Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ph RadOnc Residency PBRROE2-3 Review 2021 > Breast Cancer: Early Stage > Flashcards

Breast Cancer: Early Stage Flashcards

1
Q

Breast Cancer: Early Stage
Anatomy

The female breast lies on the anterior chest wall superficial to the _________ muscle.

A

Pectoralis major

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Breast Cancer: Early Stage
Anatomy

What are the usual cranio-caudal bony landmarks for the breast?

A

2nd and 6th anterior rib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Breast Cancer: Early Stage
Anatomy

Why is there a greater percentage of cancer in the upper outer quadrant?

A

The upper outer quadrant of the breast extends into the region of the low axilla and is frequently referred to as the axillary tail of Spence.
This anatomical feature results in the upper outer quadrant of the breast containing a greater percentage of total breast tissue compared with the other quadrants, and therefore, a greater percentage of breast cancers occur in this anatomical location.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Breast Cancer: Early Stage
Anatomy

What causes skin dimpling?

A

The surface of the breast has deep attachments of fibrous septa, called Cooper ligaments, which run between superficial fascia (attached to the skin) and the deep fascia (covering the pectoralis major and other muscles of the chest wall).

Skin dimpling may be caused by tumors of these supporting structures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Breast Cancer: Early Stage
Anatomy

What part of the breast parenchyma is the most common location breast cancer?

A

TDLU (terminal ductal lobular unit)

- the interface between the ductal system and the lobules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Breast Cancer: Early Stage
Anatomy

What muscle forms the landmark for dividing the axillary nodal stations int their respective levels?

A

Pectoralis minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Breast Cancer: Early Stage
Anatomy

Where is the most common nodal drainage of inner quadrant lesions?

A

Even in inner
quadrant lesions, axillary drainage is more common than internal mammary
drainage. However, internal mammary drainage was present in over 50% of
lower inner quadrant lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Breast Cancer: Early Stage
Epidemiology

In the United States, the incidence of breast cancer in white women is higher
than in all other populations. Recent data from the National Cancer Institute’s
Surveillance, Epidemiology, and End Results (SEER) program report incidence
rates of 128.3 cases per 100,000 white women, compared with 125.1 in African
American, 89.3 in Asian or Pacific Islanders, 91.7 in Hispanics, and 98.1 in
Native Americans or Alaskan Natives

Which of these groups has a more aggressive biology of cancer and a poorer overall prognosis?

A

African Americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Breast Cancer: Early Stage
Anatomy

Where is the most common nodal drainage of inner quadrant lesions?

A

Even in inner
quadrant lesions, axillary drainage is more common than internal mammary
drainage. However, internal mammary drainage was present in over 50% of
lower inner quadrant lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Breast Cancer: Early Stage
Risk Factors

The risk of breast cancer increases exponentially up to the age of menopause, at
which time the rate of increase in the risk slows significantly. After the age of
80, the incidence of breast cancer begins to show a slight decline

TRUE or FALSE?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Breast Cancer: Early Stage
Risk Factors

Regarding positive family history:

A) a first-degree relative confers a greater risk than a second-degree relative

B) the number of relatives increases the risk of breast cancer

C. there are reported autosomal dominant patterns of inheritance

Which statement/s is/are TRUE?

A

A, B, and C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Breast Cancer: Early Stage
Risk Factors

A prior history of benign breast biopsy findings increases the risk of breast cancer (fibrocystic changes and atypical hyperplasia).

TRUE or FALSE?

A

True.

Results from the Breast Cancer Detection
Demonstration Project, which included over 280,000 women in 29 centers,
demonstrated that women with atypical hyperplasia had 4.3 times the breast
cancer risk of women without proliferative disease (95% confidence interval
[CI], 1.7 to 11.0). In women with proliferative disease lacking atypical
hyperplasia, the RR was 1.3 (95% CI, 0.77 to 2.2). In that study, the joint
occurrence of family history and atypical hyperplasia had a strong synergistic
effect on breast cancer risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Breast Cancer: Early Stage
Risk Factors

A prior history of radiation is associated with an increase in breast cancer risk.
It increases with increasing radiation dose and age at first exposure

TRUE or FALSE?

