Breast cancer

Question 1

How do endogenous estrogen factors affect an individual’s risk of breast cancer?

Answer 1

early menarche, late menopause, few pregnancies–> more total menstrual cycles, more endogenous exposure to estrogen

Question 2

In women with an estimated 20% lifetime risk of breast cancer, _____ can detect cancers that are not found by mammogram alone

Answer 2

screening MRI

Question 3

List approaches to diagnostic imaging

Answer 3

diagnostic mammogram
ultrasound
MRI

Question 4

_________ is the preferred method of tissue sampling for pathologic examination of breast tissues

Answer 4

core needle biopsy

Question 5

The normal glandular elements of the breast are composed of two layers of cells:

Answer 5

1. inner epithelial layer

2. outer myoepithelial layer

Question 6

List chronological steps in progression to breast cancer

Answer 6

1. hyperplasia
2. atypical hyperplasia
3. DICS
4. invasiv carcinoma

Question 7

What histologic feature differentiates DCIS from invasive carcinoma?

Answer 7

DCIS is still surrounded by a myoepithelial cell and basement membrane layer

Question 8

For a purely ______ carcinoma, there is no risk of metastasis

Answer 8

in situ

Question 9

Testing for ______ overexpression could involve immunohistochemical staining or amplification of ERBB2 gene

Answer 9

Her2/neu

Question 10

Her2+ breast cancer can be treated with _________

Answer 10

trastuzumab

Question 11

The most important prognostic factor is cancer _______

Answer 11

stage

Question 12

Differentiate clinical vs pathologic staging:

Answer 12

clinical stage- tumor size measurements on imaging, palpation for nodes
pathologic stage- after breast surgery, based on microscopy of tumor and lymph node counts

Question 13

Differentiate the Halsted model from the Fisher model

Answer 13

• Halsted model: breast cancer progresses in an orderly manner, so more surgery is better. advent of radical mastectomy
• Fisher model: breast cancer is metastatic at diagnosis; less surgery and more adjuvant systemic therapy

Question 14

What is the approach to treatment for stage I-III disease

Answer 14

surgery then adjuvant therapy

Question 15

What is the approach to stage IV disease?

Answer 15

primarily medical therapy

Question 16

Describe outcomes for lumpectomy + radiation vs mastectomy

Answer 16

same overall survival

greater risk of local recurrence in lumpectomy

Question 17

What stages of cancer is adjuvant chemotherapy used for?

Answer 17

all stage II and III, some stage I

hormonal therapy for all ER/PR+ cancers because the risk of therapy is small

Question 18

Breast cancer is the _____ most common in women and the ____ most common cause of cancer death

Answer 18

most common cause, 2nd for mortality