Breast cancer

Question 1

RFs breast ca?

Answer 1

BRCA1 and 2
Sex
age
reproduction
family history
Post-meno HT
OCPs

Question 2

Prognostic factors?

Answer 2

LYMPH NODE INVOLVEMENT
Size
histo
grading
margins
vessel invasion
HER2, ER

Question 3

Predictive factors?

Answer 3

Her 2 overexpression

ER and PrG expression

Question 4

Which carcinomas in situ?

Answer 4

Ductal DCIS

Lobular DCIS

Question 5

Which carcinoma in situ is often multifocal?

Answer 5

Lobular DCIS

Question 6

Which breast ca does not have invasion of basement membrane?

Answer 6

Ductal DCIS

Question 7

Which infiltrating cancers are there?

Answer 7

Ductal and lobular

Question 8

Which breast ca is MC?

Answer 8

Infiltrative ductal

Question 9

Which breast ca type is Paget’s disease?

Answer 9

Infiltrative Ductal

Question 10

Where in breast is ca usually?

Answer 10

Upper outer quadrant

Question 11

When to start mammography?

Answer 11

40 years old, once a year

Question 12

How to diagnose breast ca?

Answer 12

Mammogram –> microcalcifications ==> BIOPSY!

Question 13

Which tumor markers in breast ca?

Answer 13

NO TM

Question 14

Where is metastasis MC?

Answer 14

Bone
Lung
Liver
Brain

Question 15

Which surgical tx?

Answer 15

TUmorectomy
Breast conserving tx
Total mastectomy (Patey’s operation)

Question 16

What is done in BC tx?

Answer 16

Remove tumor and sentinel lymph node

RADIOTHERAPY

Question 17

How to find sentinel l n?

Answer 17

Blue dye

Question 18

When is breast conserving tx contraindicate?

Answer 18

Tumor > 5 cm
too large tumor in ratio to breast
Previously irradiation-tx
retroareolar
Positive margins

Question 19

Define T4A

Answer 19

Spread to chest wall

Question 20

Define T4B

Answer 20

Spread to skin, swollen

Question 21

Define N3

Answer 21

Spread to collarbone, behind sternum

Question 22

Which classification is used to choose tx?

Answer 22

St. Galleon Consensus

Question 23

What is Ki-67?

Answer 23

Cellular marker for proliferation

Question 24

Which classes in St Galleon?

Answer 24

Luminal A
Luminal B
HER2+
Triple Negative

Question 25

Which class har best prognosis?

Answer 25

Luminal A

Question 26

Characteristics of Luminal A?

Answer 26

ER+ and PgR+ HER 2 - Low Ki-67

Question 27

Tx of Luminal A?

Answer 27

ONLY hormonal

Question 28

Characteristics of Luminal B?

Answer 28

Divided into HER2 neg and positive: HER2- : ER+, PgR+, HER2-, HIGH Ki 67 HER2+: ER+, PgR+, HER2+, ANY Ki-67

Question 29

Tx in Luminal B?

Answer 29

HER2 neg: Hormonal and Cytotoxic therapy HER2 positive: Hormonal, Anti-HER2 and cytotoxic tc

Question 30

What defines LUMINAL classes?

Answer 30

ER and PgR POSITIVE

Question 31

Which classes are ER and PgR NEGATIVE?

Answer 31

HER2 + Triple Negative

Question 32

Characteristics of HER2 positive?

Answer 32

HER2 overexpressed | ABSENT ER and PgR

Question 33

Tx of HER2 positive?

Answer 33

CYtotoxic and anti-HER2 tx

Question 34

Characteristics of Triple Negative?

Answer 34

HER2 NEGATIVE | AVSENT ER and PgR

Question 35

Tx of Triple Negative?

Answer 35

ONLY cytotoxic

Question 36

Which class has poorest prognosis?

Answer 36

Triple negative

Question 37

Can you give Anti-HER2 tx without chemotx?

Answer 37

NO!!

Question 38

When is neoadjuvant tx given?

Answer 38

Locally advanced tumors T3, N2+ | (Stage III)

Question 39

Which chemotx?

Answer 39

Doxorubicin Docetaxel Cyclophosphamide 5 FU

Question 40

Tx given in ER+ pt?

Answer 40

TAMOXIFEN LHRHA Aromatase inhibitors

Question 41

When is adjuvant HORMONAL tx given?

Answer 41

in all who show presence of ANY detectable estrogen receptors

Question 42

Which hormonal adjuvant tx to premenopausal?

Answer 42

Tamoxifen | GnRHA antagonist

Question 43

Which hormonal adjuvant tx to postmenopausal?

Answer 43

Tamoxifen | Aromatase inhibitors

Question 44

Side effects of Tamoxifen?

Answer 44

Endometrial cancer!!! | Thromboemboli

Question 45

Side effects of aromatase inhibitors?

Answer 45

Bone fractures!

Question 46

Which tx if HER2 +?

Answer 46

Trastuzumab (Herceptin)

Question 47

How long to give trastuzumab?

Answer 47

1 YEAR

Question 48

Side effects of trastuzumab?

Answer 48

Cardiotoxicity

Question 49

Follow up after tx?

Answer 49

Every 3 months first 3 years | --> every6-12 months