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PRIMARY CARE EXAM 2 > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

75% of lymphatic drainage from the breasts is into what lymph nodes?

A

axillary lymph nodes

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2
Q

This level of axillary lymph nodes is below the border of the pectoralis minor.

A

level I

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3
Q

This level of axillary lymph nodes is located superficial or deep to the pectoralis major.

A

level II

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4
Q

This level of axillary lymph nodes is located above or medial to upper border of the pectoralis minor.

A

level III

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5
Q

What is the most common etiology of breast pain?

A

it is unknown

common in females 30-50 and often prominent prior to menses

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6
Q

____% of breast lumps are benign

A

90%

likelihood of a palpable mass being cancerous increases with age

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7
Q

What is the most common location for a palpable breast lump?

A

upper outer quadrant

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8
Q

A breast mass generally becomes palpable when it is ___ cm or large.

A

2 cm

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9
Q

What is the definitive treatment for a Phyllodes tumor?

A

surgical resection with wide margins (>1 cm)

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10
Q

Which of the following statements about nipple discharge is FALSE:

a. spontaneous nipple discharge is more concerning for cancer.
b. bilateral often represents a physiological change
c. bloody is less concerning than serous
d. pathologic discharge is frequently unilateral, persistent, and spontaneous

A

c. bloody is less concerning than serous

* bloody is MORE concerning than serous*

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11
Q

If a patient presents with a breast abscess due to lactation what imaging study do you want to get to differentiate an abscess from cellultiis?

A

ultrasound

if abscess is found = I&D

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12
Q

What is the medical treatment for mastitis?

A

cephalexin 500 mg QID

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13
Q

If a patient presents with mastitis/abscess in a non-lactating breast what diagnosis should you be concerned about?

A

inflammatory breast cancer

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14
Q

Starting at age ___, women with regular risk should have the choice to begin annual screening with a mammogram

A

40

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15
Q

At age ___, every women should have an annual mammogram

A

45

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16
Q

Screening should continue as long as women are in good health and are expected to live for another ____ years or longer

A

10

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17
Q

For women at high risk of breast cancer, they should consider alternating mammogram and MRI screening every ____ months.

A

6

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18
Q

What is the best tool for early detection of breast cancer?

A

screening mammography

U/S not indicated as screening tool BUT is the modality of choice in young women

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19
Q

What is the radiation dose of a screening mammography? What does this compare to?

A

0.4 mSv (equivalent to the radiation exposure from a cross country flight)

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20
Q

Every mammogram is given a ______ score

A

BIRADS

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21
Q

What are 4 findings concerning for cancer on a diagnostic mammogram?

A
  • mass
  • architectural distortion
  • asymmetry
  • calcifications
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22
Q

What is the best biopsy maneuver for sampling breast tissue?

A

core needle biopsy

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23
Q

What is the best biopsy maneuver for sampling lymph nodes?

A

fine needle aspiration (FNA)

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24
Q

What procedure must be done to distinguish atypical ductal hyperplasia (ADH) vs. malignancy?

A

surgical excision

25
Q

What are the 3 common abnormal biopsy findings that are NOT cancer?

A
  • Atypical Ductal Hyperplasia (ADH)
  • Atypical Lobular Hyperplasia (ALH)
  • Lobular Carcinoma In Situ (LCIS)
26
Q

Patients who are carriers of these 2 genes are at an increased risk of breast cancer and ovarian cancer.

A
  • BRCA1/2
27
Q

This risk tool can be used to calculate a women’s risk of developing invasive breast cancer.

A

Gail risk model

for women aged >35

28
Q

What fraction of women will be diagnosed with breast cancer in their lifetime?

A

1/8

29
Q

What is the most aggressive subtype of breast cancer?

a. luminal A
b. luminal B
c. HER2+
d. Basal

A

d. Basal

ER/PR- HER2-

30
Q

What is the most common subtype of breast cancer?

a. luminal A
b. luminal B
c. HER2+
d. Basal

A

a. luminal A

ER/PR+ HER2-

best prognosis

31
Q

DCIS has varying outcomes, ____% of lesions never become clinically apparent if untreated, but others progress to invasive cancer

A

40%

32
Q

75% of invasive breast cancers are ____ carcinoma.

A

ductal

33
Q

This is a type of breast cancer that presents as nipple ulceration, eczema or skin changes.

A

Paget’s disease

diagnose with punch biopsy

34
Q

This is a type of breast cancer that presents as diffuse erythema and edema (called peau d ’orange)

A

Inflammatory breast cancer

35
Q

What is the mainstay of treatment for metastatic breast cancer?

a. chemotherapy
b. surgery
c. radiation
d. all of the above

A

a. chemotherapy

* surgery+radiation only palliative*

36
Q

What is the difference in survival between a lumpectomy + XRT vs. a mastectomy?

