Breast Cancer

Question 1

Breast cancer most commonly occurs in what race?

Answer 1

Caucasian

Question 2

Earliest sign of breast cancer seen on mammography?

Answer 2

microcalcifications

Question 3

Three factors in risk of cancer in order:

Answer 3

1. gender
2. age (>50years)
3. family history

Question 4

Li-Fraumeni Syndrome

Answer 4

rare autosomal dominant disorder greatly increasing risk of developing several kinds of cancer

Question 5

Atypical ductal hyperplasia (ADH)

Answer 5

identified on breast bx, increases risk for breast cancer

Question 6

When is nipple discharge likely a benign finding?

Answer 6

whitish, greenish, or yellow, produced by several ducts

Question 7

Benign changes in breast that may appear malignancy sonographically: (6)

Answer 7

• scar tissue
• diabetic mastopathy
• fat necrosis
• radial scar
• sclerosing adenosis
• granular cell tumors

Question 8

Characteristics of spiculated carcinomas:

Answer 8

• mildly invasive
• low number of tumor cells
• water poor composition
• reduced sound transmission -shadowing
• not especially hypervascular

Question 9

Characteristics of circumscribed carcinomas:

Answer 9

• highly invasive
• high number of tumor cells
• water rich composition
• increased sound transmission-enhancement
• hypervascular

Question 10

The greater the peripheral vascularity, the _____ the cancer.

Answer 10

more agressive

Question 11

Describe properties of multicentric tumor formation:

Answer 11

• multiple tumors in different quadrants
• tumor formation in both breasts
• tumors separated by more than 5cm

Question 12

Describe properties of multifocal tumor formation:

Answer 12

• multiple tumors within same area, quadrant , or ductal system
• tumors separated by less than 5 cm
• more common than multicentric formations
• better prognosis than multicentric

Question 13

What is ductal extension?

Answer 13

mass invasion of a single peripheral duct directed toward nipple

Question 14

What is branch pattern?

Answer 14

mass invasion of multiple peripheral ducts directed away from nipple

Question 15

Which carcinoma is actually not a cancer?

Answer 15

Lobular Carcinoma in Situ is actually a lobular neoplasm

Question 16

Which carcinoma is most frequently missed on imaging?

Answer 16

Invasive Lobular Carcinoma, MRI best

Question 17

Name the three Lobular Carcinomas

Answer 17

1. Lobular Carcinoma in Situ
2. Invasive Lobular Carcinoma
3. Tubulolobular Carcinoma

Question 18

Three Stromal Carcinomas:

Answer 18

1. Cystosarcoma Phyllodes
2. Lymphoma
3. Metastatic Breast Cancer

Question 19

What is the most common breast sarcoma?

Answer 19

cystosarcoma phyllodes

Question 20

Which cancer is the malignant form of fibroadenoma?

Answer 20

cystosarcoma phyllodes

Question 21

How does breast lymphoma present?

Answer 21

1. RARE
2. Palpable mass and/or diffuse thickening
3. Rapid contrast uptake on MRI

Question 22

Distant Mets

Answer 22

• once cancer cells extend to nodes outside of L1, L2, L3

- Cancer cells invading other organs

Question 23

Breast Mets most commonly move to

Answer 23

#1 Bone
#2 Liver
#3 Lung

Question 24

Stage 0 Carcinoma Stage:

Answer 24

In Situ Carcinomas

Question 25

Stage 1 Carcinoma Stage:

Answer 25

<2 cm in size, no mets, no LN involvement

Question 26

Stage 2 Carcinoma Stage:

Answer 26

1. <2 cm in size, +nodes in axilla, no mets OR 2. 2-5cm in size, +nodes in axilla, no mets OR 3. >5cm in size, no nodal involvement or mets

Question 27

Stage 3 Carcinoma Stage:

Answer 27

>5 cm AND ATLEAST ONE of the following: - local/regional spread - muscular attachment at chest wall - fused axillary lymph nodes

Question 28

Stage 4 Carcinoma Stage:

Answer 28

Any sized with muscular involvement at chest wall OR invasion to skin level AND mets to other breast spots AND significant node involvement

Question 29

The Sentinel node is most often which level?

Answer 29

Level 1...lateral to pec minor

Question 30

The most common route for mets to the breast is

Answer 30

bloodstream (hematogeneous)

Question 31

Most common distant primaries:

Answer 31

1. Melanoma (F) 1. Prostate (M) 2. lungs 3. ovaries 4. sarcoma

Question 32

In mets to breast from distant primaries, where are these lesions most commonly found?

Answer 32

subcutaneous tissues, and often multiple mass formation

Question 33

Most common type of mets occuring in the breast

Answer 33

from primary in opposite breast (occuring by direct infiltration)...usually solitary mass

Question 34

Most common route for mets to bone

Answer 34

intercostal veins

Question 35

Which drugs reduce estrogen and therefore tumor recurrence?

Answer 35

Tamoxifen and Raloxifine