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absite breast > absite breast review - Sheet1 > Flashcards

absite breast review - Sheet1 Flashcards

1
Q

What are the risk factors for breast CA?

A

Family history, history of previous breast Bx, Hx of LCIS on breast Bx (10×), Hx of ADH on breast Bx (4×), early menarche, late menopause, and BRCA gene mutation. Patients at the highest risk (BRCA) benefit from prophylactic tamoxifen therapy (50% reduction at 5 years).

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3
Q

❍ What Chromosomes are the BRCA 1 and 2 genes located on?

A

BRCA1—13; BRCA2—17. BRCA 1 has a particularly strong association with ovarian cancer as well.

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5
Q

❍ T/F: Accessory breast tissue in the axilla is usually bilateral..

A

TRUE

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6
Q

❍ T/F: Batson’s plexus is a route of metastasis for breast cancer.

A

True, vertebral veins without valves allow for metastatic “reflux” to the brain.

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8
Q

❍ T/F: Premenopausal women with node-positive breast cancer have improved survival rate with the use of adjuvant chemotherapy.

A

True.

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10
Q

❍ What is the significance of the Her-2 (erb-2) positivity of a breast tumor?

A

Increased tumor aggressiveness. Her-2 is a tyrosine kinase for epidermal growth factor. A monoclonal antibody to this receptor (Herceptin) has been developed and is beneficial in strongly (3–4+) Her-2 tumors with advanced stage/metastasis.

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12
Q

❍ What toxicities have been seen with Herceptin (trastuzumab)?

A

Cardiac toxicity when combined with doxyrubicin (Adriamycin) and cyclophosphamide (Cytoxan).

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14
Q

❍ What is the role of p53 in breast CA?

A

Mutation of this tumor-suppressor gene results in unrestricted propagation of cells with mutated DNA (cancer cells). This allows for overexpression of apoptosis inhibiting oncogenes such as bcl-2 in breast CA.

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20
Q

❍ Your patient has LCIS with a positive margin on excisional breast biopsy. What is the next step?

A

Re-excision is not necessary. LCIS is a marker for increased risk of breast cancer in both breasts with a subsequent incidence of 1% per year. Close follow-up with the patient is necessary.

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22
Q

❍ What are the most common adverse effects of methylene blue and isosulfan, respectively, for sentinel lymph node biopsy?

A

Isosulfan can cause allergic reaction with intraoperative hypotension. Methyline blue can cause skin necrosis if injected intradermally.

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24
Q

❍ When should screening mammograms be obtained?

A

Starting at the age of 40 years every 1 to 2 years and annually after the age of 50 years.

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26
Q

❍ What should be done after a positive sentinel lymph node biopsy for breast cancer?

A

Completion axillary dissection.

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27
Q

❍ What is the initial treatment of tender, firm, cord mass on lateral aspect of breast?

A

Mondor’s disease is thrombophlebitis of superficial vein on the breast. Tx: NSAID.

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28
Q

❍ DCIS is found in breast mass. What is the definitive treatment?

A

Lumpectomy + RT. Radiation has been shown to dramatically reduce recurrence.

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30
Q

❍ What is the Van Nuys Scoring System for DCIS and how does it guide therapy?

A

Three variables, grade, size, and margin of excision, are scored 1–3. Total scores 1–3 are safely treated with lumpectomy alone. Scores greater than 3 benefit from adjuvant XRT. Scores greater than 7 are best treated with mastectomy and sentinel lymph node Bx.

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32
Q

❍ T/F: Neoadjuvant chemotherapy has a survival advantage vs. postoperative (adjuvant) therapy for stage III breast CA.

A

False.

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34
Q

❍ What is the treatment for high-grade DCIS in multiple quadrants of the breast without any invasive carcinoma per se?

A

Mastectomy with sentinel lymph node biopsy. Immediate reconstruction can be offered.

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36
Q

❍ What is the treatment for a 4.5-cm focus of DCIS?

A

Excision with margin and sentinel lymph node Bx; postoperative breast radiation.

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38
Q

❍ Does tamoxifen have a role for DCIS?

A

Yes, after excision of DCIS in addition to XRT, tamoxifen reduces DCIS recurrence an additional 30%.

