BREAST Flashcards
Lesions has a risk associated breast cancer
Atypical dcutal hyperplasia
What are contraindications of normal chemotherapy and hormonal therapy regarding pregnancy
No methotrexate
No hormonal therapy
No breast-feeding with chemotherapy
No blue dye
Adverse reaction to lymphazurin urine blue dye
Anaphylaxis
Adverse reaction to methylene blue
Skin necrosis
Breast stage
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
Indication for adjuvant therapy in breast-cancer
Greater than 1 cm tumor
Node positive
Locally advanced –skin or chest wall T4
Indication for a neoadjuvant therapy for breast cancer
Locally advanced disease
Inflammatory
Contraindicated imaging studies in pregnancy for breast workup
Do ultrasound FIRST
Cranky about mammogram possibly if need more information and shield the baby
Cannot get gadolinium for MRI!
What adjunct of management is done for triple negative breast cancer
Give Taxane just for being triple negative
What breast cancer gets new adjuvant therapy
Triple negative taxne Her 2 nu positive Locally advanced Inflammatory breast cancer Clinically palpable notes
What needs to be included in the work up of a 38-year-old female with palpable breast mass
Genetic testing because lessen age 45!
How many cycles is new adjuvant therapy given
Three cycles usually Adriamycin and cisplatin Plus minus taxol
When is axillary radiation given
Four or more lymph nodes positive
What needs to be considered before doing a mastectomy
Reconstruction
Oncotype DX
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
Axillary mass unknown primary
3 cm mobile
BiRAD 1
what is work up and treatment
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
Utility a frozen section with breast cancer
Almost none
Same of melanoma and thyroidFollicular
80 year old female with 3 cm lobular ductal carcinoma
History of coronary artery disease, MI and stent placed six months ago
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
Which chemotherapy agent do you give for tripple negative
“T is for triple”
Taxane
When do you get radiation to the axilla
Four or more nodes are positive
N2 or greater (N2 = 4-9 nodes)
When you get a radiation after mastectomy
4 or more lymph nodes get axillary radiation
Chest wall involvement
Locally advanced disease - skin involvement
Inflammatory breast disease
