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RDS Test 3 > B8-039 CBCL Breast Cancer > Flashcards

B8-039 CBCL Breast Cancer Flashcards

1
Q

the T category of staging is mostly driven by

A

size

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2
Q

the N category of staging signifies

A

regional lymph node involvement

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3
Q

the M category of staging signifies

A

presence of distant metastasis

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4
Q

BRCA1 positive individuals are most likely to develop what type of breast cancer?

A

basal-like

(large % of these are triple negative)

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5
Q

BRCA2 positive individuals are most likely to develop what type of breast cancer?

A

luminal B

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6
Q

individuals with sporadic cases are most likely to develop what type of breast cancer?

A

Luminal A
followed by Luminal B

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7
Q

tumors from the lateral half of the breast are more likely to drain into the […] lymph nodes

A

axillary

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8
Q

tumors from the medial half of the breast are more likely to drain into the […] lymph nodes

A

internal mammary

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9
Q

defines lymph nodes lateral to pectoralis minor muscle

A

Ax I

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10
Q

defines lymph nodes behind pectoralis minor and to the broader space between minor and major

A

Ax II

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11
Q

defines lymph nodes medial to pectoralis minor muscle

A

Ax III

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12
Q

lymph node […] is becoming increasingly more frequent due to studies showing equal efficacy with lymph node dissection

A

radiotherapy

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13
Q

chemotherapy given after surgery

A

adjuvant

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14
Q

chemotherapy given before surgery

A

neoadjuvant

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15
Q

do patients with DCIS or early stage breast cancer who underwent mastectomy typically need radiation?

A

no

(vs. lumpectomy, yes)

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16
Q

what types of patients will require radiation therapy?

A

patients who received lumpectomy
patients with positive lymph nodes

some patients who get masectomy with high risk factors

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17
Q

hallmark of DCIS

A

cancer cells have not penetrated outside the myoepithelial layer and basement membrane

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18
Q

microcalcifications are seen on mammagraphy in [DCIS/LCIS]

A

DCIS

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19
Q

loss of E-cadherin is associated with [DCIS/LCIS]

A

LCIS

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20
Q

diffuse cytoplasmic expression of p120 catenin is associated with [DCIS/LCIS]

A

LCIS

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21
Q

Malignant proliferation of cells in ducts with no invasion of the basement membrane

A

DCIS

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22
Q

DCIS does not usually produce a mass, and so is usually seen as […] on mammography

A

calcification

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23
Q

subtype of DCIS characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts

A

comedo type

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24
Q

subtypes of DCIS are based on […]

A

architecture

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25
Q

Paget disease of the breast is […] that extends up the ducts to involve the skin of the nipple

A

DCIS

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26
Q

Malignant proliferation of cells in lobules with no invasion of the basement membrane

A

LCIS

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27
Q

[DCIS/LCIS] does not produce a mass or calcifications and is usually discovered incidentallyon biopsy.

A

LCIS

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28
Q

Characterized by dyscohesive cells lacking E-cadherin adhesion protein

A

LCIS

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29
Q

used to assess axillary lymph nodes

A

sentinel lymph node biopsy

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30
Q

[…] is the most important prognostic factor, but […] is the most useful prognostic factor

A

[metastasis] is the most important prognostic factor, but [spread to axillary node] is the most useful prognostic factor

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31
Q

only […]% of breast cancer is caused by inherited mutations

A

10

90% is sporadic

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32
Q

what molecular subtype has the best prognosis?

A

Luminal A

(ER+/PR+)

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33
Q

[what subtype]
ER+/PR+

34
Q

[what subtype]
ER+/ PR + or -

35
Q

[what subtype]
Her2+

A

ErbB2/Her2

36
Q

[what subtype]
ER- /PR- /Her2-

A

triple negative (basal)

37
Q

what molecular subtype has the worst prognosis?

A

triple negative

ER- /PR- /Her2-

38
Q

estrogen antagonists for ER+ breast cancer [2]

A

tamoxifen
fulvestrant

39
Q

aromatase inhibitors [3]

A

anastrozole
exemestane
letrozole

40
Q

Her2 antibody therapies [2]

A

Herceptin (trastuzumab)
pertuzumab

41
Q

aromatase inhibitors are used primarily in […] women to prevent peripheral conversion of estrogen

A

postmenopausal

42
Q

tamoxifen as an antagonist at the […] and agonist at the […]

A

tamoxifen as an antagonist at the [breast] and agonist at the [uterus and bone]

43
Q

what is the difference in the MOA of tamoxifen and fulvestrant?

