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139 Cards in this Set
- Front
- Back
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Axillary lymph nodes
-level I |
is the bottom level, below the lower edge of the pectoralis minor muscle
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Axillary lymph nodes
-level II |
is lying underneath the pectoralis minor muscle
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Axillary lymph nodes
-level III |
is above the pectoralis minor muscle
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breast cancer lymphatic spread
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supraclavicular, cervical, contra-lateral internal mammary, occasionally contra-lateral axillary
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breast cancer hematogenous spread
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bone, liver, brain
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breast ca
-incidence |
192,370 (1,910 men)
1 out of 8 women in US will get breast ca ( If they live past 85 ) |
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breast ca
-mortality |
40,170 (440 men)
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with breast ca, black women have a ___________ mortality rate than white women of the same age
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higher
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risks factors associated with breast cancer
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family hx
nulliparity early menarche advanced age personal hx of breast ca |
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what women can do to possibly prevent breast ca
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-be as lean as possible w/out becoming underweight
-being physically active for @ least 30 min/day -limit alcohol to one drink/day -breastfeed exclusively for 6mos |
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2/3rds of breast cancer, age over ____ years
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50
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other risk factors associated w/breast cancer
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drinking 1drink/day
dopamine antagonists - raises risk 16% |
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regular use of full strength aspirin 7x week, over 10 yrs = ____ % reduction in breast cancer
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28
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breast cancer more common in _____ breast & upper outer quadrant (after age 45)
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left
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late first birth (over 30 yrs old)
exposure to ionizing radiation (10cGy) |
risk factors for breast cancer
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BRCA 1 and BRCA 2
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-5-10% of all women w/ breast cancer may have a germ line mutation of these
-estimated lifetime risk of developing breast cancer (40-85%) |
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women w/ primary breast carcinoma have __-__x greater chance of developing 2nd cancer in contra-lateral breast compared w/risk of developing primary breast ca. among women in general population
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2-6
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___% of breast cancer occurs in women who have NO identifiable risk factors
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70
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women ages 20-39 should
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-have clinical breast exam performed by a health care prof. every 3yrs
-perform monthly BSE if they choose to |
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women age 40 & older should
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-have annual mammograms
-annual clinical breast exam -perform monthly BSE if they choose to |
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men should do _____ at the same time as _____
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BSE
TSE |
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USPSTF recommendations
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-none aged 40-49 yrs
- 50-74 yrs biennial screening mammo - ? mammo 75 yrs or older - no teaching BSE by Dr.'s |
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S/S of breast cancer
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-painless mass or abnormal mammo
-mammary tenderness (rare) -skin changes -bloody nipple discharge -change in size or shape of breast -axillary lymphadenopathy or distant mets |
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___% of breast lumps are benign
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80
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S/S of inflammatory breast cancer
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-change in breast texture (dimpled like an orange)
-increase in breast size over a short period of time -change in nipple, becomes flattened or inverted, possibly w/discharge -sudden appearance of large lump in the breast (may be fixed to skin) -pain the breast -axillary or superclavicular lymphadenopathy |
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peua d'orange
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Sign of inflammatory breast cancer
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diagnosis & staging work-up for breast ca
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hx and physical
mammography needle aspiration & biopsy chest x-rays bone scan, esp. if stage III or above CT of abdomen & thorax CBC, liver function tests ER, PR, & HER2/neu receptor status |
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average glandular dose during mammography is less than ___ cGy per single view exposure
-equivalent to a round trip flight from NY to Denver |
0.3
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oncogenes
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genetic information that work to prevent ca, by keeping cell growth in check
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oncogene over-expression
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when an oncogene (HER2/neu), malfunctions & over-expresses itself, making excess normal or abnormal proteins & receptors
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cancers that result from over-expressed oncogenes such as ________ are more likely to recur than other cancers, may respond to different types of tx than other breast cancers
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HER2/neu
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approximately ____% of patients w/ breast cancer have tumors that over-express HER2/neu
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25
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most common form of breast cancer
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ductal carcinoma
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types of ductal carcinoma
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intraductal (CIS)
infliltrating or invasive comedo inflammatory |
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types of lobular carcinoma
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intraductal (CIS)
invasive |
