Breast Cancer Lecture 1.doc

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Anatomy and Cell Biology
Anatomy and Cell Biology 4461B
Geordie Shepherd

LP Lecture 4: Breast Cancer Oncoanatomy • Normal tissue organization of a specific anatomic site that determines clinical behavior of cancers originating from that tissue inclusive of its pattern of spread • Paradigm for oncotaxonomy - anatomical extent of spread which is the basis of cancer classification and staging • Cancer invades in 6 directions: A-P, S-I, M-L • Cancer usually follows the “path of least resistance” • Along fascial and muscle planes • Through fatty areolar spaces • Entering low pressure lymphatics and venous channels • Key to deciding treatment and predicting outcome • Particularly histological staging Anatomy of a Normal Breast • Breast is a modified, specialized, cutaneous glandular structure • Functions in milk production • Located in superficial fascia between second and third ribs between the sternal edge and midaxial line • Attached via fascia to the pectoralis major • Nipple projects from anterior surface • Hyperpigmented • Mostly dense fibrous tissue covered by skin • Also contains smooth muscle fibers Areola • • Pigmented, more so during pregnancy Montgomery tubercles • • Innervation Dermatomal • • Vascular Anatomy • Internal and posterior branches of internal mammary artery • Lateral mammary branch of lateral thoracic artery • Smaller sources of arterial blood include the posterior intercostal arteries and the pec- toral branch of the thoracoacromial artery • Wide variation between women and between breasts • Course of arteries does not appear to be associated with ductal system • Deep veins run along arteries • Lymphatics • 4 major routes • Axillary • Transpectoral • Mammary • Intercostal to surrounding nodes • Up to 75% of the lymphatic drainage is to the axillary nodes • Follow the blood vessels through the pectoralis major and enter the internal thoracic/mammary nodes • Cancer in the lymph may easily enter the vascular system once it has cycled into the venous system • Breast Parenchyma • Glandular epithelium distributed within adipose tissue and supported by fibrous stroma • Branching duct system of 15-20 lobes • Lobes radiate fro nipple • Lobes shaped like a pyramid pointing toward the nipple • Lobes bound together by interlobular connective tissue • Suspensory ligaments extend from interlobular connective tissue to attach to the der- mis • Suspensory ligaments give the breast its shape • Sometimes breast cancer presents with skin retraction through pulling of the liga- ments • Liga
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