Describe the anatomical location of the breast.
anterior surface of the thorax, overlying & attached to pectoral muscles at the level of the 2nd & 6th rib
Describe the composition of each mammary gland and be able to label each part on a diagram
The mammary glands originate from parts of the skin and are, in fact, modified sweat glands.
List the number of lobes in each mammary glands
Each mammary glands is composed of 15-20 lobes, each of which are drained by lactiferous or alveolar (epithelial ducts) which opens to the nipple
State the primary pathway of lymphatic drainage for the breast
drained by lactiferous (or alveolar) which open up to the nipple.
List the lymph groups of the breast and locate each group
- Axillary Lymph Nodes
- Internal Mammary Lymph Nodes
- Supraclavicular Lymph Nodes
List the 3 common sites of spread of breast cancer
lungs, liver, & bones
Discuss the incidence of breast cancer in the US and contrast it to the incidence of breast cancer in other countries
Breast cancer is most common in caucasian & european women. It is more common in these women than any other nationalities
State the most common disease of the breast
Anatomically, where does breast cancer most often present
Left Upper Quadrant (LUQ)
List potential risk factors of breast cancer
- high ingestion of fat
- family history of breast cancer
- history of benign breast disease
- oral contraceptives
- hormones replacement therapy
- alcohol & tobacco use
- nulliparpus women, or women who had their 1st child after age 30
- Early menarche and late menopause
- radiation exposure during adolescence
State the most common symptom of breast cancer
State how most breast cancers are usually discovered
Self breast Exams (SBE)
Discuss the virtues of physical exams vs. mammography and give the accuracy rate of mammography and the guidelines for its application.
SBE's can catch cancer at the earliest stages because she can feel her breast and notice if any changes are there immediately. Even though mammograms are a very helpful tool they still miss 10 to 15% of small and moderate size breast cancers
Describe the symptoms of advance breast cancer
Discuss the types of biopsy used for breast mass
- Fine needle biopsy
- Core-Needle Biopsy
- Incisional biopsy
- Excisional biopsy (method of choice for removing small lesions)
List the most common type of breast cancer
Infiltrating ductal carcinoma is the most commoon histologic type of breast malignancy, accounting for 70% to 80% of all breast cancers
Discuss inflammatory carcinoma, its prognosis & treatment
- Does not exhibit distinct lumps or masses. It causes thickening and swelling of skin of the breast.
- Symptoms may include:
- red, pink, reddish purple or bruised appearance
- extreme tenderness
- enlargement beyond normal hormonal changes
- warm to the touch
- inflammed appearance
- ridges or pitts like an orange
- inverted nipple
- This is a very rapid growing & aggressive cancer
- The prognosis is poor
State which type of breast cancer is most likely to present as bilatral disease.
A history of breast cancer either invasive or ductal carcinoma in situ increase the risk to delvelop breast cancer in opposite breast
Discuss the factors which determine the stage of breast cancer
- There are 2 methods of staging fro breast cancer
- clinical & pathologic.
- Clinical - involves all physical exams, imaging
- pathologic - includes all those factors plus data obtained from surgical procedures
Differentiate between mastectomy & lumpectomy
Mastectomy includes the removal of the breast with its overlying skin, all the axillary lymph nodes, and the pectoral muscles.
Lumpectomy is an excisonal biopsy of the breast mass (removal of the tumor with a margin of normal appearing tissue)
States cases for which lumpectomy is not recommended
When excision of the lump would involve removing more than 30% of the breast tissue
Describe hormonal therapy as it applies to thte management of breast cancer
- A variety of drugs used to deprive cancer cells of the hormones needed for growth.
- The most commonly used are Tamoxifen & aromitase inhibitors
describe the treatment fields commonly used for RT of the breast
- Superior - 1st intercostal space
- Inferior - 1-2cm below inframammary fold
- Medial - Midline
- Lateral - Mid Axillary line
- Include 1-2 cm of lung
Beams should be coplanar
Describe the time dose fractions used in treatment of the breast
a small amount evert week day (off the weekend) until the desired overall total is reached
Discuss the use of electrons in treating the breast
The stream of radiation produced by electron accelerators damages the genetic material of the cancer cells rendering them unable to continue dividing
List and discuss the possible complications of RT
- Skin changes
- Cardiac effects
- Pulmonary effects
The breast are situated on the anterior surface of the thorax, overlying and attached to the pectoral muscles at the level of the 2nd to 6th rib
The mammary glands orginate from parts of the skin and are, in fact, modified sweat glands.
Each mammary gland is composed of 15-20 lobes, each of which are drained by lactiferous or alveolar (epithelial ducts) which opens to the nipple.
The ducts extend from the nipple like spokes of the wheel.
Under the areola, each duct has a dilated portion, called the lactiferous sinus, in which milk accumulates during lacation.
The lobes of the mammary glands are seperated fromeachother by dense connective and adipose tissues. These tissues also support the glands and attach them to the underlying pectoral muscles. Other connectived tissue, which forms dense strands called Cooper's Ligaments (suspensory) and help support the weight of the breast.
Breast parenchymal tissue often extends into the axilla through an opening in the axillary fascia. This tissue is called the axillary tail of Spence.
Two ovarian hormones, estrogen & progesterone, control the development of the breast during puberty and also play an important role in the lactation.
Prolactin (from the pituitary) stimulates milk production,
The main blood supply to the breast comes from the internal mammary artery.
The breat receives anadditional supply of blood from branches of the axillary artery and the aorta
Knowledge of the lymphatics of the breast is citical because of the clinical importance of the spread of breast cancer. The primary pathway of lymphatic (70-75%) is through the axilla.
The axillary lymph nodes lie deep in the axillary fascia in close association with the major blood vessles in the axilla.
They drain upper extremities, chest wall, and breast.
They are divided into 3 levels (I, II, III).
Other lymph groups include intermal mammar (4 on each side) at the edge of the sternum and at the 1st - 3rd intercostal space (2cm depth), and the supraclavicular nodes.
The breast is drained by the axillary, internal mammary and intercostal veins. Direct venous communications exist betweenthe breast and the superior vena cava, the vertegral venous plexus, and the portal venous system.
This explains the frequent spread to the lungs, liver and bones of the axial skeleton.