A

False.

the breast cancer risk was greatest among women who had
radiation exposure between the ages of 10 and 14 years (RR 4.5 per 0.01 Gy and
an additive risk of 6.1 per 104 person-years per 0.01 Gy); there was substantially
less excess risk with increasing age at first exposure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Breast Cancer: Early Stage
Risk Factors

A prior history of benign breast biopsy findings increases the risk of breast cancer (fibrocystic changes and atypical hyperplasia).

TRUE or FALSE?

A

True.

Results from the Breast Cancer Detection
Demonstration Project, which included over 280,000 women in 29 centers,
demonstrated that women with atypical hyperplasia had 4.3 times the breast
cancer risk of women without proliferative disease (95% confidence interval
[CI], 1.7 to 11.0). In women with proliferative disease lacking atypical
hyperplasia, the RR was 1.3 (95% CI, 0.77 to 2.2). In that study, the joint
occurrence of family history and atypical hyperplasia had a strong synergistic
effect on breast cancer risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Breast Cancer: Early Stage
Risk Factors

Physical activity can be independent from BMI as a risk for breast cancer

TRUE or FALSE?

A

True.

Physical activity can have a significant impact on BMI, so it is sometimes
difficult to separate these two effects in interpreting breast cancer risk. A
majority of studies, however, have observed a lower risk of breast cancer among
women who are more physically active compared with women who are
sedentary.
Although

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Breast Cancer: Early Stage
Risk Factors

The Gail Model have used epidemiologic risk factors to derive a model for predicting an individual’s annual and lifetime risks of breast cancer.

Which of these factors is not considered in the Gail model, in estimating an individual’s annual risk of breast cancer?

  • present age
  • number of first-degree
  • relatives with breast cancer
  • age at first birth
  • age at menarche
  • number of breast biopsies
  • history of atypical ductal hyperplasia.
  • use of exogenous hormones
A

use of exogenous hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Breast Cancer:
Prevention and Genetic screening

Breast cancer is the most common malignancy in patients with Li-Fraumeni syndrome

TRUE or FALSE?

A

True.

the lifetime risk is estimated to be 90%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Breast Cancer: Early Stage
Risk Factors

The Gail Model have used epidemiologic risk factors to derive a model for predicting an individual’s annual and lifetime risks of breast cancer.

Which of these factors is not considered in the Gail model, in estimating an individual’s annual risk of breast cancer?

  • present age
  • number of first-degree
  • relatives with breast cancer
  • age at first birth
  • age at menarche
  • number of breast biopsies
  • history of atypical ductal hyperplasia.
  • use of exogenous hormones
A

use of exogenous hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Breast Cancer
Prevention and Genetic screening

Aside from breast cancer, what other cancers are BRCA2 mutation carriers predisposed to?

A

“male” breast cancer
pancreatic cancer
ovarian cancer (lesser than BRCA1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Breast Cancer
Prevention and Genetic screening

Germline mutations in BRCA1 and BRCA2 are rare, occurring in
fewer than 7% of patients with breast cancer. Thus, only a minority of breast
cancer patients with a family history of the disease would be predicted to carry a
mutation in one of these genes.

TRUE or FALSE?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Breast Cancer
Prevention and Genetic screening

It is a placebo-controlled study by the NSABP to test the efficacy of 5 years of tamoxifen in the prevention of breast cancer.

What is this trial?

A

P-1 trial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Breast Cancer
Natural History

What is the Halsted model?

How about Fisher?

How about Hellman hypothesis?

A

The Halsted model was based on an orderly progression to the regional lymph nodes and from there to distant metastatic sites.

Later, Keynes
and Crile et al. suggested that breast cancer is a systemic disease and that
extensive surgery to achieve local tumor control was not as important as
originally believed. This alternative hypothesis was fully demonstrated in both
laboratory and clinical studies by Fisher, who advanced the concept that breast
cancer, as a systemic process involving host–tumor interactions, would not show
substantial effects on survival with variations in locoregional treatment.

