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Plastic Surgery - Breast/Aesthetics > Breast Cancer - Board Review > Flashcards

Breast Cancer - Board Review Flashcards

1
Q

What is a average woman’s lifetime risk of breast cancer?

A

12.3%

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2
Q

According to NCCN, what are high risk factors for developing breast cancer?

A
  1. History of breast cancer
  2. 5 year risk >1.7% using Gail model
  3. LCIS or atypical ductal or lobular hyperplasia (ADH/ALH)
  4. Lifetime risk >20% using family history models
  5. History of thoracic radiation (@ <30 YOA)
  6. Family with suggested or known genetic predisposition
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3
Q

What is the modified Gail model based on?

A

Age, Age at menarche, age at first live birth or nulliparity, number of first degree relatives with breast cancer, number of previous benign breast biopsies, atypical hyperplasia in a previous biopsy, race

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4
Q

What is the risk of developing breast cancer by age 70 in women with BRCA1 or BRCA2?

A

65% risk with BRCA1, 45% with BRCA2

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5
Q

What cancers are associated with BRCA1 and BRCA2?

A

BRCA1: breast, ovarian, fallopian tube, peritoneal, prostate, pancreatic
BRCA2: ++male breast cancer, female breast cancer, ovarian, prostate, pancreatic

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6
Q

What is the overall sensitivity of screening mammogram?

A

75%

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7
Q

What is the BI-RADS classification?

A 
0 - incomplete, needs more imaging
1 - negative
2 - benign
3 - probably benign
4 - suspicious (consider biopsy)
5 - highly suspicious (biopsy)
6 - known malignancy
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8
Q

For BI-RADS 3 what is the likelihood of malignancy?

A

<2%

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9
Q

For BI-RADS 5 what is the likelihood of malignancy?

A

> 95%

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10
Q

What is Mondor disease?

A

Superficial thrombophlebitis of the breast

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11
Q

What is fibroadenoma, presentation, and treatment?

A

Most common solid benign tumor of breast. Composed of stromal and epithelial elements. Estrogen sensitive. Present as solid, firm, mobile mass. Excision or observation.

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12
Q

What is considered a giant fibroadenoma?

A

<5cm

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13
Q

What is an intraductal papilloma and how does it present, treatment?

A

True polyp of the epithelium-lined breast ducts; bloody nipple discharge; excisional biopsy (20% a/w malignancy)

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14
Q

What is a phyllodes tumor and how/when does it present? What are the subtypes? Treatment

A

Rapidly enlarging painless breast mass; Histology: stromal hypercellularity and atypical spindle cells and high mitotic rate, around age 40; Subtypes: benign, borderline, malignant; WLE (1cm margins)

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15
Q

What is the most important prognostic factor following a breast cancer diagnosis?

A

Node status

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16
Q

What is the 5 year survival based on stage (in someone receiving appropriate treatment)

A 
I = 98%
II = 86%
III = 57%
IV = 20%
17
Q

What is the risk associated with LCIS and developing invasive cancer?

A

10-20% risk over the next 15 years; can decrease risk by doing bilateral mastectomies and tamoxifen

18
Q

What percentage of invasive carcinomas are ductal in origin?

A

85-90% ductal, 10% lobular

19
Q

What is the most common site of disseminated disease?

A

Bone

20
Q

Is there a survival benefit in patients undergoing mastectomy rather than lumpectomy with whole breast irradiation?

A

No

21
Q

What are the oncologic contraindications for NSM?

A
  1. Tumor <2cm away from NAC
  2. Evidence of nipple involvement (Paget’s, bloody discharge, retraction)
  3. Positive lymph nodes
  4. Inflammatory breast cancer
  5. Skin involvement
22
Q

What are the reconstructive contraindications for NSM?

A
  1. Smokers
  2. Diabetics
  3. Grade 3-4 ptosis
  4. Obese/large breasts
23
Q

Following total mastectomy, what are the indications for radiation?

A
  1. Presence of 4+ positive axillary nodes
  2. If 1-3 + nodes, strongly consider
  3. If tumor is >5cm, strongly consider
24
Q

What is the positive and negative predictive value of successful SNLB?

A

100%, 95%

25
Q

What are the levels removed during ALND and how many nodes are necessary to stage?

A

Levels I and II, 10

26
Q

If adjuvant chemotherapy is indicated, when should radiation begin?

A

After chemo

27
Q

When should preoperative chemo be considered?

A

Stage IIA, Stage IIB, T3N1M0

28
Q

Which class of endocrine therapy drugs are associated with osteoporosis?

A

Aromatase inhibitors

29
Q

What endocrine therapy drug is associated with increased risk of endometrial cancer and DVT?

A

Tamoxifen

30
Q

When is systemic adjuvant chemo indicated?

A
  1. Tumor >1cm or positive nodes
  2. Oncotype DX type
  3. HER-2 +
31
Q

What is angiosarcoma and how does it spread?

A

Highly aggressive sarcoma originating from lymphatic or capillary endothelium, can occur secondary to treatment for breast cancer; spreads hematogenously

32
Q

What syndrome describes upper extremity sarcoma development associated with lymphedema following mastectomy?

A

Stewart-Treves syndrome

33
Q

What is a risk factor for development of angiosarcoma after mastectomy?

A

Lymphedema

34
Q

What is Paget’s disease and what is it associated with?

A

Rare manifestation of breast cancer characterized by neoplastic cells in the epidermis of the NAC; 80-90% a/w cancer elsewhere in the breast (invasive or DCIS)

35
Q

What is inflammatory breast cancer?

A

Rare aggressive form of breast cancer with erythema and dermal edema (peau d’orange) of 1/3 or more of the skin of the breast. Diagnosis is clinical +skin biopsy.

36
Q

What is the treatment for inflammatory breast cancer?

A

Neoadjuvant chemo, mastectomy +ALND, radiation; Immediate reconstruction is contraindicated

Plastic Surgery - Breast/Aesthetics (18 decks)

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