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other form of breast cancer
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paget's disease of the nipple
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primary tx for breast cancer
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-total mastectomy
-breast conserving surgery plus radiation -adjuvant therapy |
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reconstruction of the breast involves
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tissue expansion & breast prostheses
flap reconstruction -latissimus flap -transverse rectus abdominis myocutaneous (TRAM) flap -free flap |
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adjuvant therapy for breast cancer
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chemotherapy (traditional)
-tamoxifen if ER positive rad therapy - chest wall |
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example of chemo for non-metastatic breast cancer
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-AC+-T (adriamycin with or without taxol)
-CMF (cyclophosphamde, metotrexate, and fluoroucil (5-FU) -CEF ( cyclophosphamide, epirbicin, and fluoruracil -FAC (fluorouracil, adriamycin, and cyclophosphamide) |
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tamoxifen blocks the effect of _________
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estrogen
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aromatase inhibitors are recommended only for __________________ women. Works by blocking the production of estrogen in muscle and fat
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postmenopausal
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examples of aromatase inhibitors
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arimidex
femara aromasin |
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chemobrain
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neurocognitive impairment
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rad therapy post breast surgery
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pts who waited longer than 20weeks had higher rates of local and distance recurrence & inferior breast cancer-specific survival compared w/ participants who started rad therapy w/in 4-8wks of surgery
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when do we tx supraclavicular nodes
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primary breast mass is 5cms or larger
4 or more lymph nodes involved in axilla |
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treating internal mammary nodes
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there is probably no benefit to treating
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accelerated partial breast irradiation APBI
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shorter time, less volume, but less long term data
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different techniques for APBI
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intraoperative radiotherapy
balloon catheter technique (mammosite) 3d conformal external beam radtherapy interstitial multicatheter technique |
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side effects of radiation therapy to breast
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skin changes
arm or breast edema breast fibrosis painful mastitis pneumonitis rib fx's (effects increased w/ collagen vascular disease) |
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Stage I skin reaction
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erythema, slight edema @ 1,500-2,000 cGy
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stage II skin reaction
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dry desquamation- destruction of sebaceous glands - itching
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stage III skin reaction
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moist desquamation, blisters @ over 4,000 cGy
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stage IV skin reaction
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necrosis
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types of APBI
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intraoperative radiotherapy (IORT)
balloon catheter technique (mammosite) 3D conformal ext. beam radiotherapy interstitial multicatheter techniques |
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IORT
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w/ electrons (IOERT) 20-22Gy
w. 50Kv xrays (intrabeam) 20Gy |
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Balloon catheter technique- mammosite
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5days, 8-10fxs, total dose 32-33Gy
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3D conformal external beam radiotherapy
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38.5Gy in 10fxs, delivered 2x daily
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interstitial multicatheter technique
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HDR iridium192 32Gy in 8fxs or 30.1 Gy in 7fxs in 2 daily sessions
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treatment of radiation therapy side effects to breast area
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-gentle washing,pat dry
-avoid tight clothes -expose to air -wear cotton -avoid intense heat & cold protect form sunlight -no makeup, deodorants, tapes, medications, etc. unless prescribed by MD |
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chronic reactions to breast irradiation
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-hyper/hypo pigmentation
-fibrosis -atrophy -telangiectasia -clinical manifestations or vascular insufficiency -slow healing - necrosis |
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cardiac complications and breast irradiation
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gated breathing may be used to reduce the dose to the heart
for left sided breast cancer- possibly implementing a step and shoot technique w/ breath holds on the tangents |
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prognosis of breast cancer dependent upon
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-age & menopausal status
-stage of dx -histologic & nuclear grade of the primary tumor -ER,PR, & HER2/neu receptor status |
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bone sarcoma incidence & mortality
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incidence = 2,570
mortality = 1,470 |
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genetic link to bone sarcoma
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p53 tumor suppressor gene
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other risk factors associated w/ bone sarcoma
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-retinoblastoma
-paget's dx (5-10%) -multiple exostoses, osteochondromas & endochondromas - radiation- tx'd @ a younger age & or treated w/ doses over 60Gy -exposure to radioactive materials (radium/strontium) |
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radiation induced bone sarcoma
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shown to develop anywhere form 4-42 yrs after therapy (avg latent period 11 yrs)
-usually @ least 30Gy is needed |
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soft tissue sarcoma
-incidence & mortality |
incidence : 10,660
mortality : 3,820 |
