Test 10/1/12 Chapter 38/breast

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RadTherapy
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Test 10/1/12 Chapter 38/breast
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2012-09-30 20:40:38
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Chapter 38 Breast
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  1. The breast are situated on the ______ surface of the thorax, overlying and attached to the ________ muscles at the level of the ____ & ____ rib.
    • anterior
    • pectoral
    • 2nd & 6th
  2. The breasts orginate from parts of the skin and are, in fact, modified_________.
    sweat glands
  3. 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
    • ducts
    • nipple
    • alveoli
  4. The ____  ______extends from the nipple like the spokes of a wheel.
      lactiferous ducts
  5. Under the areola (dark pigmented area of the breast), each duct has a dilated portion, called the _____ _____, in which milk accumulates during lactation.
    lactiferous sinus
  6. 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
  7. Other connective tissue, which forms dense strands called ______ ______ (suspensory), and help support the weight of the breast.
    Cooper's ligaments
  8. Breast parenchymal tissue extends into the axilla through an opening in the axillary fascia. This tissue is called the ______ ______ ______ _______.
    axillary tail of Spence
  9. Two ovarian hormones, ______ and ______, control the development of the breast during puberty and also play an important role in the ________.
    • estrogen and progesterone
    • lactation
  10. ________ (from the pituitary) stimulates milk production
    Prolactin
  11. The main blood supply to the breast comes from the ______ _______ _______.
    internal mammary artery(IMA)
  12. The breast receives an additional supply of blood from branches of the _____  ______ and the aorta
    axillary artery
  13. Knowledge of the _____ of the breast is critcal because of their clinical importance in the spread of breast cancer.
    lymphatics
  14. The primary pathway of the lymphatic drainage (70-75%) is through the _______.
    axilla
  15. 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
  16. 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
    • supraclavivicular
  17. The breast is drained by the ____, ____ _____ and _____ veins.
    • axillary
    • internal mammary
    • intercostal
  18. Note:
    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
  19. 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
  20. Breast cancer is the ____ _______ malignancy in women.
    most common
  21. _________ and________ women have higher incidence of breast cancer than other nationalities.
    Caucasian, European
  22. 1 in ___   or ____ %  of  women will develop breast cancer.
    8, 12
  23. Incidence______with _____and peak age is 60
    increases, age
  24. 1 in _____women at age 60 will get breast cancer.
    420
  25. The leading cause of death in _____ years of age group is
    _________.
    40-55, breast cancer
  26. _____ of breast cancers have no evident risk factors
    70%
  27. ______of recurrences will happen in ______.
    90%, 3 years
  28. The most common disease of the breast is ________.
    fibrocystic disease.(benign condition)
  29. ____ of diagnosed cases are in  ____ and the disease is _________  _________.
    1%, men, more aggressive
  30. Breast cancer appears more frequently in ____ breast.
    left
  31. _______ % 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
  32. The genes responsible for the inherited forms of breast cancer are______ and _____________ and is associated with up to an _______ likelihood of developing breast cancer.
    • BRCA1 and BRCA2, 85%
  33. 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 

  34. _________ exposure during ______ is a risk factor for breast cancer.
    žRadiation, adolescence
  35. Early______ and late _________ are risk factors because of the assumption that the overall length of ovaian function
    is realted to breast cancer risk.
    menarche, menopause
  36. Pregnancy later in life increases the risk ___ than nulliparity
    more
  37. 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)
    increases
  38. A history of _______ breast disease such as atypical hyperpalsia or lobular carcinoma in situ have an ______ risk of developing breast cancer.
    benign, increased
  39. __________ replacement therapy increases breast cancer risk but it  any increased risk disappears _____ years after cessation of therapy.
    hormone, 5
  40. ______ _______ increase  the risk  of breast cancer  slighly but all risk disappears ____ years within ______ years of cessation of use.
    oral contraceptives, 10
  41. Note: Risk Factors for breast cancer include:
       Female
       Age
       High ingestion of fat
       Family history of breast cancer
    Oral contraceptives
    • hormones replacement therapy (estrogen)
    • Alcohol & tobacco use
    • women who have children after age 30
    • early menarche or late menopause
    • radiation exposure during childhood
  42. In concerns with the lymph node status - the higher the number of nodes involved the _____ the prognosis.
    poorer
  43. Overall 5 years survival rate is  ______ %
    89
  44.  1 in ____at age 30 will get breast cancer.
    5900
  45. What percentage of bc's occur in the UOQ?
    50%
  46. What percentage of bc's occur in the LOQ?
    10%
  47. What percentage of bc's occur in the UIQ?
    15%
  48. What percentage of bc's occur in the LIQ?
    5%
  49. What percentage of bc's occur in the sub areola area?
    15%
  50. Infilltrating ductal carcinoma is the most common histologic type of breast malignancy accounting for _____ to ____%
    70-80%
  51. 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
  52. The next most common kind of breast cancer histlogically after infiltrating ductal carcinoma is infilitrating ______ 
    _________ which comprises ____ to _____% of  breast cancers.
    • lobular carcinoma, 5-10%
  53. There are several relatively rare types of b. c. such as mucinous or colloid, tubular, and papillary carcinomas that yield more_______responses.
    favorable
  54. Tumors clasified as _________ carcinoma yield an extremely _______ prognosis.
    inflammatory, poor
  55. 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
  56. Histological types of breast cancer:
    • Ductal carcinoma in situ(DCIS)
    • Ductal or infiltrating ductal carcinoma(most carcinoma)
    • Lobular(can present bilateral)
    • inflammatory
  57. _______ breast cancer can present bilaterally.
    lobular
  58. 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.
  59. Overall  5 year survival rate is ______.
    89%
  60. The 5 year survival rate decreases to ____ %  if evidence exists of regional spread.
    83%
  61. The survival rate is ____% if there are distant mets at the time of diagnosis.
    20%
  62. 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.
    systemic
  63. Nodes are positive in ___-_____ of cases.
    55-70 %
  64. 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.
  65. Breast cancer metastasizes via the _______ _______.
    blood vessels
  66. The most common sites of breast cancer  metastasis are:
    _________(the most common),  and ________.
    bone, lung
  67. 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
  68. Clinical presentation includes an abnormal ________ and lymphadenopathy including:enlargement of _____ _____ _________  and  arm edema.
    mammogram, enlargement of axillary lymph node(s)
  69. ______% of lesions are found by women doing SBEs which should be done monthly during the same time in the menstrual cycle.
    90%
  70. 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%
  71. Sonography is used totell the difference between a a solid mass and a _________ which is fluid filled.
    cyst
  72. ____ have no evident risk factors
    70%
  73. ____ of recurrences will happen in 3 years
    90%
  74. žTis – 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
  75. T1 is ?
    2 cm or less
  76. T2 is ?
    More than 2 cm but not more than 5cm
  77. T3 is ?
    Greater than 5 cm
  78. T4 is ?
    Any size with direct extension to chestwall or skin is
  79. What are the two triple chemo coctails and what is in them?
    • CAF-cytoxan, adria, 5FU
    • CMF-cytoxan, methotrexate, 5FU
  80. 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
  81. What does PAB stand for?
    Posterior axillary boost

    (dose 4500-5000 cGy......sound familiar)
  82. 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
  83. What is the PAB and what are it's borders?
    posterior axillary boost


  84. What is SCV field?
    • supraclavicular field
  85. 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

    • Positive
    • nodes:55-70%

    1 in 3 women

    1 in 5900-Age 30

    1 in 420-Age 60

    • Leading cause of
    • cancer in 40-55 yr olds

    Peak age-60

    1% in men

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