Venous drainage: the superficial veins radiate from breast & are characterized by their proximity to skin.
They are accompanied by lymphatics & drain to axillary, internal mammary & intercostal vessels.
Phlebitis of one of these superficial veins feel like a cord immediately beneath the skin. The condition produces no discoloration & may be tensed like bowstring by putting traction on it (Mondor’s disease).
Nerve supply: the secreting tissue is supplied by sympathetic nerves(2 nd -6 th intercostal nerves). The overlying skin is supplied by the ant & lat branches of 4 th , 5 th & 6 th intercostal nerves.
Beatson , a surgeon in glasgow cancer hospital was the first to demonstrate that BL oophorectomy can lead to metastatic breast cancer.
Huggins, reemphesized oophorectomy & demonstrated the effectiveness of adrenalectomy in treatment of metastatic breast cancer.
But endocrine ablation therapy has been replaced by antiestrogen therapy.
is the first line treatment of estrogen sensitive breast cancer.
Class Common examples Clinical use Selective estrogen receptor modulator(SERMS) Tamoxifen, Raloxifen, Toremifen Adjuvant therapy for metasttic disease Aromatase inhibitors(AIs) Anastrazole Letrozole Exemestane Adjuvant therapy for metasttic disease Pure antiestrogen Lutinizing hormone- releasing hormone(LHRH) Fluvistrant Goserelin Leuprolide -2 nd line therapy for metastatic disease -Adjuvant therapy for metasttic disease Progestational agents Megestrol 2 nd line therapy for metastatic disease Androgens Fluoxymesterone 3 rd line therapy for metastatic disease High dose estrogens Diethylstilbestrol 3 rd line therapy for metastatic disease