Breast Disease Flashcards

Flashcards on breast disease.

What are the borders of the breast?

Superior: clavicle

Medial: lateral edge of the sternum

Inferior: inframammary fold

Lateral: medial edge of the latissimus dorsi

What are the borders of the axilla?

Superior: axillary vein

Deep: serratus

Medial: edge of the lat dorsi

Posterior: subscapularis

Inferior: meeting of the lentissimus dorsi in the chest

Describe the axillary lymph node levels.

Level one is lateral to the pectoralis minor. Level two are posterior to the PEC minor. And level three are medial to the PEC minor.

What are important risk factors to ask about in a breast-specific history?

Age of first menarche and menopause, first live birth, any breastfeeding history, family history for breast cancer, prior mammograms and biopsies, oral contraceptive use, fertility treatments, and hormone replacement therapy

Classic symptoms of a breast infection

Pain, erythema, swelling, often during breastfeeding

What are the most common bacteria in breast infections?

Staph aureus and streptococci

What does a green nipple discharge indicate?

Usually related to fibrocystic disease; if cyclic, almost always benign

What is the most common cause of bloody nipple discharge?

Intraductal papilloma

Treatment for intraductal papilloma causing bloody discharge

Excision, especially if symptomatic

What are some concerning features of nipple discharge that should be worked up?

Bloody, unilateral, spontaneous, nonlactational, and persistent

Characteristics of a fibroadenoma

Painless, slow growing, rubbery, well circumscribed palpable mass

Buzzwords for Phyllodes histology

A leaf like pattern, cleft like spaces, and hypercellular stroma

How does malignant phyllodes spread?

The tumor spreads hematogenously, not lymphatically

How does DCIS present?

Usually presents as calcifications and are seen on screening mammogram

Treatment options for DCIS

Lumpectomy followed by radiation, or mastectomy. Endocrine therapy (eg Tamoxifen) if ER and/or PR positive.

On the biopsy, what receptor status is needed?

ER, PR, HER2

What is inflammatory breast cancer?

Lymphatic invasion of carcinoma cells.

How is inflammatory breast cancer treated?

Neoadjuvant chemotherapy, modified radical mastectomy, and adjuvant radiation

What is the definition of breast conserving therapy?

Removal of just the tumor with a rim of normal tissue and almost always requires radiation to reduce local recurrence

What is the sentinel lymph node biopsy?

Evaluation of nodes for potential spread, technically with radioactive kind of tracer, and then some kind of blue dye.

What are the two kinds of endocrine therapy?

Selective estrogen receptor modulators or aromatase inhibitors

Which surgical option improves survival for breast cancer: lumpectomy (with radiation) vs mastectomy?

Neither; overall survival is the same