A

tamoxifen is an ER receptor antagonist

fulvestrant degrades the ER receptor

44
Q

second-line therapy used for tamoxifen resistant breast cancers

A

fulvestrant

45
Q

LHRH analogs used in premenopausal women with ER+ breast cancer for ovarian suppression [3]

A

leuprolide
goserelin
triptorelin

46
Q

treatment of ER+ breast cancer in premenopausal women

A

tamoxifen +/- ovarian suppression

47
Q

treatment of ER+ breast cancer in postmenopausal women

A

tamoxifen or aromatase inhibitors

fulvestrant if needed

48
Q

Clinical features that suggest hereditary breast cancer [3]

A

multiple first-degree relatives with breast cancer

tumor at an early age (premenopausal)

multiple tumors in a single patient.

49
Q

[…] mutation is associated with breast and ovarian carcinoma

50
Q

[…] mutation is associated with breast carcinoma in males

51
Q

most important single gene mutations
associated with hereditary breast cancer [2]

52
Q

patients with genetic predisposition to breast cancer may elect to undergo double mastectomy, but a small risk for cancer remains because […]`

A

breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall.

53
Q

what are the molecular subtypes of breast cancer? [4]

A

luminal A (ER+/PR+)
luminal B (ER+/PR-)
Her2 +
triple negative

54
Q

most breast cancers are driven by activation of the […] hormone receptor

55
Q

binds to extracellular domain of the Her2 protein and stops it from being activated

A

trastuzumab

56
Q

monocolonal antibody used to treat Her2+ breast cancers

A

trastuzumab

57
Q

BIRAD score of 3 is consistent with high probability of being […]

58
Q

DCIS and LCIS are associated with a […]x risk for invasive breast cancer

59
Q

most patients that present with Pagets have underlying […]

A

DCIS or invasive carcinoma

(90%)

60
Q

atypical ductal hyperplasia is associated with […]x risk for invasive breast cancer

61
Q

most aggressive subtype of DCIS

A

comedonecrosis

62
Q

BIRAD score of 4 is consistent with reasonable probability of being […]

A

malignant

biopsy recommended

63
Q

treatment recommendations for atypical ductal hyperplasia

A

annual mammograms
tamoxifen

64
Q

a hallmark of […] is positive E-cadherin

65
Q

does usual ductal hyperplasia increase risk of breast cancer?

66
Q

most common cause of breast pain and swelling in a woman who is breastfeeding

67
Q

standard of care for any patient with a palpable breast mass

68
Q

women with extremely dense breasts (level 4) should be alternatively screened using what modalities?

A

MRI or automated breast ultrasound

69
Q

most common breast lesion in young women who present with breast lumps and pain that gets worse around their period

A

fibroadenoma

70
Q

patients diagnosed with […] do not benefit from radiation or lumpectomy

A

LCIS

(tamoxifen alone is sufficient)

71
Q

what muscle is used to guide levels of the axilla for lymph node dissection?

72
Q

common anesthesia regimen used for breast cancer cases

A

propofol, midazolam, and fentanyl

73
Q

resistance to Her2 targeted therapies are often due to

A

cleavage of Her2 extracellular domain

74
Q

the […] domain of the Her2 protein is the target of pertuzumab

A

dimerization domain

75
Q

use of anti-estrogens depends on

A

scoring the tumor ER positive

(any tumor over 1% is considered ER+)

76
Q

targets the intracellular tyrosine kinase activity of Her2

77
Q

blocks Her dimerization through the extracellular domain

A

trastuzumab

78
Q

mTOR inhibitor

A

everolimus
afinitor

79
Q

mutations within the […] domain of the estrogen receptor are linked to tamoxifen resistance

A

ligand binding

(Y537 and D538G)

80
Q

palbociclib, abemaciclib, and ribociclib can be used to inhibit […] in metastatic breast cancer

81
Q

exemestane is an […] inhibitor

82
Q

combining endocrine therapy with […] inhibitor in HR+ breast cancers is effective in treating metastatic disease

A

CDK4/6 (-ciclibs)

RDS Test 3 (15 decks)

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