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28 Cards in this Set
- Front
- Back
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Location of the breast
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2-6th rib, 2/3 on pec major, 1/3 on serratus anterior
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Areolar glands
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Are called the areolar glands of Montgomery, and may form sebaceous cysts and become infected
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Blood supply to the breast
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1. From the axillary artery via its lateral thoracic and acromiothoracic branches
2. From the internal throacic via its perforating branches 3. From the intercostal arteries via their lateral perforating branches |
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Triple assessment of breast
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1. Careful history and examination
2. Mammography (old), ultrasound (young, i.e. <35) 3. Fine needle aspiration cytology or core biopsy |
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TNM staging of breast tumour
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T1 = Tumour < 2cm
T2 = Tumour 2-5 cm T3 = Tumour > 5cm T4 = Direct extension to chest wall N0 = No palpable lymph nodes N1 = Mobile lymph nodes on same side N2 = Fixed lymph nodes on same side N3 = Supraclavicular or infraclavicular LNs or arm lymphoedema M0 = No evidence of distant metastases M1 = Distant metastases present |
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Clinical features of non-proliferative lesions
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Pain, focal areas of nodularity or cysts often in the upper outer quadrant, frequently bilateral, mobile, varies with menstrual cycle, nipple discharge (straw like, brown, green)
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Most common breast tumour
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Fibroadenoma
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Features of a fibroadenoma
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Smooth, rubbery, discrete, well-circumscribed, non-tender, mobile, hormone-dependent
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Investigations of a fibroadenoma
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Core or excisional biopsy required as FNA cannot distinguish fibroadenoma from phyllodes tumour
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Intraductal papilloma
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Most common cause of spontaneous, unilateral bloody nipple
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Most important RF for breast cancer
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Female, >age (rare <30), family history (BRCA1 on 17Q, BRCA 2 13Q), early menarche/late menopause, nulliparity, European.
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Investigations of breast cancer
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Mammography every two years for women 50-69. Needle aspiration. Excisional biopsy.
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Signs and symptoms of breast cancer
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Painless increasing mass which may also be associated with nipple discharge, skin tethering, ulceration, oedema and erythema. 80% present with metastases.
If metastatic - bone pain, pleural effusion, dyspnoea, anorexia and weight loss. |
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Staging of breast cancer
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1. Confined to the breast, mobile
2. Growth confined to breast, mobile lymph nodes in ipsilateral axilla 3. Tumour fixed to muscle, skin matted, nodes may be fixed, skin involvement larger than tumour 4. Tumour completely fixed to chest wall, distant metastases involved |
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Management of fibroadenoma
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Conservative if < 40 and diagnosis proven. Excision if age >40 and size >4cm
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Classic shape of phyllodes tumour
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Tear
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CF duct papilloma
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Single or multiple lumps, blood stained discharge.
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Screening in UK
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Every 3 years age 50-64
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Breast cyst management
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Aspiration. If bloodstained or persistently re-filling, biopsy or excise.
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Duct papilloma management
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Microdochectomy
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Most common type of breast cancer
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Invasive ductal carcinoma
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Indications for mastectomy
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Tumour is multifocal and/or central in location, large tumour in small breast, DCIS>4 cm, patient choice
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Indications for wide local excision
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Tumour is solitary and/or peripheral in location, small tumour in large breast, DCIS<4 cm, patient choice
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Treatment for hormonal breast pain
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(Think oestrogen)
Tamoxifen, danazol, bromocriptine |
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Nipple discharge causes
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Unilateral - duct papilloma, breast cancer
Bilateral - periductal mastitis |
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Breast abscess management
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Metronidazole, flucloxacillin, augmentin
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Adjuvant chemotherapy for breast cancer
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CMF (cyclophosphamide, methotrexate, 5-fluoracil) or FEC (5-fluoracil, epirubicin, cyclophosphamide).
Six cycles with a 3-4 week gap between each for a total treatment time of 4.5-6 months |
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Hormonal therapy for breast cancer
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Tamoxifen
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