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Concept Dis. Ch.16

The Breast

x-ray of breast, used to detect tumors & other abnormalities within the breast mammogram
lymph node, in group of nodes, located closest to a malignant tumor sentinel lymph node
sentinel lymph nodes are examined to determine whether the tumor has spread to the node
node dissection would not be required if the sentinel node is not involved in metastasizing of a malignant tumor
suspensory ligaments affix the breasts to the chest wall
the breast have ___ blood supply abundant
the breasts have lymphatic ___ drainage
extend from axillae to groin mammary ridges
mammary ridges may occasionally produce extra breasts & nipples
better contrast, regarding mammogram, would be found on ___ women younger
less contrast, regarding mammogram, would be found on ___ women older
younger womens' breasts are normally denser
older womens' breasts are normally less dense (lighter)
mammograms provide better contrast on ___ breast tissue lighter (less dense)
involves inspection, palpation, & exam of axillary tissues clinical exam of the breast
mammograms are important for detecting lesions invisible to a clinical exam
aggravation of unequal sized breasts is more likely to be aggravated by ___ changes, resulting in enlargement of breasts hormonal
an irregular response to hormones can cause benign cystic disease
well-circumscribed tumor of glandular & fibrous tissue found predominantly in younger women fibroadenoma
malignant tumor that is prone to early detection, metastasizing, & late recurrence carcinoma of the breast
increased rate of breast carcinoma from hormone treatment can be alleviate by not using progestin
a metastasizing breast carcinoma gains movement into other parts of the body through lymph nodes
lump on the breast, skin edema, & nipple retraction are all ___ ___ of breast carcinoma clinical manifestations
involves combination of surgery and chemotherapy breast carcinoma treatment
sarcoma of the breast is a large tumor that is treated through surgery
mutations of BRCA1&2 have are at higher risk for breast & ____ carcinoma ovarian
carcinoma, benign fibroadenoma, & benign cyst are 3 of the common conditions that cause a lump in the breast
persons w/mutations of BRCA1/BRCA2 have greatly increased risk of breast carcinoma as well as ___ carcinoma. ovarian
benign cysts, benign fibroadenoma, & carcinoma are common conditions that cause a lump in the breast
clinical examination, mammogram, biopsy are used in this order to determine the nature of a lump in the breast
the breasts are ___ ___ ___ specialized to secrete milk modified sweat glands
the breasts main function is to produce milk
the breasts are made up of glandular and stromal tissues
the lobules & ducts are made up of ___ tissue glandular
the supporting tissue is __; including fatty & fibrous connective tissue stromal
the stromal tissue gives the breasts their size, shape & support
the breasts are composed of 20 lobes of glandular tissue
a cluster of milk-producing glands lobules
Each lobe made up of a lobule
lobules are connected by branching ducts
lobules converge at the nipple
bands of fibrous tissue extending from skin of breast to the connective tissue covering chest wall muscles suspensory ligaments
axillary lymph nodes axilla
lymph nodes above the clavicle supraclavicular
lymph nodes beneath the sternum mediastinal
axillary nodes are the supraclavicular and mediastinal nodes
if breast cancer cells reach axillary nodes & continue to grow, the nodes will swell and cancer is more likely to spread to other organs
the breasts contain an abundant blood supply and lymphatic drainage
most lymph vessels of breast lead to the axillary nodes
during puberty the breasts enlarge in response to estrogen and progesterone
accumulation of adipose tissue & proliferation of glandular and fibrous tissue are post-pubertal changes
variations in breast size depend on amount of ___ tissue rather than glandular tissue stromal
the breasts are extremely responsive to hormonal stimulation
mild cyclic hyperplasia followed by involution of breast tissue occurs normally during the menstrual cycle
pregnancy & lactation cause hypertrophic glandular and ductal tissues
after menopause the sex hormone levels decline, and the breasts decrease in size
ages 35-40 are the baseline for mammograms to identify ___ not detected on clinical exams lesions
from age 40 and up a mammogram should be done annually
show up white on mammogram denser cysts & tumors
