Flashcards in Chapter 36 WS Deck (45)
how many lymph nodes are in each axilla
10 - 38
_______ are located caudal and lateral of the pectoralis minor and are the most superficial lymph nodes in the axilla. They often represent the first station of drainage from breast
level I lymph nodes
_________ are located beneath the muscle.
level II lymph nodes
___________ are located cranial and medial to the pectoralis minor.
Level III lymph nodes
(infraclavicular lymph nodes)
At what level nodes is the sentinel node most commonly found?
Levels I and II
List a minimum of 4 physical signs of a locally advanced breast cancer.
a. Enlarged or matted axillary or supraclavicular lymph nodes
b. Abnormal breast contours
c. Nipple discharge or retraction
d. Palpable mass with or without fixation to the chest wall or involvement of the skin
e. In addition, skin findings, sucah as erythema, thickening, peau d’orange, and ulcerations.
What are the two views used in a routine screening mammogram?
Craniocaudal and mediolateral oblique
What is the difference between a screening mammogram and a diagnostic mammogram?
A screening mammogram is performed in a patient with no clinical symptoms of breast cancer; a diagnostic mammogram is performed in a patient who presents with clinical suspicion.
Which one of these types of breast cancer has a higher frequency of bilateral breast involvement (Invasive lobular carcinomas or Invasive ductal carcinoma
invasive lobular carcinomas
Invasive lobular carcinomas are mostly __________________. (ER +or ER-)
____________________ (Black Women, White women) are at higher risk for developing triple negative breast cancer than _______________________ (black women, white women)
List three contraindications to breast-conserving surgery
a. Multicentric disease with 2 or more primary tumors in separate quadrants of the breast such that they cannot be encompassed in a single excision.
b. Diffuse malignant microcalcifications on mammography
c. Persistent positive resection margins after multiple attempts of re-excision
List three indications for mastectomy for patients.
• Patients who are not candidates for breast-conserving therapy
• Patients who prefer mastectomy
• For prophylactic purposes in extremely high-risk populations
What is removed in a Radical mastectomy?
the breast with overlying skin, the pectoralis muscles, and all the axillary lymph nodes
What is removed in a modified radical mastectomy
the breast and the underlying fascia together with removal of the level I and II axillary lymph nodes.
what is removed in a total mastectomy
The entire breast without removal of level I and II lymph nodes
Eighty-five percent of lymphatic drainage from the breast goes to which lymph nodes
axillary lymph nodes
What level nodes are removed in an axillary dissection?
Levels I and II
advantages of immediate breast reconstruction
The streamline of surgical procedures (mastectomy and reconstructive surgery), which decreases the overall surgical time and also provides benefits in preserving the normal body image in women.
disadvantages of immediate breast reconstruction
The potential heightened post-reconstruction complications from adjuvant chemotherapy and radiation therapy.
advantages of delayed breast reconstruction
Allows for the completion of adjuvant treatments, and therefore may limit the immediate post-reconstruction complications.
disadvantages of delayed breast reconstruction
Limited reconstructive options because of tissue fibrosis after radiation therapy or chemotherapy
What endocrine therapy drug is given to premenopausal women after chemotherapy who have ER+ breast cancer? And how long will this drug be taken?
tamoxifen; 5 years
What are the advantages of treating the breast with the patient in the prone position
Minimizes lung and/or heart tissue in the treatment field as the breast falls away from the chest wall.
what patients should not be treated in the prone position?
Women with small breast or with breast implants. If the chest wall needs to be included in the treatment field. If regional lymph nodes need to be treated.
During simulation of the whole breast, the radiation oncologist may place wire at the borders of the possible treatment field. Indicate where these wires are to be placed.
medially at the mid-sternum, laterally at the level of mid-axilla, superiorly at the level of clavicular head, and inferiorly approximately 2 cm below the inframammary fold.
What are the two most important critical structures to consider in the design of breast radiation treatments?
lung and heart
DIBH is used when treating the _______________ (left or right) breast in order to minimize dose to which critical structure.
Whole breast tangent field border: superior, at the most cephalad of the following points:
- superior extent of the palpable breast tissue
- edge of the head of the clavicle