BREAST

Question 1

Radiation Therapy For Breast Cancer

Answer 1

breast-conserving surgery

stage III breast cancer
(four or more positive lymph nodes, or other features that lead to stage III disease)
after treatment with a modified radical mastectomy NEED:
Adjuvant RADIATION
or neoadjuvant chemotherapy.

stage II disease is CONTROVERSIAL - consider in:
extracapsular extension, lymphovascular space invasion, age 40 years or younger, close surgical margins, a nodal positivity ratio of 20% or greater, and those patients who have undergone less than a standard axillary level I or II dissection.

NOT indicated:
after mastectomy and sentinel lymph node for
T1N0 
or 
T2N0 breast cancer,

Question 2

recommendations for adjuvant chemotherapy for breast cancer

Answer 2

Stage I:
greater than 1 cm -hormone receptor negative-

Stage II ( and node NEGATIVE):
 hormone receptor negative

 stage II (node POSITIVE):
 hormone receptor  POSITIVE and negative

Question 3

recommendations for neoadjuvant chemotherapy for breast cancer

Answer 3

inflammatory breast cancer,
large, fixed, or erosive lesions not amenable to mastectomy,
advanced nodal disease: fixed, bulky, or causing arm edema.

Most of these patients will then undergo mastectomy, radiation therapy, and possibly additional systemic therapy.

Question 4

BI-RADS

Answer 4

0 - incomplete
1- negative - resume routien screening
2- benign - resume routine screening
3- prob benign - short interval f/u 6 mo
4 - suspicious - biopsy recommended (intermidiate risk)
5 - highly suggestive of malignancy - “appropriate” action recommended (95% malig)
6 - known cancer - bx proven

Question 5

relative contraindications to breast conservation

Answer 5

over the age of 70 with estrogen receptor positive

large tumor size compared the breast size

Inability to undergo radiation

Multicentric disease

Question 6

utility of incisional biopsy breast mass

Answer 6

not done

excisional biopsy is done to

Question 7

indications for sentinel node biopsy DCIS

Answer 7

Extensive disease
Micrometastases
High-grade
Patient’s treated with mastectomy

adjuvant radiation also given for her DCIS it has been treated with lumpectomy test