Breast

Question 1

What is the incision used for mastectomy?

Answer 1

Elliptical Stewart incision

Question 2

What are the types of Mastectomy

Answer 2

1) Simple - Only breast+ NAC removed, pectoral fascia, no LN (done for Phyllodes tumor as only <10% or breast is involved)

2) Radical - Everything removed ie. Breast, NAC, pectoralis major and minor, Axillary LN level 1,2,3
(not done anymore)

3) Modified radical (MRM)

Question 3

Boundaries of axillary dissection.

Answer 3

Superior- Inferior border of Axillary vein

Medial - Halstead ligament

Lateral - Thoracodorsal pedicle

Inferior - Angular vein

Question 4

Structures preserved in MRM

Answer 4

1) Axillary vein
2) Thoracodorsal pedicle
3) Long Thoracic Nerve
4) Pectoralis major +/- P.minor
5) Lateral & medial pectoral nerves

Question 5

Techniques of sentinel lymph node biopsy.

Answer 5

Following methods used to identify the sentinel LN

1) Blue dye
- methylene blue
- Isosulfan blue
- Patent blue 5

2) Radionuclide method
- Tc-99 tagged with sulfa-colloid
- Gamma camera used to detect

3) Indocyanin green + methylene blue
- SLN appears blue & under special filter it appears green

4) Sentimag technique:
- Ferric oxide compounds injected
- Magnetic scanner to detect
- Advantage: No radiation exposure

Best technique: Combination of Blue dye + Radionuclide

Question 6

Chemotherapy indications in breast cancer

Answer 6

1) positive LN
2) LABC
3) ER, PR -ve
4) Her2neu +ve

Question 7

Breast CA Chemotherapy regimen

Answer 7

Traditional regimens were CAF & CMF, which are not replaced by AC followed by T/ EC followed by T

For Her2neu +ve: Add Herceptin/Trastuzumab

New Her2neu directed drug: Pertuzumab/Perjeta

Question 8

Side effect of Cyclophosphamide
Prevention?

Answer 8

Hemorrhagic cystitis
Caused by metabolite Acrolin

Prevention using Mesna

Question 9

S/E of Adriamycin

Answer 9

Dilated cardiomyopathy

Question 10

S/E of Placlitaxel

Answer 10

Neuropathy

Question 11

S/E of Trastuzumab/Herceptin. How to monitor?

Answer 11

Cadiotoxicity

Hence ECG done every 2-3 months to monitor

Question 12

Radiotherapy indication in Breast Ca

Answer 12

1) All cases where BCS is done
2) Tumor >5 cm
3) Positive LN
4) LABC

Question 13

What are the Mammography views. Which view is better & why?

Answer 13

1) Craniocaudal (CC) view

2) Mediolateral Oblique (MLO) View
Better because - More breast tissue is visualised
- Axilla is appreciated

Question 14

Different types of calcifications seen in the breast

Answer 14

1) Popcorn - Fibroadenoma
2) Leadpipe- Fat necrosis
3) Broken needle- Duct ectasia
4) Tea cup- Fibrocystic disease

Question 15

Risk reduction techniques for those with family history of breast cancer.

Answer 15

1) Bilateral prophylactic mastectomy
- reduces risk of breast ca by 95%

2) RRSO (Risk Reduction Salpingo-oophorectomy)
- Reduces risk of ovarian cancer by 90%
- But there is still 10% risk of Fallopian tube stump cancer & Primary peritoneal cancer
- 50% reduction in risk of breast Ca

3) SERM
- Reduces risk of breast Ca by 47%

Question 16

Van Nyus index

Answer 16

It is a prognostic index for DCIS.

It takes into account 4 factors
1) Size
2) Margins
3) Grade & necrosis
4) Age of pt