NAPPI CH.2 BREAST, STOMACH, OVARIES, ETC.

How many lobes are in the breast

15 to 20

The lobes produce what and drain where

milk and drain to the nipple

Where is the breast positioned?

between the second and 6th rib and from the sternum to the midaxillary line

____________ refers to the breast tissue that is close to the axilla

tail of spence

These are connective tissue that extend throughout the breast and help support it

cooper’s ligaments

Where is the most common site for breast cancer

upper outer quadrant

What is the most common chemo combo used for breast cancer

CMF

What are the agents in CMF

cyclcophosphamide, methrotrextate, and 5-FU

What can be used to treat hormone-receptor-positive and early-stage breast cancers?

tamoxifen

Where are the superficial nodes in the breast

on the skin overlying the breast

where are the deep nodes in the breast

in the axillary, internal mammary, and supraclav nodes

Where is the main site of drainage from the ipsilateral breast?

axillary nodes

how many nodes in each axilla and how many levels?

10-38 (10-50) ; 3 levels

Level 1 axillary nodes:

lowest and most superificial, first place for drainage; locatedlateral to the pectoralis minor muslce

What level of axillary nodes are located under the pec minor muslce,and are more superior than level 1

Level 2 axilla

What level is located superior to the pec minor, and more superior than level 2?

Level 3 Axilla

Internal mammary nodes are located…

lateral to the sternum on either side

WHere are the internal mammary nodes?

in the first and third intercostal spaces

How many nodes are there on each side of the sternum? IM nodes

4 nodes each side

Supraclavicular nodes are…

above the clavicle (less common site for nodal spread)

In the TNM staging system… MX stands for…

mets are not looked for

What is the most common pathology for breast cancer?

infiltrating ductal carcinoma; Infil. lobular is second most common

Ductual or lobular carcinoma IN SITU means…

the cancer cells did not invade the basement membrane

Inflammatory breast cancer is…

very rare and accounts for 1 percent of all cases, and has a very poor prognosis witha survival rate of less than 2 years

peau d’orange, erythema, thickening, warmth, and hardening of the breast are all symptoms of

inflammatory breast cancer

male breast cancer is…

less than 1 percent of all breast cancer cases

Breast lymphnodes can spread through

skip mets

If IM nodes and supraclav nodes have dz in breast cancer, the prognosis is…

worse

Common sites of distant mets for breast cancer are

lung, liver, bone, brain

Breast cancer spreads form the _____ to the skin

batson venous plexus

THe prone breast board would be used for pts with

pendulous breasts , pendulous breasts and cardiac issues

how many lobes are in the right lung and how is it shaped?

3 lobes and it is shorter and wider than the left lobe which has 2 lobes

the lungs are lined by two membranes called…

the pleura

_____ pleura lines the surface of the lung

visceral

_______ pleura lines the thoracic wall

parietal

Where is the carina located

T4-T5

Where is oxygen and carbon dioxide exchanged?

alveolar ducts

_____ is where blood vessels, lymphatic vessels, and nerves gain entry to the lungs

hilum

what is the main symptom of lung cancer

cough

________ tumor occurs when the tumor is in the apex of the lung and the pt experiences pain in the shoulder and arm, muscle atrophy and horner syndrome

pancoast tumor

What occurs when the tumor compresses the SVC and makes it difficult to breathe?

Superior Vena Cava syndrome

A pt with SVC syndrome may present with…

blockage, and promiment blood vessels

What is the main method of regional spread for lung cancer

lymph nodes

Where does all the lymph from the lungs drain to?

intrapulmonary nodes

the paratracheal nodes, pretracheal nodes, retrotracheal nodes, and azygos nodes are the…

superior mediastinal nodes

the subcarinal, paraesophageal, and pulmonary ligament nodes are the…

inferior mediastinal nodes

What is SCLC called and what does it include?

oat cell and includes anaplastic carcinomas

SCLC have a…

high mortality rate and are very aggresive

Since SCLC can mets early to the brain, what can be done to prevent this?

PCI

NSCLC includes what pathologies?

adenocarcinoma, large cell carcinoma, and epidermoid/squamous cell carcinoma

NSCLC adenocarcinomas are not connected with

tobacco use

SCLC is more commonly found in

men

NSCLC is found more in

women and toward the periphery of the lungs

What has a better prognosis? SCLC or NSCLC?

