The breast are situated on the ______ surface of the thorax, overlying and attached to the ________ muscles at the level of the ____ & ____ rib.
- 2nd & 6th
The breasts orginate from parts of the skin and are, in fact, modified_________.
Each breast is composed of ____ to ____ lobes, which are embedded in _____ ____.Each lobe is drained b system of ______ which open to the ______.In each lobe numerous lobules contain milk producing _______.
- 15 to 20
- adipose tissue
The ____ ______extends from the nipple like the spokes of a wheel.
Under the areola (dark pigmented area of the breast), each duct has a dilated portion, called the _____ _____, in which milk accumulates during lactation.
The lobes of the mammary glands are seperated from each other by _____ _____ and ______ ______.
These tissues also support the glands and attach them to the underlying pectoral muscles.
- dense connective
- adipose tissue
Other connective tissue, which forms dense strands called ______ ______ (suspensory), and help support the weight of the breast.
Breast parenchymal tissue extends into the axilla through an opening in the axillary fascia. This tissue is called the ______ ______ ______ _______.
axillary tail of Spence
Two ovarian hormones, ______ and ______, control the development of the breast during puberty and also play an important role in the ________.
- estrogen and progesterone
________ (from the pituitary) stimulates milk production
The main blood supply to the breast comes from the ______ _______ _______.
internal mammary artery(IMA)
The breast receives an additional supply of blood from branches of the _____ ______ and the aorta
Knowledge of the _____ of the breast is critcal because of their clinical importance in the spread of breast cancer.
The primary pathway of the lymphatic drainage (70-75%) is through the _______.
The ____ ____ _____ lie deep inthe axillary fascia in close association with the major blood vessles in the axilla. They drain the upper extremities, chest wall, and breast. They are divided into 3 levels (I, II,III) .
axillary lymph nodes
Other lymph groups include _____ _____ (4 on each side) at the edge of the sternum and at the ___ & ___ intercostal space (2cm depth) and the __________ which are in the hollow above the collarbone, just lateral to where it joins the breast bone.
- internal mammaries
- 1st & 3rd
The breast is drained by the ____, ____ _____ and _____ veins.
- internal mammary
Direct venous communications exist between the breast and the superior vena cava, the vertegral venous plexus, and portal venous system,
This explains the frequent spread to the lungs, liver and bones of the axial skeleton
Label the structures:
- 1. Chest wall
- 2. Pectoralis muscles
- 3. Gland Lobules
- 4. Nipple
- 5. Areola
- 6. Lactiferous Duct
- 7. Fatty tissue
- 8. Skin
- *note-ligaments of cooper which support the breast tissue are not shown in this diagram
Breast cancer is the ____ _______ malignancy in women.
_________ and________ women have higher incidence of breast cancer than other nationalities.
1 in ___ or ____ % of women will develop breast cancer.
Incidence______with _____and peak age is 60
1 in _____women at age 60 will get breast cancer.
The leading cause of death in _____ years of age group is
40-55, breast cancer
_____ of breast cancers have no evident risk factors
______of recurrences will happen in ______.
90%, 3 years
The most common disease of the breast is ________.
fibrocystic disease.(benign condition)
____ of diagnosed cases are in ____ and the disease is _________ _________.
1%, men, more aggressive
Breast cancer appears more frequently in ____ breast.
_______ % occur in upper outer quadrant, ____% in the upper inner quadrant, ______% in the lower outer quadrant, ______ %in the lower inner quadrant, and ____ % in the ____ ______ area. Some are ______ or ______
- 50%, 15%, 10%, 5%, 15 %, sub areola, multicentric, multifocal
The genes responsible for the inherited forms of breast cancer are______ and _____________ and is associated with up to an _______ likelihood of developing breast cancer.
Is a women who has children at an early age at more or less risk for breast cancer han a women who waits until laer in life?
- She would be at LESS risk because:
- Nulliparous or women(women who have never given birth to a viable fetus) or women who have their first child after age 30 is a risk factor for breast cancer
_________ exposure during ______ is a risk factor for breast cancer.
Early______ and late _________ are risk factors because of the assumption that the overall length of ovaian function
is realted to breast cancer risk.
Pregnancy later in life increases the risk ___ than nulliparity
A history of breast cancer, either invasive or DCIS in one breast _______ the risk of *ipsilateral breast cancer recurrence.
*(breast cancer in the breast on the same side)
A history of _______ breast disease such as atypical hyperpalsia or lobular carcinoma in situ have an ______ risk of developing breast cancer.
__________ replacement therapy increases breast cancer risk but it any increased risk disappears _____ years after cessation of therapy.
______ _______ increase the risk of breast cancer slighly but all risk disappears ____ years within ______ years of cessation of use.
oral contraceptives, 10
Note: Risk Factors for breast cancer include:
High ingestion of fat
Family history of breast cancer
- hormones replacement therapy (estrogen)
- Alcohol & tobacco use
- women who have children after age 30
- early menarche or late menopause
- radiation exposure during childhood
In concerns with the lymph node status - the higher the number of nodes involved the _____ the prognosis.
Overall 5 years survival rate is ______ %
1 in ____at age 30 will get breast cancer.
What percentage of bc's occur in the UOQ?
What percentage of bc's occur in the LOQ?