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soft tissue sarcomas may arise in mesodermal tissues
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extremities 50%
trunk & retroperitoneum 40% head and neck 10% |
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causes/risk factors w/ soft tissue sarcomas
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-little known
-slight male predominance -greater than 60yrs of age -sometimes related to previous radiation, chemical, chemotherapy, or chronic lymphedema -chronic inflammatory processes |
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soft tissue sarcomas occur more frequently in patients w/
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-von Recklinghausen's disease (neurofibromatosis)
-Gardner's syndrome -Werner's syndrome -tuberous sclerosis -basal cell nevus syndrome -Li-fraumeni syndrome (p53 mutations) |
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most common primary malignant tumor arising of bone from bone forming mesenhymal cells
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osteosarcoma
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most common type of bone cancer in children
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osteosarcoma
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osteosarcomas most common in the distal ______, the proximal _______, the proximal ________, and the distal _________, in that order
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femur
tibia humerus radius |
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________________ most frequent bone cancer occurring in the 2nd decade of life & accounts for 4% of childhood &adolescent malignancies
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Ewing's family of tumors
-including primitive neroextodermal tumor (PNET) |
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other types of bone cancers
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-chondrosarcoma
-fibrosarcoma -giant cell tumor -aneurysmal bone cyst -chordoma |
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most common soft tissue sarcoma
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malignant fibrous histiocytoma (40%)
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25% of soft tissue sarcomas are_____________
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liposarcomas
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S/S of bone sarcomas
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-pain
-hard, enlarging mass -pathologic fx uncommon -elevated serum levels of alkaline phosphatase |
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S/S of soft tissue sarcomas
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-asymptomatic mass
-mass effects on organs & tissues involved may cause symptoms -pain w/ metastatic disease |
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diagnosis/ staging & work-up for sarcomas
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-hx and physical
-dx imaging studies -labs -fine or core needle, or open biopsy |
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___________, primary tx of choice for most sarcomas
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surgery
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____________ ___________ may be done pre/post op for sarcomas
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radiation therapy
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EBRT for sarcomas
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include scar, spare 1.5-2cm strip along limb
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use of chemotherapy for sarcomas has an enhanced ____________
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survival
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extra-articular resection of the knee joint which was reconstructed w/ _______________
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rotationplasty
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TD 5/5 Femoral Head
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5,200
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TD 5/5 TMJ
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6,500
6,000 6,000 |
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TD 5/5 Ribs
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5,000
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reactions depend on treatment ________, and _______ of patient
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site
age |
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___________lesion has a better prognosis, when dealing with bone malignancies
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extremity
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bone prognosis dependent upon
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size of tumor
gender histology presence of metastatic lesions surgical resectability |
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soft tissue prognosis dependent on
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age
size histologic grade stage |
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factors associated w/ poorer prognosis for soft tissue malignancies
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older than 60yrs
tumors larger than 5cms high grade histology |
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____ Gy can prematurely close epiphysis
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20
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___ Gy can ablate bone marrow
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40
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___ Gy to bone cortex can cause fx and healing problems
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50
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multiple myeloma is a systemic malignancy of _________ cells, that is highly treatable but rarely ________
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plasma
curable |
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multiple myeloma is potentially curable if it presents as a solitary _____________ of bone or as an extramedullary _____________
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plasmocytoma
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multiple myeloma
-incidence -mortality |
incidence- 20,580
mortality - 10,580 |
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risk factor associated w/ multiple myeloma
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more common in men than women
more common in african americans familial farmers and industrial workers exposure to ionizing rad (atomic bomb) |
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15% of all hematological malignancies
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multiple myeloma
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S/S of multiple myeloma
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-bone pain
-compression fx's -hypercalcemia -polyneuropathy -anemia -renal insufficiency -hyperviscosity -bruising, nose bleeds, hazy vision, headache, gi bleeding, sleepiness, neurological symptoms, infections |
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tx for multiple myeloma
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chemotherapy
-conventional, including thalidomide -bone marrow transplant |
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tx for multiple myeloma cont.
