Breast Cancer

Question 1

List the risk factors for breast cancer

Answer 1

age >50, family h/o, HRT, h/o benign breast dz, menarche 15, nulliparity, age at first pregnancy >30

Question 2

Most common tumor type of breast cancer (80%)

Answer 2

infiltrating ductal carcinomas

Question 3

Specialized form of intraductal carcinoma that arises in the main excretory ducts of the breasts and extends to involve the skin of the nipple and areola, producing an eczematoid appearance

Answer 3

Paget’s disease of the breast

Question 4

Type of breast cancer associated with pregnancy and is characterized by warmth, redness, and induration of the surrounding breast tissue

Answer 4

inflammatory breast cancer

Question 5

Areas of lymphatic spread of breast cancer in order of appearance

Answer 5

axillary nodes, internal mammary node chain, supraclavicular nodes

Question 6

Main locations of hematogenous spread of breast cancer

Answer 6

lungs, liver, and bones

Question 7

Term for blockage of skin lymphatics causing edema and thickening of the skin

Answer 7

peau d’orange

Question 8

Procedure that consists of en bloc dissection of the entire breast together with the pectoralis major and minor muscles and content of the axilla

Answer 8

radical mastectomy

Question 9

Means of determining the tumor status in the axilla that has largely replaced sentinel lymph node dissection

Answer 9

lymphatic mapping and sentinel lymph node resection

Question 10

What should be the next step of treatment if sentinel node is positive?

Answer 10

axillary dissection

Question 11

Why is the axilla not routinely irradiated after axillary node dissection?

Answer 11

high incidence of lymphedema

Question 12

Single most important prognosticator for the prognosis of breast cancer

Answer 12

status of the axillary lymph nodes (83% 5 yr survival for negative nodes compared to 73% with 1-3 + nodes, 45% for 4-5 , and 28% for 13+)

Question 13

two general categories of mammographic findings suggestive of a breast cancer

Answer 13

spiculated soft tissue masses and clustered microcalcifications

Question 14

Initial diagnostic approach to palpable mass in younger women

Answer 14

US of breast followed by mammography if US studies suspicious. Bx probably warranted even if mammography is negative

Question 15

Initial diagnostic approach to palpable mass in older women

Answer 15

bilateral diagnostic mammography performed prior to biopsy

Question 16

Recommendations for mammography screening

Answer 16

every 2 yrs starting at age 50 and continuing depending on clinical preference (70-75yr or until life expectancy less than 5 yrs)

Question 17

Recommendations for clincal breast exam based on ACOG

Answer 17

every one to three years from age 20 to 39, and annually thereafter

Question 18

Describe each BI-RADS assessment category and its associated recommendation

Answer 18

0-incomplete, need further eval
1-normal, normal interval follow-up
2-benign, normal interval follow-up
3-probably benign, shorter interval follow-up
4-suspicious abnormality, consider biopsy
5-most likely malignant, biopsy or surgery
6-biopsy proven carcinoma, appropriate tx

Question 19

General treatment for early stage breast cancer

Answer 19

primary surgery (lumpectomy or mastectomy) to the breast and regional nodes with or without radiation therapy (RT)

Question 20

comprised of lumpectomy plus radiation therapy (RT)

Answer 20

breast conserving therapy

Question 21

Criteria that preclude breast conserving therapy

Answer 21

multicentric disease, large tumor size, diffuse microcalcifications, prior h/o chest RT, pregnancy

Question 22

General treatment for locally advanced breast cancer

Answer 22

neoadjunvant systemic therapy followed by surgery

Question 23

“classic” characteristics of a cancerous lesion

Answer 23

hard, immovable, single dominant lesion with irregular borders

Question 24

signs of more advanced locoregional disease

Answer 24

axillary adenopathy or skin findings such as erythema, thickening, or dimpling of the overlying skin