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40
Q

❍ What is the sensory innervation of the breast?

A

The lateral and anterior cutaneous branches of the second through sixth intercostal nerves.

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43
Q

❍ What is the treatment for a subareolar abscess in a 35-year-old woman?

A

Needle aspiration. Staphylococcus is the most frequent etiology. Abscesses refractory to aspiration and ABX can be surgically drained.

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45
Q

❍ Where are Rotter’s nodes located?

A

In the interpectoral region.

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46
Q

❍ What are Level II lymph nodes?

A

Those located behind the pectoralis minor muscle.

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48
Q

❍ Positive supraclavicular lymph nodes in breast cancer confer what stage?

A

Stage IIIC (formerly stage IV).

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49
Q

❍ T/F: Adolescent males often experience bilateral gynecomastia.

A

False; it is usually unilateral.

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50
Q

❍ How much radiation is delivered per mammogram?

A

0.1 rad.

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51
Q

❍ When is radiation therapy after mastectomy beneficial?

A

T3 and T4 primary tumors and greater than four positive axillary lymph nodes. XRT reduces local recurrence in these settings and has a small survival advantage as well.

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54
Q

❍ When T4 breast cancer is downstaged with neoadjuvant chemotherapy, are postoperative chemotherapy and hormonal therapy still necessary?

A

Yes.

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56
Q

❍ What mammographic findings are suggestive of cancer?

A

Fine, stippled calcium in an occult or suspicious lesion, architectural distortion, duct dilatation, asymmetry, and fibronodular densities.

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59
Q

❍ What is the true-positive rate of mammography when conducted in an optimal environment?

A

Greater than 90%.

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60
Q

❍ Which genetic mutation is associated with male breast cancer?

A

BRCA2. Male breast cancer is typically ER+ and tends to present at advanced stage because of a lack of awareness of breast CA potential.

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63
Q

❍ What percentage of patients with clinically detected breast cancer have positive axillary nodes at diagnosis?

A

Greater than 50%.

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66
Q

❍ What percentage of patients with mammographically detected breast cancer have positive axillary nodes at diagnosis?

A

Less than 20%.

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69
Q

❍ How does the treatment of invasive lobular carcinoma and invasive adenocarcinoma of the breast differ?

A

In no way. Treatment is identical stage for stage.

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71
Q

❍ What are the ultrasound features of invasive breast CA?

A

Disrupted tissue and fascia planes, hyperechoic border to the mass, and displacement of surrounding breast tissue.

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73
Q

❍ What tumor markers are negatively associated with outcome in breast CA?

A

Estrogen receptor negative, Her-2 Nu positive, and progesterone receptor negative.

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74
Q

❍ What is the role for prophylactic mastectomy in patients without breast cancer?

A

Primarily for patients with the BRCA genetic mutations who will invariably develop breast cancer. Breast reconstruction is typically performed at the same time.

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77
Q

❍ What is the role of MRI in detection of breast cancer?

A

MRI has increased sensitivity in detecting breast CA relative to mammography and US, yet the lack of specificity and high cost make routine screening with MRI less advantageous. Its role in screening is unclear. However, it is valuable in detecting metastasis to the vertebral bodies and musculoskeletal system.

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79
Q

❍ What is the primary indication for ductography?

A

Evaluation of bloody nipple discharge. While intraductal papilloma is the most common cause of bloody nipple discharge, the presence of a mass with bloody nipple discharge makes ruling out cancer essential.

82
Q

❍ What is the treatment for a mammary fistula with recurrent subareolar abscess?

A

Probe-guided fistulectomy.

83
Q

❍ What is the appropriate initial diagnostic procedure for identification of a palpable breast mass?

A

Fine needle aspiration (FNA).

84
Q

❍ Core biopsy reveals atypical ductal hyperplasia. What is the next step?

A

Excisional breast biopsy.

85
Q

❍ What is the current technique for localizing nonpalpable breast masses?

A

Mammographic needle localization.

86
Q

❍ Stereotactic core biopsy reveals lobular carcinoma in situ. What is the next step in management?

A

Needle localization excisional breast biopsy.

88
Q

❍ A 42-year-old female presents with a palpable breast mass. Mammogram is BIRADS 2 (low risk for CA), and FNA reveals benign cells without dysplasia. What is the next step in management?

