Breast Cancer

Question 1

stage 0 cancer

Answer 1

DCIS (ductal carcinoma in situ)

Question 2

abundant atypical overgrowth within ductal cells; noninvasive (hasn’t broken through BM)

Answer 2

DCIS

Question 3

core biopsies are taken from ____ in suspected DCIS

Answer 3

calcifications

Question 4

med for estrogen receptor + DCIS

Answer 4

take anti-estrogen medication

Question 5

loss of E-cadherin staining is seen in:

Answer 5

LCIS (L oss = L CIS)

Question 6

how to differentiate between DCIS and LCIS

Answer 6

E-Cadherin staining (none in LCIS)

Question 7

most common cause of pathological nipple discharge

Answer 7

intraductal papilloma (fingerlike growth out of side of duct); may remove duct

Question 8

precursor to DCIS

Answer 8

atypical ductal hyperplasia

Question 9

lead to increased risk for breast cancer: (3)

Answer 9

• intraductal papilloma (1.5-2x ^ risk for breast cancer)
• atypical ductal hyperplasia
• lobular carcinoma in situ (0.5-4% of population)

Question 10

Other factors that increase breast cancer risk:

Answer 10

• BRCA1/2 mutation (60-85% increased risk for lifetime breast cancer)
• p53; PTEN mutation (Cowden’s Syndrome)
• smoking, estrogen (HRT), alcohol, obesity
• duration from menarche to first pregnancy (unopposed estrogen effects) - older age at 1st pregnancy and younger age at menarche increase risk
• nuliparity

Question 11

primary and secondary preventative measures

Answer 11

• increase physical activity

- have kids; have kids at younger age

Question 12

management of LCIS and DCIS involves:

Answer 12

1. excision of both
2. post-op options:
   - anti-estrogen therapy in DCIS if estrogen-sensitive receptors (tamoxifen)
   - prophylactic surgery (bilateral mastectomy?)

Question 13

44 yo woman presents with abnormal mammogram and 2 cm palpable mass in R breast. next step?

Answer 13

ultrasound and biopsy

Question 14

histology findings of invasive ductal carcinoma

Answer 14

• cells are heterogeneous
• lots mitotic figures
• cells transverse basement membrane

Question 15

Triple negative

Answer 15

ER- (estrogen receptor)
PR- (progesterone receptor)
HER2Neu- (human epidermal growth factor receptor 2/neu over expresion = grow faster)
CUT OUT

Question 16

T or F: Mastectomy has a greater survival than lobectomy + radiation

Answer 16

F: no change in survival when comparing either a L or M verse a L + radiation

Question 17

T or F: L + Radiation has a higher rate of recurrence than mastectomy alone

Answer 17

true

Question 18

options for 35 y.o. woman with strong FHx of breast cancer:

Answer 18

• screen: MRI, mammogram, physical exam
• bilateral prophylactic mastectomy
• tamoxifen (anti-estrogen)
• genetic counselor: does her mother have BRCA mut?

Question 19

genetic testing options for breast cancer

Answer 19

• BRCA 1/2

- mutigene panel

Question 20

precursor to breast cancer

Answer 20

DCIS

Question 21

marker of breast cancer risk

Answer 21

LCIS

Question 22

surgical options for breast cancer

Answer 22

partial mastectomy and mastectomy (adjuvant therapies depending on tumor/patient: +/- radiation)

Question 23

high risk patient management:

Answer 23

accelerate screening and offer preventative therapies

Question 24

uses of genetic testing in breast cancer:

Answer 24

• identify individuals at high risk for cancer
• guide screening
• guide prevention