BREAST

Question 1

Lesions has a risk associated breast cancer

Answer 1

Atypical dcutal hyperplasia

Question 2

What are contraindications of normal chemotherapy and hormonal therapy regarding pregnancy

Answer 2

No methotrexate
No hormonal therapy
No breast-feeding with chemotherapy
No blue dye

Question 3

Adverse reaction to lymphazurin urine blue dye

Answer 3

Anaphylaxis

Question 4

Adverse reaction to methylene blue

Answer 4

Skin necrosis

Question 5

Breast stage

Answer 5

draw out table

T1 less than or equal to 2 cm
T2 two – 5 cm
T3 greater than 5 cm
T4 scanner chest wall invasion

N1 one – three
N2 four – nine
N3 10 or more

Stage one:
T1 N0

Stage II:
T1 N 1
T2 N 0-1
T3 N0

Question 6

Indication for adjuvant therapy in breast-cancer

Answer 6

Greater than 1 cm tumor
Node positive
Locally advanced –skin or chest wall T4

Question 7

Indication for a neoadjuvant therapy for breast cancer

Answer 7

Locally advanced disease

Inflammatory

Question 8

Contraindicated imaging studies in pregnancy for breast workup

Answer 8

Do ultrasound FIRST

Cranky about mammogram possibly if need more information and shield the baby

Cannot get gadolinium for MRI!

Question 9

What adjunct of management is done for triple negative breast cancer

Answer 9

Give Taxane just for being triple negative

Question 10

What breast cancer gets new adjuvant therapy

Answer 10

Triple negative taxne
Her 2 nu positive
Locally advanced
Inflammatory breast cancer
Clinically palpable notes

Question 11

What needs to be included in the work up of a 38-year-old female with palpable breast mass

Answer 11

Genetic testing because lessen age 45!

Question 12

How many cycles is new adjuvant therapy given

Answer 12

Three cycles usually Adriamycin and cisplatin Plus minus taxol

Question 13

When is axillary radiation given

Answer 13

Four or more lymph nodes positive

Question 14

What needs to be considered before doing a mastectomy

Answer 14

Reconstruction

Question 15

Oncotype DX

Answer 15

Get this test when Her-2-nu NEGATIVE

Gives recurrence score

the popular 21-gene assay for breast cancer recurrence risk (Oncotype DX, Genomic Health) have been retrospective, so the evidence is less desirable.

less than 17 = no chemo

Question 16

Axillary mass unknown primary

3 cm mobile

BiRAD 1

what is work up and treatment

Answer 16

BIRAD is increased to three because it’s in the axilla!

If this is young in an unknown primary gig BRACA testing

Core needle biopsy adenocarcinoma of the axilla

Ask pathology for:
S 100 - rule out melanoma
B Raff
ER PR
Her 2 nu
CEA - rule out colon cancer

Breast MRI negative

CT scan:
Chest
Abdomen and pelvis
Head neck

If neg:
Triple endoscopy:
Frango laryngoscopy
Upper scope
Bronchoscopy

Treatment:
Modified radical mastectomy

Specimen returns 0.5 cm invasive ductal carcinoma ERP are positive

Needs chemo and XRT because axilla was positive for notes

Question 17

Utility a frozen section with breast cancer

Answer 17

Almost none

Same of melanoma and thyroidFollicular

Question 18

80 year old female with 3 cm lobular ductal carcinoma

History of coronary artery disease, MI and stent placed six months ago

Answer 18

Do not do lump backed me in sentinel lymph node - because cannot handle the radiation required

Do not give chemo:
Cannot handle the adriamycin that is cardiac toxic
(in general be cautious of getting chemo if greater than 70-75 years old)

This patient probably’s only manage with the aromatase inhibitor

Question 19

Which chemotherapy agent do you give for tripple negative

Answer 19

“T is for triple”

Taxane

Question 20

When do you get radiation to the axilla

Answer 20

Four or more nodes are positive

N2 or greater (N2 = 4-9 nodes)

Question 21

When you get a radiation after mastectomy

Answer 21

4 or more lymph nodes get axillary radiation

Chest wall involvement

Locally advanced disease - skin involvement

Inflammatory breast disease