A

THERE IS NO SURVIVAL DIFFERENCE

37
Q

What factor do you take into account when determining if a lumpectomy or mastectomy is a better procedure?

A

size of disease in relation to the patient’s breast size

38
Q

Which of the following procedures for lymph node evaluation has an increased risk for lymphadema?

a. sentinel node biopsy
b. axillary node dissection

A

b. axillary node dissection

39
Q

Gene expression scores are used in what type of breast cancer?

a. luminal A
b. luminal B
c. HER2+
d. Basal

A

a. luminal A

ER/PR+ HER2-

40
Q

A ____ gene expression score means that the patient will benefit from chemotherapy followed by endocrine therapy.

A

high

41
Q

What are the 2 endocrine medication therapies available?

A
  • Selective estrogen receptor modulators (SERM)

- Aromatase inhibitors: estrogen receptor antagonist

42
Q

What are the 2 commonly used Selective estrogen receptor modulators (SERM)?

Which one is indicated for pre vs. post menopausal women?

What are their side effects?

A
  1. tamoxifen
    - pre/post menopausal women
    - side effects: DVT, uterine malignancies
  2. raloxifine
    - post menopausal women
    - no side effects, provides osteoporosis protection
43
Q

Anastrozole, exemestane, letrozole are what type of drugs?

What are their side effects?

A
  • Aromatase inhibitors: estrogen receptor antagonist

- side effects: joint pain, hot flashes

44
Q

When is breast radiation indicated? (3 instances)

A
  • post-lumpectomy
  • mastectomy patients with large tumor > 5 cm
  • positive lymph nodes
45
Q

What are the 2 common chemotherapy regimens?

Which one is indicated in HER+?

A
  • AC-T (Adriamycin, Cytoxan, Taxol)

- THP (Taxol, Herceptin, Pertuzumab) = more common in HER+

46
Q

What is the goal of whole breast radiation?

A

eliminate any remaining tumor cells following breast surgery

47
Q

A patient has a smooth, mobile, round mass. It commonly changes with menstrual cycles. On ultrasound you see a fluid filled duct. What type of palpable breast lump does this patient have?

a. cyst
b. fibroadenoma
c. fat necrosis
d. infections
e. cancer

A

a. cyst

48
Q

A patient has an irregularly shaped, hard, flat lump. She has a previous history of breast trauma. The lump is made of dead fat cells. What type of palpable breast lump does this patient have?

a. cyst
b. fibroadenoma
c. fat necrosis
d. infections
e. cancer

A

c. fat necrosis

49
Q

A young patient presents with a movable, round, firm lump. It is made up of a collection of stroma cells. What type of palpable breast lump does this patient have?

a. cyst
b. fibroadenoma
c. fat necrosis
d. infections
e. cancer

A

b. fibroadenoma

50
Q

A breast feeding patient presents with swelling, pain, redness, and warmth over the breast with an associated lump. What type of palpable breast lump does this patient have?

a. cyst
b. fibroadenoma
c. fat necrosis
d. infections
e. cancer

A

d. infections

51
Q

A older patient presents with a solid, immobile mass with associated skin changes. What type of palpable breast lump does this patient have?

a. cyst
b. fibroadenoma
c. fat necrosis
d. infections
e. cancer

A

e. cancer

52
Q

This type of tumor is developed in the connective tissue, is large and multi-lobulated and is characterized by rapid growth.

A

Phyllodes Tumor

53
Q

What BIRADS score classifies a negative mamogram?

A

1

54
Q

What BIRADS score is the threshold for follow-up mammograms vs. biopsy.

A

4+ require biopsy

55
Q

This type of cancer makes up about 25% of all newly diagnosed breast cancer cases. It commonly presents as calcifications on screening mammography. It is classically called a “stage 0 breast cancer” due to it’s non-invasive nature.

A

ductal carcinoma in situ (DCIS)

56
Q

What are the 2 treatment options for DCIS?

A
  • lumpectomy (clear margins > 2mm) + radiation therapy
  • mastectomy

*if ER+ endocrine therapy with Tamoxifen is indicated (Anastrozole if post-menopausal)

57
Q

Management options for invasive carcinoma include which of the following:

A. Surgery, XRT, endocrine therapy
B. Surgery, adjuvant chemotherapy, XRT, endocrine therapy
C. Neoadjuvant chemotherapy, surgery, XRT, +/- endocrine therapy
D. all of the above

A

D. all of the above

58
Q

When performing a lumpectomy, ___ margins are removed around the lumpectomy bed, to confirm no cancerous cells are left in the breast.

A

6 margins

PRIMARY CARE EXAM 2 (5 decks)

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