General Surgery Chapter 20 (Breast)

Front 1

What are Cooper's ligaments?

Back 1

• connective tissue structures that are derived from the superficial fascia of the skin
• suspends the breast on the chest wall
• retraction of Cooper's ligaments can produce skin dimpling

Front 2

What are acini (in female breasts)?

Back 2

proliferations of the terminal ducts lined with secretory cells for milk production

Front 3

What are the American Cancer Society Recommendations for breast cancer detection in asymptomatic women ages 20-39? ages > 40?

Back 3

• 20-39:
- clinical breast exam » every 3 years
- breast self-exam » monthly (optional)
- mammogram » N/A

• > 40:
- clinical breast exam » yearly
- breast self-examination » monthly (optional)
- mammogram » yearly

Front 4

When is ultrasound most useful in breast examination?

Back 4

• can characterize palpable lesions or suspicious areas found on mammogram or physical examination (especially in women where likelihood of breast CA is low)

• can distinguish solid masses from cysts and simple cysts from complex cysts

Front 5

What are different breast biopsy options?

Back 5

• Fine-needle aspiration cytology
• Core-needle biopsy
• Open biopsy (either excisional or incisional)

Front 6

This is a very common benign tumor of the breast that usually occurs in young women

Back 6

Fibroadenoma

Front 7

Describe typical characteristics of a fibroadenoma upon palpation

Back 7

• 1-3 cm in size
• freely movable, discrete, firm, rounded mass

Front 8

Which type of breast mass resemble normal mammary lobules in that they show lactation in pregnancy and involution in menopuase?

Back 8

fibroadenoma

Front 9

What is the most common cause of breast mass in women in their fourth and fifth decades of life?

Back 9

breast cyst

Front 10

Describe typical characteristics of breast cysts upon palpation

Back 10

• may be solitary or multiple
• presents as firm, mobile, slightly tender masses
• often has less well-defined borders compared to fibroadenomas

Front 11

What is the most common cause of nipple discharge?

Back 11

duct ectasia (a nonneoplastic condition characterized by multiple dilated ducts in the subareolar space)

Front 12

What is the cause of most cases of unilateral, bloody nipple discharge?

Back 12

intraductal papilloma

Front 13

What are different histologic types of breast cancer?

Back 13

• Colloid or mucinous carcinoma
• Ductal carcinoma in situ (DCIS)
• Infiltrating ductal carcinoma
• Infiltrating lobular carcinoma
• Inflammatory carcinoma
• Lobular carcinoma in situ (LCIS)
• Medullary carcinoma
• Paget's disease of the nipple
• True papillary carcinoma
• Tubular Carcinoma

Front 14

This is a preinvasive form of ductal cancer which can develop into invasive cancer if not treated adequately

Back 14

Ductal carcinoma in situ (DCIS)

Front 15

What is the typical appearance of DCIS on mammography?

Back 15

microcalcifications (rarely a mass on pohysical examination or mammography)

Front 16

This type of breast cancer consitiutues approximately 90% of invasive breast cancer and produces the characteristic firm, irregular mass on physical examination.

Back 16

infiltrating ductal carcinoma

Front 17

This type of breast cancer makes up approximately 10% of breast cancers and is often difficult to detect on mammogram or physical exam because of its indistinct borders.

Back 17

infiltrating lobular carcinoma

Front 18

What are chacteristics of tubular carcinoma?

Back 18

• well-differentiated form of ductal carcinoma
• forms small tubules, randomly arranged, each lined by a single uniform row of cells
• tends to occur in women who are slightly younger than the average patient with breast cancer

Front 19

What are characteristics of medullary carcinoma?

Back 19

• another form of infiltrating ductal cancer
• characterized by extensive tumor invasion by small lymphocytes
• less commonly metatasizes to regional lymph nodes

Front 20

Which type of breast cancer is characterized histologically by clumps and strands of epithelial cells in pools of mucoid material?

Back 20

Colloid or mucinous carcinoma

Front 21

What are the most common areas of breast cancer metastasis?

Back 21

• bone
• lung
• liver
• brain

Front 22

Describe the tumor classification of the TMN stagaing system for breast cancer

Back 22

• Tis: Carcinoma in situ
• T1: Tumor < 2 cm
• T2: Tumor 2-5 cm
• T3: Tumor > 5 cm
• T4: Tumor any size with extension to chest wall or skin

Front 23

Describe the classification of lymph node involvement in the TMN staging system for breast cancer

Back 23

• N0: no lymph node metastasis
• N1: metastasis in 1-3 axillary lymph nodes
• N2: metastasis in 4-9 axillary lymph nodes
• N3: metastasis in 10 or more axillary lymph nodes

Front 24

Describe the different classifications of metastasis in the TMN staging system for breast cancer

Back 24

• M0: no distant metastasis
• M1: distant metastasis

Front 25

Differentiate between simple/total, modified radical, and radical mastectomy

Back 25

• Simple, or total, mastectomy removes the entire breast with the pectoralis major fascia
• Modified radical mastectomy is a simple mastectomy with axillary dissection
• Radical mastectomy removes the breast, both pectoralis muscles, axillary contents, and overlying skin

Front 26

Which nodes are removes in axillary dissection?

Back 26

• removes level I and level II lymph nodes
• includes nodes in the axillary fat pad, below the pectoralis major muscle, and behind the pectoralis minor muscle

Front 27

What is the most common chemotherapy regimen used to treat breast cancer?

Back 27

• cyclophosphamide
• doxorubicin
• 5-fluorouracil

* given over 9-10 weeks at 3-week intervals

Front 28

What hormonal therapy is used to treat estrogen-receptor-positive tumors (particularly in postmenopausal women)?

Back 28

Tamoxifen