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absite breast
| Question | Answer |
|---|---|
| role of estrogen, progesterone, and prolactin in breast development | estrogen=duct development, progesterone=lobular development, prolactin synergizes both |
| during cycle how do progesterone and estrogen affect breast tissue | estrogen swelling/grwth glandular; progesterone=maturation of glandular tissue and wdrawal causes menses |
| which hormones lead to breast tissue atrophy s/p menopause | progesterone and estrogen |
| what long thoracic innerv, injury causes | serratus anterior, winged scapula can't ABD past horiz |
| what thoracodorsal innerv, injury causes | lat dorsi; adduction (ie pull ups) is its role |
| what nerves innerv pec mscls | lat pec innerv pec major only; med pec innerv pec major and minor |
| what inervostobrachial n innerv, where/when do you find it | sensation to medial arm and axilla, just below axillary vein in axillary LN dissection |
| what is Batson's plexus | venous plexus that allows direct hem met of Br Ca to spine |
| what arteries supply breast | internal thoracic, intercostal, thoracoacromial, lat thoracic |
| where does lymph drain from breast | 97% axillary, 1-2% internal mammary LN and any quadrant can drain there |
| if 1ry axillary adenopathy what dz is it | lymphoma |
| what are suspensory lig of breast called | Cooper |
| what abscesses assoc w, bugs, tx | breast feeding, S Aureus MC, then Strep; I&D, d/c breast feeding, ice, heat, breast pump, Abx |
| what is infxs mastitis assoc w? what need r/o | breast feeding, S Aureus MC, need to r/o necrotic cancer (incisional bx incl skin) |
| MC location accessory breast tissue, name | polythelia, axilla |
| what's poland's syndrome | hypoplasia of chest wall, amastia, hypoplastic shoulder, no pec mscl |
| cuases gynecomastia | Some Drugs create awesome knockers” spironolactone, dig, cimetidine, EtOH, ketocanazole |
| tx mastodynia | danazol (modified testosterone, had been used for endometriosis), OCPs, NSAIds, evening primrose oil, bromocriptine. d/c caffeine, nicotine, methylxanthines |
| cause mastodynia? Cancer? | no cancer, if cyclic fibrocystic dz; if contiuous acute/subacute infxn |
| what's Mondor's dz, location/cuase, tx | superficial vein thrombophlebitis, cordlike and pianful assoc trauma&strenous exercise lower outer quadrant, tx=NSAID |
| which fibrocystic dz have increased risk of cancer, tx | atypical ductal or lobular hyperplasia; remove all suspicious areas no need free margin |
| which fibroycstic dz can look like cancer, incrsd risk ca? | slcerosing adenosis (bc cluster of Ca++), not really incrsd risk |
| RF benign br dz | early menarche, late menopause, sm breast size, nml or low body wgt, irreg menses, premeno, h/o spont abortions |
| MC cause of bloody discharge, premalignant? Tx? | intraductal papilloma, not premalignant but need ductogram and resxn |
| w/u fibroadenoma depending on age | <30 U/S or mammo c/w w fibroadenoma, need FNA; >30 excisional |
| mgmt br cyst | aspirate, if bloody fluid on aspiration, failure of mass to resolve completely, and prompt refilling of same cyst need to get surgical bx |
| types of nipple discharge and mgmt | green=fibrocystic; blood=intraductal papilloma; serous=worrisome for cancer need excisional bx; spont discharge=worrisome for cancer no matter what color |
| what is diffuse papillomatosis? Imaging, sympt, cancer | affects mltpl ducts of both breasts, serous discharge, mammo shows swiss cheese, 40% cancer |
| DCIS: pathol, malig? | ductal epithelium w/o invasion of BM; premalig and 50% get cancer |
| DCIS mgmt | lumpectomy w 2-3cm margin + XRT; if comedo subtype simple mastectomy…no ALND |
| LCIS: risk of cancer, who gets | seen in premenopausal; 40% cancer EITHER side but NOT PREMALIGNANT, and 70% get DUCTAL cancer |
| LCIS mgmt | don't need negative margin, either observe or tamoxifen or b/l subQ mastectomy |
| w/u breast mass depending on age | <30 U/S: if solid FNA; 30-50 b/l mammo and FNA; >50 b/l mammo and excision or core bx. If FNA undiagnostic excisional bx |
| sensitivity and specificity of mammo | 90% sensitivity/specificity, that increases in age, must be 5mm to be detected |
| key features suspicious lesions mammo | irreg borders, speculated, mltpl clustered, thin/linear/or branching Ca++, asymmetric density, ductal asymm, distortion of architecture |