A

Excisional breast biopsy.

91
Q

❍ Stereotactic core biopsy of a BIRADS 4 lesion reveals benign cells. What is the next step in management?

A

Needle localization excisional breast biopsy.

92
Q

❍ What is the treatment for a 0.9 cm invasive breast CA (T1b)?

A

Wide excision, SLNBx, and XRT. Antiestrogens if ER+. The role of chemotherapy is minimal for this stage.

94
Q

❍ What organisms are most frequently recovered from the nipple discharge of a patient with an infected breast?

A

Staphylococcus aureus and streptococci.

95
Q

❍ What is the treatment for hypercalcemia associated with metastatic breast CA?

A

Calcitonin (inhibits osteoclasts), IV fluid, Lasix, and bisphosphonates (bind hydroxyapetite).

96
Q

❍ What fungal infections most frequently affect the breast?

A

Blastomycosis and sporotrichosis. Infantile feeding is the most common cause of these infections.

98
Q

❍ What are the boarders of a formal axillary dissection?

A

Latissimus dorsi, chest wall, and axillary vein; thoracodorsal nerve.

99
Q

❍ Which nerve innervates the muscle responsible for arm adduction?

A

The thoracodorsal, which innervates the latissimus dorsi.

100
Q

❍ Which nerve is responsible for sensation to the medial aspect of arm?

A

Intercostobrachial.

101
Q

❍ Poland syndrome consists of what congenital abnormalities?

A

Hypoplastic shoulder

102
Q

Amastia

A

Absence of pectoralis muscles

104
Q

❍ What is the appropriate management of patients with Mondor’s disease?

A

Salicylates, warm compresses, restriction of range of motion, and shoulder and brassiere support.

106
Q

❍ When is fibrocystic disorder associated with an increased risk of breast cancer?

A

When there is an associated dysplasia.

107
Q

❍ T/F: The risk of developing breast cancer increases with age.

A

True. Risk in the fifth decade is less than 2%. Risk increases with age to a lifetime risk approaching 10%.

110
Q

❍ What are the side effects of tamoxifen?

A

Increased endometrial CA, increased DVT risk, and cataracts; inhibits the p450 system, thus increasing relative levels of Coumadin, Ca+ channel blockers, etc.

112
Q

❍ How long after treatment for breast cancer is a woman recommended to wait before becoming pregnant?

A

24 months, if no evidence of residual disease exists.

113
Q

❍ What should recurrent breast abscesses in the same location necessitate?

A

Dermal biopsy.

114
Q

❍ What is the next step in management following drainage of a large, clear, fluid-filled breast cyst?

A

Send fluid for cytology, reassurance if no malignant/atypical cells seen.

115
Q

❍ T/F: Male breast cancer, stage for stage, has a worse prognosis than adenocarcinoma of the breast in a female.

A

False, male breast cancer tends to present at a later stage (and later age), but the stage-specific survival is similar to that of women. Male breast cancer should be treated with adjunctive tamoxifen when ER+.

117
Q

❍ What is the leading risk factor for TRAM flap dermal necrosis?

A

Active smoking at the time of operation.

119
Q

❍ What is the appropriate treatment following drainage of a cyst that contained bloody fluid?

A

Cyst excision.

120
Q

❍ What is the etiology of skin dimpling in women with breast cancer?

A

Glandular fibrosis and shortening of Cooper’s ligaments.

121
Q

❍ What is the effect of adjuvant radiotherapy following mastectomy for breast cancer?

A

It decreases the local recurrence rate.

122
Q

❍ T/F: Atypical hyperplasia is associated with a 10-fold increased risk of breast cancer.

A

False, it is approximately 4× greater though, the only finding in fibrocytic disease associated with increased CA rate.

125
Q

❍ What are the characteristics of sclerosing adenosis?

A

Lobulocentric changes causing distortion and enlargement of lobular units and an increased number of acinar structures and fibrous changes.

128
Q

❍ What is the current recommended therapy for patients with Stage I and II breast cancer?

A

Wide local excision with axillary sentinel node biopsy/axillary dissection PRN and radiation therapy.

130
Q

❍ What is the typical clinical presentation of ductal ectasia?