NSCLC

Where does mesothelioma occur?

in the lining of the lungs

Lung spread pattern; the tumor can extend …

locally to other locations in the lung and organs nearby such as ribs, heart, esophagus, and vertebrae

Distant spread for lung cancer occurs through what system

circulatory system

Distant spread sites for lung cancer…

liver, brain, bones, bone marrow, adrenal glands, kidneys, cervical nodes, and contralateral lung

Muscular tube located between the pharynx and the stomach

esophagus

Where does the esophagus start?

after the cricoid cartilage around C6 and ends at T10

how long is the esophagus

25 cm

What are the four regions of the esophagus

• cervical esophagus

• upper thoracic

• middle thoracic

• lower thoracic

What are the 3 layers of the esophagus

• mucosa

• submucosa

• muscular layer

What are common symptoms with esophagus cancer

difficulty swallowing and weight loss

ESOPHAGUS: adenocarcinoma is related with…

barrett’s esophagus

____ esophagus drains to the paratracheal, hilar, subcarinal, paraesophageal, and supraclav nodes

middle thoracic

——— ——- esophagus drains to the internal jugular, cervical, paraesophageal, and supraclav

upper thoracic

____________ esophagus drains to the celiac axis, gastric nodes, and nodes within the lesser curvature of the stomach

lower thoracic

What kind of carcinomas are most common in the upper and middle sections of the esophagus

squamous cell

What kind of carcinomas are most common in. the lower section of the esophagus and GE junction, and is the most common type of esophageal cancer in the US

adenocarcinomas

Distant spread of the esophagus is to…

liver and lungs

Where is the stomach located?

in the upper left region of the abdomen

What are the 5 regions of the stomach in order

1. Cardia (closest to esophagus)

2. Fundus (superior)

3. body

4. antrum

5. pylorus (valve that empties food into SI)

What are the 5 layers of the stomach from inner to outer

1. mucosa

2. submucosa

3. muscularis propria

4. subserosa

5. serosa

in the stomach, where do most tumors start?

the mucosa

In the stomach what does the depth of the tumor in layers determine?

stage and prognosis

What are the most common nodes in the stomach?

celiac nodes

What is the most common pathology for stomach cancer?

adenocarcinomas

What is the spread pattern of the stomach?

direct extension to the omenta, pancreas, diaphragm, transverse colon, and duodenum

Distant spread of the stomach spread to…

liver and lungs - stomach

Where does the small bowel start?

pyloric sphincter and ends at the ileocecal valve

what are the four layers of the small bowel?

1. mucosa

2. submucosa

3. muscular layer

4. serosa

what are the 3 sections of the small bowel?

1. duodenum

2. jejunum

3. ileum

what are the nodes of the small bowel

mesenteric and celiac

what are the patholiges for small bowel cancer

adeno, lymphoma, sarcoma, and carcinoid tumors

what is the most common site for distant spread of the small bowel

liver

HWere does the large bowel start and end

starts at the ileocecal valve and ends at the anus

What are the 8 regions of the colon

1. cecum

2. ascending colon

3. hepatic flexure

4. transverse colon

5. splenic flexure

6. descending colon

7. sigmoid

8. rectum

what parts of the large intestine are located intraperitoneal?

cecum, transverse colon, and sigmoid

what parts of the large intestine are located retroperitoneal?

ascending colon, hepatic flexure, splenic flexure, and descending colon

What kind of surgery removes the colon, but leaves the sphincter and rectum

anterior resection

what kind of surgery removes the anus and part of rectum

abdominal resection (APR)

What is a genetic disorder of the colorectal area with multiple benign polyps that may develop as a teen and have a possibility in becoming malignant if not removed

familial adenomatous polyposis (FAP)

What is the historc staging system of large bowel cancer

dukes staging system

where does the right colon drain to

the ileocecal and right colic nodes

where does the left colon drain to

the mid-colic, inferior mesenteric, and left colic nodes

where does the sigmoid colon drain to

inferior mesenteric nodes, and nodes that run alongside the superior rectal, sigmoidal, and sigmoidal mesenteric vessels

Upper rectum drains to the nodes that follow along the…

middle rectal vessels

The middle and lower rectum drain to the

internal iliac nodes

Lower rectal and anal canal drain to the

inguinal nodes