Breast 3

Question 0

Which breast cancer patients get chemotherapy?

Answer 0

All patients with node positive disease and all premenopausal women

Question 1

Management –

stage 0 and stage 1 breast cancer with tumor <1 cm?

Stage 1 cancer with 1-2 cm tumor?

For stage 2 cancer?

Answer 1

Lumpectomy, axillary sampling, radiation therapy (if ER positive, add hormone therapy)

Lumpectomy, axillary sampling, radiation therapy, and adjuvant therapy (hormonal or chemo)

Modified radical mastectomy, axillary sampling, radiation therapy, Agilent therapy

Question 2

Follow-up for postoperative breast cancer patients?

Answer 2

Two visits a year with CXR and LFTs

If had lumpectomy, mammogram every six months for 2 years

Question 3

Management for stage III cancer? Stage IV cancer?

Answer 3

Neoadjuvant chemotherapy before surgery

Palliative radiation and chemotherapy. Surgery only for local control of primary tumor

Question 4

Histopathology of the suspected breast tumor shows cancer cells invading dermal lymphatics and vessels – diagnosis?

Answer 4

Inflammatory carcinoma

Question 5

Five years post breast cancer surgery, patient presents with elevated LFTs – suspect? Tests?

Answer 5

Suspect metastasis to the liver. Contrast enhanced CT scan of the abdomen

if poor renal function MRI with gadolinium enhancement

Question 6

Five years post breast cancer surgery, Patient presents with a femur fracture – suspect? Next steps?

Answer 6

Pathologic fracture secondary to metastasis

Orthopedic repair, Local cancer control with irradiation

Question 7

Five years post breast cancer surgery patient develops decreased sensation and motor function in the right leg – Suspect? Management?

Answer 7

Extradural metastasis to the spine. MRI, steroids, cord decompression and radiation

Question 8

Five years post breast cancer surgery presents with new onset seizures and focal findings – suspect? Management?

Answer 8

Metastasis to the brain – CT/MRI followed by steroids and surgery/irradiation

Question 9

Five years post breast cancer surgery, presents to emergency department with coma/confusion and no focal findings – suspect?

Answer 9

Acute hypercalcemia due to bony metastasis or parathyroid related peptide

Question 10

Breast-feeding mother develops painful breast, low-grade fever, and red, tender, indurated breast mass and shotty nodes – differential and treatment?

Answer 10

1. Mastitis – warm compress, antibiotics

2. Abscess – open surgical drainage

Question 11

Breast-feeding mother develops painful breast, low-grade fever, and red, tender, indurated breast mass and shotty nodes – Does not respond to multiple different antibiotics – suspect?

Answer 11

Inflammatory carcinoma – get biopsy

Question 12

Changes in treating breast cancer in pregnancy?

Answer 12

1. Postpone radiation until after delivery (so discourage lumpectomy in early pregnancy because of the need for radiation)
2. Chemotherapy after the first trimester

Question 13

Treatment for male with breast cancer?

Answer 13

Mastectomy and postoperative radiotherapy