| what is the range of BIRADS class | 1-5 (1 negative, 2 benign…4 suspicious, 5 highly suspicious malign |
| mammo screening | Mammo q2-3y >40, yearly >50; High risk: 10yr before the youngest; NO mammo <30 unless high risk |
| what are the axillary node levels | I=lat to pec minor; II=beneath; III=medial |
| most impt px staging for br cancer, other factors | LN MOST impt prognostic staging, other factors include tumor size, grade, estrogen receptor |
| where does br ca met | bone |
| Stage Iia br cancer | N1 (T0 or 1), T2N0M0 |
| Stage Iib br cancer | T2N1M0, T3 |
| Stage IIIa br cancer | N2 or T3N1M0 |
| Stage IV br ca | M1 |
| BRCAI, BRCAII assoc dz | BRCAI ovarian and endometrial cancer, BRCAII male br ca |
| when prophylactic mastectomy | FMH w BRCA, LCIS |
| greatly incrsd risk br ca | BRCA, FMH 2 1ry w b/l or premeno br ca, DCIS/LCIS, fibrocystic w atypical hyperplasia |
| mod incrsd risk br ca | FMH Br Ca, menarche<12 and meno>55, nulliparity or birth>30, radiation, prev Br Ca, high fat/obesity |
| how estrogen/progest receptors affect px | progesterone better than estrogen, best px is if both +, more common + receptors in postmeno; positive receptors have better response to hormones, chemo, surgery |
| what type of cancer do males get | ductal |
| 4 subtypes of ductal br cancer, which good px | medullary (usu P and E receptor +), tubular, mucinous/colloid, scirrhotic (worse px) |
| tx ductal cancer | MRM (modified radical mastectomy) or lump w ALND, + XRT |
| which most common 2 types br ca | ductal 85%, lobular 10% |
| features of lobular br ca, which subtype bad px | extensively infiltrative w/o Ca, incrsd b/l mutlifocal/multicentric; signet ring worst px |
| tx lobular br ca | MRM (modified radical mastectomy) or lump w ALND, + XRT [same as ductal] |
| mgmt inflamm br ca | may need chemo and XRT first, then mastectomy, considered T4 very aggressive |
| what causes skin changes in inflamm br ca | dermal lymphatic invasion causing peu d orange |
| what is simple mastectomy and when used | preserves nipple, leaves 1-2% br tissue, for DCIS and LCIS but not cancer |
| absolute contraindication for br conserving | 2 or more 1ry tumors in sep quadrants, persistent + margins, preg is contraindication to XRT or h/o prior radiation |
| relative contraindication for br conserving | extensive multifocal dz, large tumor in small breast, large breast where XRT dose not homogenous, scleroderma/Lupus |
| when sentinel LN bx | fewer cxns, for malignant tumors>1cm w/o clinically positive nodes (need ALND) |
| contraindications sentinel LN bx | preg, multicenter dz, neoadj, + LN, prior axillary surgery, inflamm or advanced dz |
| what does modified radical mastectomy involve | removes all breast tissue incl nipple areolar complex and ALND (Level I) |
| what does radical mastectomy involve | includes overlying skin, pec major and minor, level I, II, II ALND…rarely performed |
| cxns ALND | infxn, lymphedema, lymphangiosarcoma; axillary vein thrombosis (sudden, early post op swelling). Lymphatic fibrosis (slow swelling over 18mos). Intercostal brachiocut n |
| MC nerve injured s/p mastectomy and s/s | Intercostal brachiocut n-hyperesthesia of inner arm and lateral chest wall |
| dose XRT for br ca; cxns | 5K rad,edema, erythema, rib fx, pneumonitis, ulceration, sarcoma |
| indications XRT s/p mastectomy | >4nodes, skin/chest wall involvement, + margins, >5cm (T3), extracapsular LN invasion, inflamm ca, fixed axillary node (N2) or internaly mammary nodes (N3) |
| when give chemo | positive LN: all chemo exc postmeo w positive estrogen (tamoxifen); >1cm negative LN: all chemo exc positive E; <1cm no further. |
| risk of cxns w tamoxifen | 1% blood clots, 0.1% endometrial ca |
| signs and pathol of Paget's dz | scaly skin lesion; bx showed Paget’s cells.. Have DCIS or ductal cancer |
| mgmt Pagets dz | MRM if cancer, otherwise simple mastectomy |
| what is cystosarcoma phyllodes, tx | large, 10% malignant, no nodal mets, WLE w negative margins no ALND |
| what is a dark purple mark on arm 5yr s/p mastect? | stewart-treves syndrome=lymphangiosarcoma from chronic lymphedema s/p ALND |
| br ca in preg | 1st,2nd tri: MRM; 3rd tri if late can do lumpectomy and ALND and postpartum XRT. No chemo or XRT while preg; no breast feeding |
Created by:
ehstephns
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