abnormality

29

What is a ‘radial scar’ seen on mammogram?

Spiculated mass with central lucency, +/- microcalcifications
Associated with Tubular carcinoma

30

When do you proceed to open biopsy for a breast cyst?

- Second cyst recurrence
- Bloody fluid in cyst
- Palpable mass after aspiration

31

Preop staging workup for patient with breast cancer?

Bilateral mammogram
CXR
LFTs
Serum calcium, alkaline phosphate
Other tests based on symptoms

32

Breast cancer - Stage I

Tumor

33

Breast cancer - Stage IIA

Tumor

34

Breast cancer - Stage IIB

Tumor 2-5cm
Mobile axillary node
OR
Tumor >5cm
No nodes

35

Breast cancer - Stage IIIA

Tumor >5cm
Mobile axillary node
OR
Any sized tumor
Fixed axillary nodes
No metastases

36

Breast cancer - Stage IIIB

Peau d'orange OR
Chest wall invasioin/fixation OR
Inflammatory cancer OR
Breast skin ulceration OR
Breast skin satellite metastases OR
Any tumor + ipsilateral internal mammary LN

37

Breast cancer - Stage IIIC

Any size tumor
NO distant mets
Positive - supraclavicular, infraclavicular, internal mammary LN

38

Breast cancer - Stage IV

Distant mets
Including ipsilateral supraclavicular nodes

39

Common sites of metastases in breast cancer?

LN
Lung/pleura
Liver
Bone
Brain

40

Major treatment options for breast cancer?

Modified radical mastectomy
Lumpectomy and radiation + sentinel LN dissection

+/- postop chemotherapy or Tamoxifen

41

Indications for radiation after a modified radial mastectomy?

Stage IIIA/B
Pectoral muscle/fascia invasion
Positive internal mammary LN
Positive surgical margins
>4 positive axillary LN postmenopausal

42

What carcinomas are candidates for breast-conserving therapy?

Stage I/II

43

Treatment for inflammatory carcinoma of the breast?

Chemo first
Then radiation and/or mastectomy

44

What is a modified radical mastectomy?

Breast, axillary nodes (level Ii, I) and nipple-areolar complex are removed
Pectoralis msucles are NOT removed
Drains in axilla and chest wall

45

When do you remove drains after axillary dissection?

46

Common options for breast reconstruction?

Transverse Rectus Abdominis Myocutaneous flap (TRAM flap)
Implant
Latissimus dorsi flap

47

AE of Tamoxifen?

Endometrial cancer
DVT, PE
Cataracts
Hot flashes
Mood swings

48

Chemotherapy for breast cancer?

CMF - Cyclophosphamide, Methotrexate, 5-Flurouracil
CAF - Cyclophosphamide, Adriamycin, 5-Fluorouracil

49

When do you use Tamoxifen?

ER +
Postmenopausal ER -

50

What make a high risk tumor?

>1cm in size
Lymphatic/vascular invasion
High nuclear grade
High S phase
ER negative
HER-2/neu overexpression

51

Most common cause of bloody nipple discharge in a young woman?

Intraductal papilloma

52

Most common breast tumor in patients younger than 30yo?

Fibroadenoma

53

Define paget's disease of the breast

Scaling rash/dermatitis of the nipple
Due to invasion of skin by cells from a ductal carcinoma

54

Risk factors for male breast cancer?

>65yo
Increased estrogens
Radiation
Gynecomastia from increased estrogen
Estrogen therapy
Klinefelter's syndrome (XXY)
BRCA2 carrier

55

What is the most common cause of green, straw-colored or brown nipple discharge?

Fibrocystic disease

56

What is the most common cause of breast mass after breast trauma?

Fat necrosis

57

What is Mondor's disease?

Thrombophlebitis of superficial breast veins

58

What must be ruled out with sponatneous galactorrhea (+/- amenorrhea)?

Prolactinoma
Pregnancy test and prolactin level

59

What is cystosarcoma phyllodes

Mesenchymal tumor arising from breast lobar tissue
Most are benign

60

What is a fibroadenoma?

Benign tumor of breast consisting of stromal overgrowth
Collagen arranged in swirls

Solid, mobile, well-circumscribed round breast mass,

61

What is fibrocystic disease?

Common benign breast condition consisting of fibrous, rubbery and chystic changes in breast
Varies with menstrual cycle

62

What is the treatment of fibrocystic disease?

Stop caffiene
Pain meds (NSAIDS)
Vit E, primrose oil
Danzol and OCP

63

What is mastitis? When does it occur?

Superficial infection of the breast
Associated with breast-feeding

64

Bacteria associated with mastitis?

Staph aureus

65

Causes of a breast abscess?

Mammary ductal ectasis (stenosis of duct)
Mastitis

66

Causes of male gynecomastia?

Medications
Illicit drugs (marijuana)
Liver failure
Increased estrogen
Decreased testosterone