Book 4 - Self Instructional Manual for Cancer Registrars - SEER ...

A tumor specified as "subareolar" is coded to the central portion of the breast (C50.1) indicatingthat the tumor is located directly under the nipple.Extending outward from the nipple and areola and covering the entire surface of the breast is alayer of skin. Skin changes are significant in the clinical evaluation of breast cancer and indicateinvolvement of parenchymal tissue as well as invasion of the skin itself. Changes such as dimpling,tethering, and nipple retraction are presumed to be due to tension on Cooper's ligaments and notto actual skin involvement; adherence, attachment, fixation, induration, and,thickening are usuall),dueto extension of tumor to the skin or subcutaneous tissue. Edema, peau d orange, 1 en cuirasse _, andulceration clinically indicate extensive skin involvement.The blood supply to the breast is from both the internal thoracic (subclavian) and the lateralthoracic (axillary) arteries. The veins form both superficial and deep plexuses and correspond ingeneral to the arterial pattern.Regional Lymph NodesThe lymph nodes of the breast may be divided into the following categories:Axillary lymph nodes (ipsilaterai)Low axiUary(Level I): area adjacent to the tail of the breastMid axillary (Level II): central, interpectoral (Rotter's node)High axillary (Level III): apex of the axilla including those designated assubclavicular, infraclavicular, and apical nodesInternal mammary (parasternal) lymph nodes (ipsilateral): in the intercostal spaces alongthe edge of the sternum in the endothoracic fasciaNodules of cancer cells found in the axillary fat which are not specifically identified as lymph nodesare considered to be nodes which have lost their architectural configuration or to be intransitmetastases in the lymphatics.Contralateral or bilateral involvement of any of the above lymph nodes is considered distant lymphnode metastasis.All other lymph node metastases are coded as distant metastases, including any supraclavicular,scalene, and cervical lymph nodes.lpeau d'orange--a dimpled skin condition resembling the skin of an orange.2en cuirasse--an inflammatory process in which skin involvement resembles armor plate.302