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rad therapy
-50gy for solitary plasmocytomas 15,20 up to 35Gy for multiple -TBI & Hemi body 7.5-.5Gy |
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median survival for multiple myeloma
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24-30months
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10 yr survival for multiple myeloma is ___%
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3
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what is the most common tumor found in bone?
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mets
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most bone mets involve _________skeleton
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axial
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bone mets rarely occur distal to _______ or _________
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elbows or knees
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bone mets spread ___________
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hematogenously
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___% of skeletal mets are multiple
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90
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most bone met lesions are ____________
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asymptomatic
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most common tumors to metastasize to bone
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prostate- blastic
breast- mixed lung - lytic renal cell- lytic |
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bone mets... _________ of life, not quantity
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quality
single fx of 8Gy compared w/ 6fx of 4Gy each |
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dx primarily in lymph nodes
REED sternberg cells must be present |
Hodgkin's
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can be in any lymphatic tissue
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non-hodgkin's lymphoma
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primary lymph organs
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thymus
bone marrow |
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secondary lymph organs
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tonsils
spleen peyer's patch appendix lymph nodes lymphatic vessels |
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unpaired pharyngeal tonsil in the roof of the pharynx, paired palatine tonsils & lingual tonsils scattered in the root of the tongue
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Waldeyer's tonsilar ring
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Hodgkin's incidence
& mortality |
incidence :8510
mortality: 1290 |
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risk factors/ causes associated w/ hodgkin's
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-affects more men
-more common in ages 15-40, peaks around 25-30 & after age 55 -rare before 5yrs old |
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possible associated w/ ______________
: epstein bar virus (mono) aids organ transplant pts-who take immuno-suppressive drugs -congenital immunodefiiency syndromes |
Hodgkins
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NHL
incidence and mortality |
incidence: 65,980
mortality : 19,500 |
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rates of NHL have _________ since the early 70s
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doubled
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__% of NHL cases are in ppl aged 60 and older
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50
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NHL is much _______predictable than Hodgkins, far greater chance to disseminate to extranodal sites
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less
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aggressive lymphomas are seen in _____ positive patients
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HIV
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________ are a heterogeneous group of lymphoproliferative malignancies w/ differing patterns of behavior and responses to tx
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NHL
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radiation + chemo = increased risk for secondary ___________ or _____
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leukemias
NHL |
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risk factors for NHL
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-chemicals (benzene ,herbicides, & insecticides)
-organ transplantation -HIV -T-cell leukemia/lymphoma virus -rheumatoid arthritis -higher SES |
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other risk factors associated w/ NHL
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-helicobacter plylori (MALT lymphoma)
-celiac dx -obesity & sedentary lifestyle |
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S/S of NHL & Hodgkins
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lymphadenopathy
mass |
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majority of hodgkins patients present in ________ node, usually presents as painless lymphadenopathy in ________ lymph nodes involving (cervial, axillary, inguinal)
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cervical
superficial |
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Hodgkins & NHL systemic B symptoms
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-unexplained loss of more than 10% of body wt, in 6mos before diagnosis
-unexplained fever w/ temps above 38degrees C -drenching night sweats |
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Hodgkins and NHL
staging and workup |
-hx & physical
- biopsy (FNA, exsisional or incisional) -lab studies ( include sedimentation rate) -thoracic & abdominal/ pelvic CT's -lymphangiography -bone barrow biopsy (if B symptoms present) |
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_________ lymphomas , have relatively good prognosis, w/ median survival as long as 10 yrs, but they usually are not curable in advanced clinical stages
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indolent
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________lymphoma, has a shorter natural hx, but 30% to 60% of these pts can be cured w/ intensive combination chemotherapy regimens
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aggressive
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NHL
histology |
-low grade
-intermediate grade -high grade (burkitts & non-burkitts) |