A third
hypothesis put forward by Hellman considers breast cancer as a heterogeneous
disease with a spectrum extending from a tumor that remains localized
throughout its course to one that disseminates systemically, even when detected
as a small lesion, suggesting that metastases are a function of tumor growth and
progression factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Breast Cancer
Prevention and Genetic screening

It is a placebo-controlled study by the NSABP to test the efficacy of 5 years of tamoxifen in the prevention of breast cancer.

What is this trial?

A

P-1 trial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Breast Cancer
Natural History

Factors associated with IMN spread

A

Size (>2 cm)
location (medial or central)
+axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Breast Cancer
Natural History

Three predictive factors for SCF spread

A

high histologic grade

more than four positive nodes

axillary level II or III involved nodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Breast Cancer
Natural History

Factors associated with IMN spread

A

Size (>2 cm)
location (medial or central)
+axilla

27
Q

Breast Cancer
Screening

What are the recommendations on regular screening mammography for the general population by the ACS, ACR, and SBI?

A

start at 45
45-54 - annually
55+ biennial or annual
continue as long as overall health is good or life expectancy 10y+.

28
Q

Breast Cancer
Screening

What are the recommendations on regular screening mammography for the general population by the USPSTF?

A

biennial 50 to 74

29
Q

Breast Cancer
Screening

What is the disadvantage of fine needle aspiration biopsy?

A

It provides cytology but not tissue architecture

30
Q

Breast Cancer
Screening

What are the recommendations on regular screening mammography for the general population by the USPSTF?

A

biennial 50 to 74

31
Q

Breast Cancer
Screening

What is the disadvantage of fine needle aspiration biopsy?

A

It provides cytology but not tissue architecture

32
Q

Breast Cancer
Staging

What is the N stage for a positive finding in the supraclavicular nodes?

A

N3c

c or p

33
Q

Breast Cancer
Staging

What is the N stage for a positive finding in more than 3 axillary
lymph nodes and in internal mammary lymph nodes with microscopic disease
detected by sentinel lymph node dissection but not clinically apparent

A

pN3b

34
Q

Breast Cancer
Staging

What are the components of the prognostic staging for breast cancer?

A 
T
N
M
histologic grade
ER
PR
HER2
35
Q

Breast Cancer
Pathology

What is the most common type of breast cancer?

It appears as solid cords or
groups of ductal tumor cells varying in size and cytoplasmic content and degree
of differentiation

A

Invasive (infiltrating) ductal carcinoma

36
Q

Breast Cancer
Pathology

Identify:

It is composed of structures typically lined by a
single layer of well-differentiated epithelium. The cells simulate those of
normal ducts or ductules, are arranged in multiglandular cribriform or
adenocystic configurations, and are frequently associated with other in situ
carcinomas of the breast. They have a nonaggressive growth
pattern, with an excellent prognosis

A

Tubular carcinoma

37
Q

Breast Cancer
Pathology

Identify:

composed of cords and masses of large cells with
reticular pleomorphic nuclei containing prominent nucleoli. There is a scant
fibrous stroma, but lymphoid infiltrate is prominent. These tumors are
microscopically and grossly well circumscribed. Prognosis, in general, is better
than for other tumors. These tumors are more frequently seen in younger women
and are commonly associated with patients with BRCA1 mutations

A

Medullary carcinoma

38
Q

Breast Cancer
Pathology

What histology is often mammographically silent?

may be interspersed with; the cells appear singly
or in small clusters in a targetoid or single-file pattern. Some scirrhous
carcinomas probably are invasive lobular lesions; these tumors tend to be
aggressive and multicentric and are prone to development of distant metastases.

much more commonly ER positive than is invasive ductal carcinoma
(IDC).