What percentage of bc's occur in the UIQ?
What percentage of bc's occur in the LIQ?
What percentage of bc's occur in the sub areola area?
Infilltrating ductal carcinoma is the most common histologic type of breast malignancy accounting for _____ to ____%
The higher the number of nodes involved the poorer the prognosis:less than _____ positive nodes equals a low risk, _____ or more positive nodes indicates a high risk, and greater than ______ positive axillary lymphy nodes is extremely poor.
3, 4, 10
- 0-3 = low risk
- 4-10=high risk
- 11+ = extremely poor risk
- The involvement of internal mammary nodes by cancer. with or without axillary node involvement further reduces disease free survival rates. Similarly, subclav node involvement implies a poor prognosis
The next most common kind of breast cancer histlogically after infiltrating ductal carcinoma is infilitrating ______
_________ which comprises ____ to _____% of breast cancers.
There are several relatively rare types of b. c. such as mucinous or colloid, tubular, and papillary carcinomas that yield more_______responses.
Tumors clasified as _________ carcinoma yield an extremely _______ prognosis.
The diagnoses of inflammatory carcinoma is based on pathological evidence of malignancy and clinical findings of ________ ________ and enlargement, peu d'orange appearance(orange peel skin), erythema, warmth, and diffuse _______ of the skin.
breast tenderness, induration (sclerosis or hardening.)
tenderness, enlargement, redness, warmth, diffuse hardening, "orange peel" skin
Histological types of breast cancer:
- Ductal carcinoma in situ(DCIS)
- Ductal or infiltrating ductal carcinoma(most carcinoma)
- Lobular(can present bilateral)
_______ breast cancer can present bilaterally.
Samples of tumor should be tested for levels of _____, _____ and ______receptors on the cells.
estrogen, progesterone, Her-2/neu
- Her-2/neu positive tumors have a poorer prognosis, but can be treated with Herceptin. Estrogen and progesterone positive tumors have a better prognosis and can be treated with estrogen suppresion therapy like Femara or Tamoxifen.
Overall 5 year survival rate is ______.
The 5 year survival rate decreases to ____ % if evidence exists of regional spread.
The survival rate is ____% if there are distant mets at the time of diagnosis.
The 5 year survival rate is no the best indicator of survival for breast cancer beacause of its ______ nature. Patient's may relapse up to ______ years after treatment.
Nodes are positive in ___-_____ of cases.
Grows locally involving ______ and adjacent ________ and local or ________ lymph nodes. Breast cancer grows in an orderly and _______ manner. Recurrance can occur locally, in ____ ______, or a a distant metastatic sites
ducts, tissues, regional, progressive, lymph nodes.
Breast cancer metastasizes via the _______ _______.
The most common sites of breast cancer metastasis are:
_________(the most common), and ________.
The most common presentation is a _______ lump which is usually greater than .5 cm. Other symptoms include nipple_____, ________, or _________., as well as skin changes and alterations such as dimpling, ________, ________,ulceration, and/or Peau d'orange.
painless. discharge, retraction , warmth, irritation
Clinical presentation includes an abnormal ________ and lymphadenopathy including:enlargement of _____ _____ _________ and arm edema.
mammogram, enlargement of axillary lymph node(s)
______% of lesions are found by women doing SBEs which should be done monthly during the same time in the menstrual cycle.
Mammograms-baseline line at age _____and every other year starting at age_____ and every year starting at age ____. Can miss _____-______% of lesions.
35, 40, 50, 10-15%
Sonography is used totell the difference between a a solid mass and a _________ which is fluid filled.
____ have no evident risk factors
____ of recurrences will happen in 3 years
Tis – stands for ?
is Carcinoma in situ or early form of cancer that is defined by the absence of invasion of tumor cells into the surrounding tissue, usually before penetration through the basement membrane
T2 is ?
More than 2 cm but not more than 5cm
T3 is ?
Greater than 5 cm
T4 is ?
Any size with direct extension to chestwall or skin is
What are the two triple chemo coctails and what is in them?
- CAF-cytoxan, adria, 5FU
- CMF-cytoxan, methotrexate, 5FU
What are the magic numbers for radiation therapy dose?
*hint-it is the same dose for all the tangents and boosts except for one
- 4500-5000 cGy
- this is the dose for Breast and Chest Wall tangents
- (with a boost to 6,00-6,600 cGy) AND
- Boost to:
- SCV , PAB, and Internal Mammary Nodes
What does PAB stand for?
Posterior axillary boost
(dose 4500-5000 cGy......sound familiar)
What are the borders for the Internal Mammary Field?
- Superior: to match the supraclavicular field
- Inferior: the xiphoid process
- Medially: 1 cm pas the midline on the contrallaterel side or the midline
What is the PAB and what are it's borders?
posterior axillary boost
What is SCV field?
- supraclavicular field
All those stats(yawn)...
12 total (1 is a three part)
90% found by SBE
- 90% of recurrences
- happen in 3 year
- 5 year survival: 89%
- -regional spread:83%-mets:20%
BRC1 and 2-85%
- 70% have no evident
- risk factors
1 in 3 women
1 in 5900-Age 30
1 in 420-Age 60
- Leading cause of
- cancer in 40-55 yr olds
1% in men