A

A perimenopausal woman with palpable lumpiness beneath the areola and nipple discharge.

133
Q

❍ T/F: Gynecomastia in a male is associated with an increased rate of future breast cancer.

A

False. It is a benign disease typically symmetric and located beneath the nipple. Peak onset is adolescence at which time it should be observed. If persistent, beyond puberty it can excise. Second peak incidence late in life, caused by relative testosterone deficiency.

135
Q

❍ What is the characteristic gross appearance of a fibroadenoma?

A

Sharp circumscription with smooth boundaries and a glistening, white cut surface.

137
Q

❍ T/F: Fibroadenomas are invariably related to estrogen sensitivity.

A

True.

138
Q

❍ What is the most frequently employed hormonal manipulation in patients with breast cancer?

A

Estrogen blockade (tamoxifen—receptors; arimidex/anastazole—synthesis).

139
Q

❍ What is the most common initial site of metastases in breast cancer?

A

The bone.

140
Q

❍ Is there a benefit to resecting isolated breast CA metastasis detected 36 months after treatment of the primary tumor?

A

Yes, isolated mets, as proven by PET/CT scanning, can be resected with 30% to 40% 5-year survivals.

142
Q

❍ How much does tamoxifen therapy reduce the incidence of recurrent breast cancer when used for 5 years?

A

50%.

143
Q

❍ Do premenopausal women, with node-positive breast cancer, benefit from radiation therapy after receiving wide excision with negative margins, axillary dissection, and chemotherapy?

A

Yes, local recurrence rate in this patient subgroup is reduced from 30% to 15%.

145
Q

❍ What is the most common cause of bloody nipple discharge?

A

Intraductal papilloma. A filling defect on galactography will be visualized. Treatment is excision.

147
Q

❍ What type of breast cancer most frequently presents with a palpable mass?

A

Infiltrating ductal carcinoma.

148
Q

❍ What primary ductal carcinoma presents with a chronic, erythematous, oozing, and eczematoid rash involving the nipple and areola?

A

Paget’s disease of the breast.

150
Q

❍ T/F: Use of combined oral contraceptives increases the risk of breast cancer.

A

False.

151
Q

❍ What is the initial treatment for inflammatory breast cancer?

A

Chemotherapy, followed by surgical excision and XRT. Dermal lymphatic invasion of tumor cells on skin biopsy is the diagnostic key for inflammatory breast CA.

154
Q

❍ Which type of breast cancer is inflammatory breast carcinoma a variant of ?

A

Infiltrating ductal carcinoma.

156
Q

❍ What is the most common primary sarcoma of the breast?

A

Cystosarcoma (phyllodes tumor). Treatment is wide excision without lymph node biopsy as sarcomas spread hematogenously.

159
Q

❍ What percentage of cystosarcomas are malignant?

A

10%.

160
Q

❍ T/F: Women with a history of ovarian cancer are at increased risk of breast cancer.

A

True.

161
Q

❍ What is the appropriate treatment for a patient with a small, localized phyllodes tumor?

A

Local excision without lymph node biopsy.

162
Q

❍ What percentage of breast carcinomas occur in men?

A

1%.

163
Q

❍ What is the most important prognostic indicator for recurrent breast cancer and metastatic disease in women with breast cancer?

A

Nodal status at the time of initial diagnosis.

165
Q

❍ What is the average age at diagnosis of invasive breast cancer?

A

60 years.

166
Q

❍ What percentage of invasive lobular carcinomas are estrogen sensitive?

A

90%.

167
Q

❍ What is the treatment for an involuted nipple?

A

If an underlying mass or mammographic abnormality is present strong suspicion for CA must exist with appropriate oncological surgery. If congenital and no mass present than simple release of hypoplastic ducts can improve cosmesis.

169
Q

❍ What is the distinguishing feature of LCIS?

A

Cytoplasmic mucoid globules.

170
Q

❍ What are the most common complications of breast cancer radiation therapies?

A

Skin erythema and desquamation. Lymphedema after axillary therapy. Secondary malignancy from the XRT itself is rare (1% of patients).

173
Q

❍ What is the medical treatment of radiation mastitis?

A

Trenal (pentoxifylline).

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