A

Lobular invasive carcinoma

39
Q

Breast Cancer
Pathology

Identify:

It is also called mucoid or colloid carcinoma, has been observed in older women with relatively long duration of symptoms.
It is more likely to be devoid of a cellular reaction; necrosis and lymphatic invasion are very rare.
It is slowly growing with a pushing border and has a low frequency of axillary lymph node metastasis.
Survival is appreciably better than with IDC.

A

Mucinous carcinoma,

40
Q

Breast Cancer
Pathology

Identify:

It is characterized by growth of tumor cell clusters in prominent clear spaces resembling dilated angiolymphatic vessels.

A

Invasive micropapillary carcinoma of the breast

41
Q

Breast Cancer
Pathology

Spindle cell carcinoma of the breast, a variant of metaplastic carcinoma,
includes a wide spectrum of lesions with mildly atypical features that may
resemble fasciitis, fibromatosis, or myofibroblastic tumors. Like spindle cell carcinomas in general, they have propensity for distant metastasis.

TRUE or FALSE?

A

False.

Unlike spindle cell
carcinomas in general, they have no propensity for distant metastasis and should
be termed tumors rather than carcinomas.

42
Q

Breast Cancer
Pathology

Identify:

This tumor is usually a benign lesion; in broad, fibrous beads
that look “leaflike” are cystic clefts lined by a single layer of cells. These tumors
are large; usually, they are encapsulated, without invasion of the adjacent
breast.62 The lesions frequently develop from preexisting fibromas and have a
long initial period of slow growth followed by a sudden, rapid increase in size.
The grade (mitotic rate), surgical margins, and proliferative index have
prognostic importance.

A

Cystosarcoma phyllodes

43
Q

Breast Cancer
Pathology

What is the most common histologic subtype of primary mammary lymphomas?

A

DLBCL

44
Q

Breast Cancer: Early Stage
Surgical Treatment

What is the most common complication of a complete axillary dissection?

A

arm edema

45
Q

Breast Cancer: Early Stage
Surgical Treatment

Differentiate simple mastectomy from radical mastectomy and RM from MRM

A

simple mastectomy - removal of breast, no lymph nodes.

RM - removal of breast + chest wall muscles + lymph nodes

MRM - like RM but does not include muscles

46
Q

Breast Cancer: Early Stage
Surgical Treatment

Name some major studies that demonstrated that many of patients with one or two metastatic sentinel nodes can safely avoid a completion axillary node dissection.

A

IBCSG 2301

ACOSOG Z0011

47
Q

Breast Cancer: Early Stage
Surgical Treatment

This multicenter randomized study on sentinel nodes compared SLND vs. ALND or RNI

A

ALMANAC

48
Q

Breast Cancer
Treatment

What are the absolute contraindications to BCT requiring RT?

A
  • RT during pregnancy
  • Diffuse suspicious or malignant appearing microcalcifications
  • widespread disease where local excision will result in an unacceptable cosmetic deficit
  • diffusely positive surgical margins
  • homozygous for ATM mutation
49
Q

Breast Cancer
Treatment

What are the relative contraindications to BCT requiring RT?

A
  • prior chest wall RT
  • collagen vascular disease affecting the skin
  • positive pathologic margin
  • known or suspected genetic predisposition to breast cancer
50
Q

Breast Cancer: Early Stage

What is the definition of a positive margin?

A

NCCN/ASTRO/SSO - ink on invasive cancer or DCIS

NSABP >2 mm beyond invasive cancer

51
Q

Breast Cancer

What is the Harvard definition of an EIC?

A

According to the Harvard definition of EIC, 25% or more of the primary tumor is intraductal carcinoma, and intraductal carcinoma is seen outside (adjacent to) the infiltrating tumor border.

52
Q

Breast Cancer
Molecular Factors

Differentiate the following from each other based on ER, PR, HER2, Ki67, EGFR, CK5/6 status:

Luminal A
Luminal B
Luminal Her2
Her2 enriched
Basal like
A

luminal A (ER positive or PR positive and Ki-67 <14%)

luminal B (ER positive or PR positive and Ki-67 ≥14%)

luminal-HER2 (ER positive or PR positive and HER2 positive)

HER2 enriched (ER negative, PR negative, and HER2 positive)

basal-like (ER negative, PR negative, HER2 negative, and EFGR positive or CK5/6 positive).

