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absite breast

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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