Flashcards in The Surgical Review- Breast Deck (42)
what are the boundaries of the breast?
sternum medially, latissimus dorsi laterally, clavicle superiorly, inframammary crease inferiorly
blood supply of the breast?
1. internal mammary
2. lateral thoracic arteries
5 important nerves to identify during mastectomy
1. Lateral pectoral: pectoralis major
2. Medial pectoral: pectoralis minor
3. Long thoracic nn: serratus anterior and subscapularis
4. Thoracodorsal: latissimus dorsi
5. Intercostobrachial: sensory fibers to the skin of axilla, medial upper arm and lateral breast
What are the BIRADs scores?
0. incomplete, additional imaging needed
1. negative, routine mammo
2. benign finding, routing mammo
3. probably benign, short term fu
4. suspicious, consider biopsy
5. highly suggestive of malignancy
what is mondor's disease?
thrombophlebitis of superficial veins of the anterior chest wall and breast
tx: anti-inflammatories and warm compresses
most common cause of bloody nipple discharge?
what are the five subtypes of DCIS?
1. Comedo: high grade and necrosis
what are 4 other less well known subtypes of invasive breast carcinoma?
what are the major determinants of prognosis in breast cancer?
tumor size and lymph node status
what are the most common sites of distant metastasis in breast ca? 5
HER2-neu is associated with what 3 factors of prognosis?
1. Increased rate of metastases
2. Poorer overall survival
3. Refractoriness to chemotherapy
what is the function of HER2neu
tyrosine kinase growth factor receptor
what is the pathogenesis of peak d'orange in inflammatory breast ca?
dermal lymphatic congestion with tumor cells
what is the strongest risk factor for male breast cancer?
how do phyllodes tumors metastases and where to?
to lung, bone, and abdominal viscera
what 3 veins are most commonly affected in mondors disease?
1. Lateral thoracic vein
2. thoracoepigastric vein
3. superficial epigastric vein
what are the three management options when LCIS is discovered?
1. close surveillance
2. Tamoxifen (shown to reduce breast ca risk)
3. Bilateral total masties w recon
what is the difference in breast ca of BRCA 1 vs BRCA2 mutations?
BRCA1 more likely to be poorly differentiated and hormone receptor negative whereas BRCA2 is well differentiated and hormone receptor positive
hereditary breast ca accounts for what percentage of all breast cancers?
what accounts for nearly 40% of male breast cancers?
Increased risk family history of breast cancer includes what? (6)
1. At least 3 first or second degree relatives with breast ca at any age
2. 2 first degree relatives with breast ca including one who was diagnosed
which type of DCIS is assoc w the worse prognosis?
which type of cancer stains positive for S-100 antigen?
which type of invasive breast ca has the most favorable prognosis?
neighborhood calcification is a feature characteristic of what?
what defines a women at "high risk" for breast cancer?
a women as least 35years of age with a 5yr predicted risk of breast cancer of 1.67% or greater (using the gail model)
the primary severe adverse reaction to trastuzumab is?
cardiac toxicity: CHF and decreased LVEF
what is the most common type of breast lymphoma?
B cell: diffuse large B cell lymphoma
treatment of breast lymphoma?
if low grade/localized: excision
if high grade: CHOP + XRT