53
Q

Breast Cancer: Early Stage

Name some major randomized studies that demonstrated elderly women may not be treated with adjuvant RT?

A

CALGB

and Canadian Study by Hughes

54
Q

Breast Cancer: Early Stage

This trial randomized patients with early breast cancer (pT1-3a, pN0-1, M0) at 23 centers in the UK who were assigned after primary surgery to receive 50 Gy in 25 fractions of 2.0 Gy over 5 weeks or 40 Gy in 15 fractions of 2.67 Gt over 3 weeks.

The overall treatment time was not consistent in both arms.
With the primary endpoint of locoregional tumor relapse, 1,105 women were assigned to the 50 Gy group and 1,110 to the 40 Gy group.
With a median follow-up of 6.0 years (interquartile range 5.0 to 6.2), the rate of locoregional tumor relapse at 5 years was 2.2% (95% CI, 1.3 to 3.1) in the 40 Gy group and 3.3% (95% CI, 2.2 to 4.5) in the 50 Gy group, representing an absolute difference of –0.7% (95% CI, –1.7% to 0.9%).

A

UK Start B

Standardisation of Breast Radiotherapy

55
Q

Breast Cancer
Early Stage

The prognosis of breast cancer in pregnant patients, (stage for stage) appears to be similar to age-matched controls.

TRUE or FALSE?

A

True

56
Q

Breast Cancer
Early Stage

What causes a poor prognosis in pregnant patients?

A

delay in diagnosis

57
Q

Breast Cancer
Early Stage

If the disease in a pregnant patient is operable, when is the earliest safest time to do the surgery?

A

after the 12 week of pregnancy

58
Q

Breast Cancer
Early Stage

How long after adjuvant chemotherapy is a patient usually advised to wait before conceiving?

A

minimum of 12 months

59
Q

Breast Cancer
Early Stage

Is there a randomized trial that assessed the efficacy of boost with regard to local control after after BCT?

A

Yes.

The Lyons Breast Cancer Trial.

randomly
assigned to receive or not a boost of 10 Gy with electrons to the tumor bed.713
With a median follow-up of 3.3 years, at 5 years 10 of 521 women who received
a boost (3.6%) and 20 of 503 (4.5%) who received no further treatment
experienced a local breast relapse (P = .044). Time to local recurrence is shown
in Figure 59.52, with more patients failing after 7 years in the no-boost arm.

However, there are no trials that solidify the indications for boost.

60
Q

Breast Cancer

What are the borders of the posterior axillary boost field?

A

medially, the border is drawn to allow 1.5 to 2 cm of lung to show on the portal film;

inferiorly, the border is at the same level as the inferior border of the supraclavicular field;

laterally, the border just blocks fall-off across the posterior axillary fold;

the superior border splits the clavicle and the superolateral border shields or splits the humeral head.

61
Q

Breast Cancer: Early Stage

Enumerate some techniques used in APBI

A
  1. Interstitial Brachytherapy
  2. MammoSite
  3. 3DCRT
  4. IORT (single dose)
62
Q

Breast Cancer: Early Stage

How do you follow-up a patient treated conservatively?

A

history and physical examination - every 3 to 6 months for 3 years and every 6 months for the following 2 years and annually thereafter.

diagnostic mammogram - within 3 to 6 months postradiation therapy and then annually thereafter is sufficient unless the radiologist recommends more frequent examinations.

Monthly breast self-examination in the upright and supine positions.

At least yearly evaluation is mandatory even 10 years after therapy because of the possibility of late breast relapses and occasional distant metastases.

63
Q

Breast Cancer: Early Stage

What are the most common secondary cancers aside from contralateral breast cancers?

In decreasing order of risk.

A

Sarcoma
Esophagus
Leukemia
Lung

Ph RadOnc Residency PBRROE2-3 Review 2021 (57 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions