HER-2

HER-2
- gene responsible for encoding a transmembrane typrosine kinase (growth stimulating activity)
- when over-expressed in breast cancer causes more rapid growth and aggressive behaviour of tumor cell
- over-expressed in ~30% of breast cancers
- over-expression is an independent predictor of worse prognosis
- Herceptin: monoclonal antibody targetting HER-2 membrane receptor

BRCA

BReast CAncer 1 and 2
- higher incidence of breast and ovarian cancer
- Autosomal dominant with incomplete penetration
- 85% chance of developing breast cancer over lifetime; majority will present before age 50
- risk of ovarian cancer BRCA-1 40%, BRCA-2 20%
- 10% of males with BRCA-2 develop breast cancer

Li-Fraumeni Syndrome

mutations of p53 gene
- breast cancer
- sarcoma
- brain tumors
- adrenocortical carcinomas
- leukemia

Breast Cancer in Pregnancy

Breast cancer 2nd most common malignancy in pregnancy
(1:3,000 pregnancies)
Diagnosis:
- Mammography can be performed if fetus shielded
- U/S
Treatment:
- mastectomy usually operation of choice (radiation contraindicated in all trimesters)
- lumpectomy can be performed very late stages of pregnancy
- Tc99 can be used for SLNB
- avoid isosulfan blue dye and vital blue dyes
- chemotherapy acceptable in 2nd and 3rd trimester but avoid in 1st trimester

Locally Recurrent Breast Cancer

Local recurrence after mastectomy - 10%
Treatment:
-local excision plus irradiation
- use of systemic therapy is contraversial
Prognosis:
-almost always accompanied by distant metastatic disease
- Long-term prognosis poor 20 yr survival <10%

Male Breast Cancer

<1% of breast cancers
Risk factors:
- (increased estrogen levels): cirrhosis, Klinefelter sydnrome
- radiation
- BRCA2
most common tumor type is infiltrating ductal cancer
- stage for stage same as female breast cancer but detected later
management:
- mastectomy SLNB +/- ALND
- large majority are ER positive and adjuvant treatment should be offered the same as females

Keys Steps: Parotidectomy

1) raising skin flaps
2) dissection down to posterior belly of digastric mm.
2) identification of facial nerve


- Posted from iPhone

TMcM - adrenal talk

Aldosteronoma:
- usually very small tumors
- if larger tumor on one side --> is it a redherring and its actullay another type of adrenal tumor
NP25 scan available at CCI for localizing
Adrdrenal venous sampling
pheo 30% are thought to be genetic
- now all pts get screened MEN2a/b, vHL, NF-1, tuberous sclerosis, SDH mutations
- pheos alpha block 2-3 wks before OR
- fluid load 3L day of surgery
- can tank pressures from other causes

DCW Salivary gland AHD talk

cystic lesions of minor salivary glands
- due to trauma (biting lip)
- treated by excision of entire cyst and reapproximation of oral mucosa
minor salivary glands can also be biopsied when asked for salivary gland bx for sjogren's diagnosis
salivary duct stones
- can be extracted with baskets by interventional radiologist
sialadenitis
- staph aureus
- hydration
- sialogogues - lemon drops
- antibiotics
- drainage: through stensen's duct or 14G needle aspiration
Parotid lesions:
- parotid glands are now FNA'd whereas in past went straight to OR
rate of needletrack seeding
- 25G - 0.01%
Parotidectomy
1% chance of permenant facial nerve dysfunction
- marginal mandibular branch is long and thin and most likely involved
- 20% of temporary dysfunction
posterior belly of digastric for deptth
- finger on mastoid point to nose
- 1/2 distance at depth of digastric belly
Fascial layers of neck