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Therapy Prin & Procedure > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Breast cancer is the number ___ malignancy in American women and the number ___ cause of death to women by cancer

A

1:2

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2
Q

What is the likely reason why people who are over weight are at a higher risk of developing breast cancer

A

Fat cells generate higher levels of estrogen

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3
Q

BRCA-1 and BRCA-2 are

A

Oncogenes: tumor suppressor genes: DNA mutation

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4
Q

Most of the breast tissues over lies the

A

Pectoralis major

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5
Q

Ductal carcinoma occurs in the

A

Lactiferous ducts

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6
Q

Lobular carcinoma occurs in the

A

Lobules

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7
Q

What nodal group is not part of the nodal staging for breast cancer

A

Intramammary

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8
Q

Medial and lateral breast tangents are typically how far apart

A

180 degrees apart (Coplanar)

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9
Q

The typical treatment for ductal carcinoma is

A

It is the patients preference

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10
Q

What is the most common acute side effect of breast radiation

A

Erythema

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11
Q

Which is a disease of the lymphatics and not characterized by a local lesion

A

Inflammatory carcinoma

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12
Q

Whole breast radiation is typically given to a total dose of

A

45-50 Gy

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13
Q

Which is cardiotoxic

A

Herceptin, doxorubicin

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14
Q

Why did the incidence of BC increased in the 1980

A

Due to the use of hormonal replacement drugs

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15
Q

Average age for BC

A

55

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16
Q

Most important risk factor is

A

Gender

100 women to 1 men will develop BC

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17
Q

T/F

Alcohol, tobacco and night work increases the risk for BC

A

True

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18
Q

BC is more common in ____ women

A

White women BUT black women present with more advanced disease

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19
Q

Women with mothers or sisters who have/had BC are more _____ times more likely

A

2-3 times

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20
Q

What are BRCA1/BRCA2

A

These are tumor suppressor scenes that fight off tumors. When these are mutated, risk for BC increases greatly

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21
Q

Which tumor suppressor gene (BRCA1/BRCA2) is more common

A 
BRCA1 is more common (50-55%0 
BRCA 2 (45%)
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22
Q

T/F

First child after 35 is just as likely of developing BC as a nulliparous woman

A

True

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23
Q

T/F

History of BC, either invasive or ductal carcinoma in situ (DCIS) increase risk for other breast

A

True

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24
Q

T/F

BC is curative at young age

A

True

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25
Q

Examples of benign disease

A 
Atypical hyperplasia (over production of abnormal cells) 
Lobular carcinoma in situ (together with fam hx, risk increases 11 times)
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26
Q

The breast is composed of

A

Subcutaneous fat
Glandular tissue
Fibrous stroma (hold everything together)

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27
Q

Location of the breast

A

Located between ribs 2-6

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28
Q

The breast attaches at

A

Sternocostal junction to mid axillary line (tissue is often beyond these borders)

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29
Q

Breast tissue consist of how many lobes

A

Each breast has 15-20 lobes

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30
Q

Each lobe is drained by a system ducts that opens at the

A

Nipple

Tumors in these are known as lobular carcinoma

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31
Q

Each lobes has numerous lobules that contains

A

Alveoli that produces milk

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32
Q

Ductal carcinoma originates in the

A

Lactiferous ducts

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33
Q

What are the 2 sets of lymphatic chain associated with the breast

A

Superficial

Deep

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34
Q

The superficial lymphatics drains

A

The skin

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35
Q

The deep lymphatic drains

A

Internal tissue

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36
Q

70% of drainage is to the

A

Axillary

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37
Q

30% of drainage is to the

A

Intermammary nodes

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38
Q

Primary deep drainage occurs to the

A

Ipsilateral axillary

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39
Q

IM nodes are located

A

Near the edge of the sternum

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40
Q

IM nodes are embedded in the fat in the

A

Intercostal spaces (most are in the 1st, 2nd, 3rd)

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41
Q

Major prognostic indicators includes

A

Lymph nodes status
Tumor event
Histology grade
ER/PR and HER2/neu status

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42
Q

Which lymph involvement is the most important prognostic indicator

A

The number of axillary lymph involvement

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43
Q

Increased risk of recurrence is associated with

A

Higher number of node involvement

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44
Q

Low risk is how many node

A

3 or less

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45
Q

High risk is associate with how many nodes

A

4 or more

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46
Q

What lymph nodes status would indicate poor prognosis

A

IM and S’clav involvement is poor prognosis

10 or less nodes involvement is an extremely poor prognosis

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47
Q

T/F

Location does not seem to matter except in instances of attachment of tumor to chest wall

A

True

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48
Q

Most common BC histology

A

Infiltrating ductal carcinoma (70-80%)

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49
Q

Second most common BC histology

A

Infiltrating lobular carcinoma

50
Q

If the tumor is fueled by estrogens and progesterone then positive estrogen and progesterone tumors may respond well to

A

Hormone therapy

51
Q

Overall 5 year survival rate is

A

89%
Decreases to 83% if regional spread
Decrease to 20% if distant mets presents at diagnosis

52
Q

T/F

Because of the systemic nature of BC, patients may relapse up to 20 yrs after treatment

A

True

53
Q 
T/F 
Multi focal (tumors appears in same area) are the most common and has the best prognosis
A

True

Compared to multi centric- tumors appears in several areas

54
Q

Upper outer lesions usually metastasize to

A

Axillary nodes

55
Q

Medial lesions tends to metastasize to

A

IM nodes

56
Q

Local reocurrence can be treated with

A

Surgery

57
Q

Regional reoccurrence is usually treated with

A

Chemotherapy and/or surgery

58
Q

How does BC spread

A

Via blood vessels

59
Q

Common places for mets

A

Bone
Lung
Liver
Brain

60
Q

Age recommended for mammo

A

40

61
Q

T/F

If detected early, BC is one of the most curable cancers

A

True

62
Q

Most common presentation is

A

Painless lump

63
Q

What kind of masses are more suspicious

A

Post menopausal masses

64
Q

What is the second most common symptom/presentation

A

Nipple discharge or retraction and also Paget’s disease

65
Q

Other BC presentation includes

A

Lymphadenopathy of axillary

Arm edema

66
Q

What imaging modality is recommended for high risk women

A

MRI

67
Q

Most common form of biopsy

A

Excisional biopsy (lumpectomy)

68
Q

What is fine needle biopsy

A

Small needle
Least painful
Difficult to know what you’re looking at

69
Q

What is core needle biopsy

A

Larger needle to remove core of mass

More painful but gets a better cross section of the tumor

70
Q

What is incisional biopsy

A

Partial removal of mass for examination

Done is mass is too large

71
Q

What are the odds of American women developing breast cancer

A

1:8

72
Q

Breast cancer is ____ times more likely to occur in women than men

A

100 times

73
Q

Breast cancer occurs slightly more in ___ women but is more advanced in ____ women

A

More in white women

Advance in black women

74
Q

What is likely the reason why people who are overweight at a higher risk of developing BC

A

Fats cells generate higher levels of estrogen

75
Q

Who is LEAST likely to develop BC

A

A women who has 3 children between the ages of 20-30

76
Q

T/F

Breast pathology in one breast increases the risk of a second pathology in the contra lateral breast

A

True

77
Q

A women with a first degree relative that has or had BC has a ____ risk of developing BC

A

2fold

78
Q

T/F

Men are not susceptible to BRAC2 mutations

A

False

79
Q

What factors increases the risk of women developing BC

A

Alcohol
Tobacco
Obesity
Night shift work

80
Q

Most of the breast tissues overlies the

A

Pectoralis major

81
Q

Breast parenchyma consist of how many lobes

A

15-20 lobes

82
Q

Ductal carcinoma originate in the

A

Lactiferous ducts

83
Q

Which nodal groups are part of the nodal staging

A

Axillary
Internal mammary
Supra clavicle

84
Q

Medial and lateral breast tangents fields are typically how far apart

A

Greater than 180 degrees apart

85
Q

The typical treatment regime for ductal carcinoma.

