Lymph Nodes

Axillary nodes, relation to Pectoralis Minor:

  • Level 1: infero-lateral to pectoralis minor
  • Level 2: behind pectoralis minor & inferior to axillary vein
  • Level 3: medial to pectoralis minor

Intercosto-brachial nerve: (off 2nd intercostal nerve)

  • Sensation to medial arm
  • Most commonly nerve injured in ALND or breast surgery
  • Ok to sacrifice

Long thoracic Nerve: to serratus anterior

  • Injury = winged scapula

Thoracodorsal Nerve: to latissimus dorsi,

  • Injury = weak arm adduction/pull ups

Medial pectoral Nerve: to pectoralis major and minor

Lateral pectoral Nerve: to pectoralis major only

Batson's Plexus: valveless verterbral veins, allow direct mets to spine

Poland syndrome: amastia, hypoplastic shoulder, no pectoralis

Mastodynia: Tx with danazol, OCP, evening primrose oil, tamoxifen (?) Vitamin E not useful

Mondor's disease: thrombophlebitis of superficial vein of breast. Cord like mass laterally

  • Tx: NSAIDS

Tumor Grading:

  • T1 < 2cm

  • T2 2-5cm

  • T3 > 5cm

  • T4 skin or chest wall involvement (peau d’orange, inflammation = grave signs)

  • N1 (+) ax nodes

  • N2 matted or fixed nodes

  • N3 internal mammary nodes

  • Stage I: T1
  • Stage II: T2N1 or T3N0
  • Stage III T4 or N2
  • Stage IV Mets (includes supraclavicular node, unlike lung CA)

Breast metastasis: to bone, lung, and brain.

Her 2 neu: a marker for breast CA, Implies worse prognosis

  • Herceptin now available for Tx.

Erb B 2, p53, cathepsin: all indicate worse prognosis

1cm tumor: is ~5 years old

Tamoxifen: Reduces risk 50% in high risk, Increase endometrial CA, DVT

Atypical hyperplasia:

  • Raises risk x 4 (only finding in fibrocystic that increase risk)

ER+PR+: is better than ER-PR+, which is better than ER+PR-, which is better than ER-PR-


  • 50% develop invasive carcinoma, is a precursor.

  • Usually lumpectomy + RT

  • Mastectomy for high grade/large tumor/poor margins

  • 50% of DCIS recurrence is invasive


  • 30-40% develop invasive carcinoma (either breast),

  • Is a marker of risk

  • Treatment options: nothing, tamoxifen, or bilateral mastectomy

Comedo Breast CA:

  • Likely multicentric, do mastectomy
  • Poor Prognosis

Paget's disease of the breast:

  • Eczematous lesions on nipple
  • There is underlying DCIS or Ductal CA.

Cystosarcoma Phyllodes or 'Phyllodes tumor':

  • Only 10% malignant
  • Large
  • Rare
  • No nodal metastasis; as other sarcomas, CP spreads hematogenously, not lymphatic.
  • Tx: is wide local excision, rarely mastectomy
  • No need axillary node dissection


  • 85% have CA by age 70.
  • BRCA1 a/w ovarian CA (50%)

  • BRCA2 a/w male breast CA

Indications for RT after mastectomy:

  • >4 nodes

  • Skin or chest wall involvement

  • (+) Margins

Stewart Treves: lympangiosarcoma in lympedematous limb

  • Presents with purplish mass on arm

  • @~ 10 yrs s/p MRM

Intraductal Papilloma: no risk of CA.

  • #1 cause of bloody nipple discharge (although 1/2 are serous)

All items (1)