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