show up dark on mammogram less dense fatty tissue
are well circumscribed on mammogram cysts & benign tumors
have irregular borders & frequently contain fine flecks of calcium, on mammogram malignant tumors
most commonly found in the armpits or on lower chest below and medial to the breasts accessory breasts and nipples
at puberty, one or both breasts over-respond to hormonal stimulation breast hypertrophy
true hypertrophy is from overgrowth of fibrous tissues, not glandular or fatty
ductal and fibrous tissue of adolescent male breast proliferate affecting one or more breast gynecomastia
gynecomastia is from a temporary imbalance of female/male hormones in the male at puberty, there in an increase in estrogen
single/multiple benign cystic changes in the breast fibrocystic disease
fibrocystic disease proliferates ___ & ___ tissues glandular; fibrous
fibrocystic disease is an irregular cyclic response to hormones during the menstrual cycle
helpful in distinguishing a cystic from a solid mass ultrasound examination
aspiration of &/or surgical excision if no aspiration is obtained/able to be performed treatment for fibrocystic disease
fibroadenoma treatment includes surgical excision
familial tendency, hormonal factors, birth of first child after age 30, early menarche & late menopause, both sexes are affected, & occurs 1 in every 10 women breast carcinoma risk factors
synthetic compound with progesterone activity progestin
increases density of breast tissue, complicating the interpretation of mammograms estrogen-progestin hormone therapy
increases breast and ovarian carcinoma risk, breast cancer risk at 80%, ovarian cancer risk is at 20–40%, & is a large gene with many different mutations BRCA1 gene
breast cancer risk at 80% & a lower ovarian carcinoma risk at 10–20% BRCA2 gene
lump in the breast, nipple or skin retraction, & skin edema (orange peel sign) are all clinical manifestations of breast carcinoma
90% of breast carcinomas are ductal carcinomas
10% of breast carcinomas are lobular carcinomas
confined initially within the duct or lobule then becomes invasive & extends toward adjacent breast tissue Non-infiltrating or in-situ cancer
site of origin, presence/absence of invasion, & degree of differentiation of tumor cells classification of breast carcinoma
cells that resemble normal breast tissue are well-differentiated
bizarre cells arranged haphazardly; immature; very different from normal breast tissue poorly-differentiated
also called total mastectomy with axillary lymph node dissection; resecting entire breast, axillary tissue w/lymph nodes; leaves pectoral muscles may be followed by breast reconstruction modified radical mastectomy
removing only part of breast with the tumor partial mastectomy
removing tumor + small amount of adjacent breast tissue lumpectomy
axillary lymph nodes removed followed by radiation to eradicate any remaining carcinoma in the breast lumpectomy and partial mastectomy
anticancer drugs adjuvant chemotherapy
anti-estrogen drugs adjuvant hormonal therapy
in order to eradicate any tumor cells that may have spread beyond the breast adjuvant chemotherapy & adjuvant hormonal therapy
have gene that speeds up growth rate of tumor cells & a less favorable prognosis HER-2 positive tumors
part of tumor obtained is surgically tested to detect presence of estrogen/progesterone receptors & amplification of HER-2 gene
better differentiated with favorable prognosis hormone receptor positive tumors
may receive adjuvant hormonal therapy with antiestrogen drug patients with ER positive tumors
tumors with hormone receptors respond to anti-estrogen adjuvant therapy
may appear many years after original tumor has been resected or tumor no longer curable, treatment is to control growth, relieve symptoms, and improve quality of life recurrent or metastatic carcinoma
hormone receptor status of tumor, age, time since initial treatment to appearance of metastasis are factors to determine treatment of recurrent carcinoma
Premenopausal: anti-estrogen drugs / Postmenopausal: aromatase inhibitor drugs are treatments for hormone-receptor positive recurrent/metastatic tumor
Hormonal manipulation if unresponsive to tamoxifen or aromatase inhibitor is treatment for hormone-receptor negative recurrent/metastatic tumor
To control metastatic deposits in bone and soft tissues radiation
arises from fibrous tissue or blood vessels, large bulky tumor, may metastasize widely & treatment is by surgical resection of the involved breast breast sarcoma