A

Lumpectomy followed by XRT

86
Q

What is this advantage of prone breast treatment

A

Reduced dose to the heart and lungs

87
Q

T/F

The central axis of tangent fields are typically not Coplanar

A

True

88
Q

What is the most common side effect of breast radiation

A

Erythema

89
Q

Whole breast radiation is typically given a dose of

A

45-50Gy

90
Q

Compared to whole breast radiation, hypo fractionated partial breast radiation (PBI) delivers:

A

A lower number of fractions, higher daily dose and lower total dose

91
Q

Herceptin and doxorubicin is

A

Cardiotoxic

92
Q

T/F

DCIS (ductal carcinoma in situ) increase the risk for BC

A

False.

LCIS (lobular carcinoma in situ) increase the risk for BC

93
Q

What is multi centric

A

Different area of the breast

94
Q

What is multifocal

A

Different lesions within the same region

95
Q

IDC tends to spread to

A

Axillary nodes

96
Q

Some researchers believe that BC is a systematic disease due to:

A

Little change in survival since radical mastectomy

Late distant mets continue even as advanced detection and treatment occurs

97
Q

Most common lymphatic involvement

A

Axillary nodes

98
Q

Level I nodes included

A

Axillary and is more lateral

99
Q

Level II nodes include:

A

In the middle and deeper

100
Q

Level III nodes includes :

A

Supraclavicluar region

101
Q

Internal mammary nodal involvement is more commonly seen in what age group

A

Younger age are higher IM positive nodes

102
Q

IM nodes are ____ positive

A

20% positive

103
Q

IM and S’clav nodal involvement will have _____ prognosis

A

Poor prognosis

104
Q

T/F
All 3 modalities, meaning chemo, surgery and XRT is used for BC since it is very complex
however, decision about treatment are patient and tumor specific

A

True
Chemo for microscopic disease and more aggressive tumors
Surgery to remove the tumor
XRT post op (usually)

105
Q

The modified radical mastectomy includes what nodal levels?

A

Level I and Level II lymphatics

106
Q

Total mastectomy is done for

A

High risk patients, BRAC1 and BRAC2 mutations. This removes entire breast and has a 90% survival

107
Q

this type of biopsy is Used for staging when axillary are negative

A

Sentinel node biopsy

108
Q

Adjuvant mean

A

After surgery

109
Q

Neo-adjuvant means

A

Before surgery

110
Q

Most common route for chemo

A

IV

111
Q

Used to deliver deprive cancer cells of hormone that promote growth. Most common agents tamoxifen and aromitase inhibitors

A

Endocrine therapy

112
Q

Inoperable tumors can receive

A

Nemo-adjuvant chemo and XRT (before surgery)

113
Q

NCCN guidelines for BC with negative nodal involvement

A

XRT to whole breast with or without boost or PBI

114
Q

NCCN guidelines for BC with 1 and more nodal involvement

A

XRT to whole breast with or without boost, S’clav , infra clave and IM strongly consider

115
Q

Boost breast dose

A

Boost to 60-66Gy

Regular dose is 45-50Gy

116
Q

Lung limitations

A

1cm-3.4cm

117
Q

Lateral field border

A

2cm of flash/beyond tissue

118
Q

Inferior field border

A

1.5cm below breast tissue/inframammary fold

119
Q

Superior field border

A

First intercostal space or as superior as possible

120
Q

Medial field border

A

Midline

121
Q

Pins and shift system is also known as

A

Landmark and coordinate system

Therapy Prin & Procedure (17 decks)

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