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True Learn Studying 2021 > Breast Cancer Review > Flashcards

Breast Cancer Review Flashcards

1
Q

when would you offer palliative care for patient with breast cancer?

A

for patients not expected to survive 2-3 years secondary to other co-morbidities

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2
Q

what kind of hormonal therapy do you consider for pre-menopausal woman with hormone responsive breast cancer?

A

Tamoxifen

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3
Q

what kind of hormonal therapy do you consider for post-menopausal woman with hormone responsive breast cancer? (give example of drug)

A

Aromatase inhibitor

- anastrozole

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4
Q

what are the side effects of Anastrozole?

A
  • osteoporotic fractures
  • myalgia
  • arthralgia
  • lipid profile abnormalities
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5
Q

Mechanism of action of Anastrozole

A
  • reversible binding of aromatase enzyme

- blocks conversion of androgens to estrogen in the periphery (extragonadal tissue)

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6
Q

Mechanism of action: Tamoxifen

A
  • Selective estrogen receptor modulator

- think of it as a partial estrogen receptor agonist (less response by tissue than binding estrogen itself)

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7
Q

Mechanism of action: Trastuzumab

A
  • monoclonal antibody to domain IV of extracellular segment HER2/neu receptor
  • arrests cells in G1 phase of cell cycle
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8
Q

in general what kind of reconstruction do you propose for a patient with inflammatory breast cancer and why

A

delayed autologous graft reconstruction

prevents the delay of radiation treatment…also you don’t want to use an implant in a field that has been or will get radiation

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9
Q

breast mass looks like fat necrosis on imaging, but no history of trauma…what do you do?

A

biopsy the lump

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10
Q

Rapidly growing breast mass, smooth contour, biopsy shows stromal overgrowth with hypercellularity…what is it?

A

Phyllodes tumor

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11
Q

What margin do you want for a phyllodes tumor

A

1 cm margin

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12
Q

What margin do you want for DCIS excision

A

2 mm margin

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13
Q

Indication for mastectomy in DCIS

A
  • multi-centric
  • large/high grade DCIS
  • failure to achieve adequate margins with partial mastectomy
  • previous radiation/contraindication to radiation (need post op rads when doing lumpectomy)
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14
Q

when do you consider adjuvant chemotherapy in IDC?

A
  • tumor > 1 cm
  • nodal involvement
  • pathologic specimens with aneuploidy
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15
Q

What is the chemotherapy regimen of choice for IDC in breast cancer?

A
  • doxorubicin (adriamycin)
  • cyclophosphamide
  • paclitaxel
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16
Q

what test should you get before starting chemotherapy in breast cancer?

A
  • transthoraxic echocardiogram

- the agents used cause cardiotoxicity (doxorubicin, cyclophosphamide, paclitaxel)

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17
Q

what test do you do before starting Trastuzumab?

A
  • echocardiogram, it causes cardiac toxicity
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18
Q

What is tamoxifen metabolized by in the body?

A

CYP2D6

19
Q

what drugs should you discontinue before starting tamoxifen?

A

SSRIs like fluoxetine and paroxetine

20
Q

what is included in a modified radical mastectomy?

A
  • mastectomy

- axillary lymph node dissection

21
Q

how do you treat secondary angiosarcoma from radiation done for breast cancer?

A

completion mastectomy with adjuvant chemotherapy

22
Q

what does a fibroadenoma look like on mammography?

A
  • well circumscribed mass with coarse calcifications
23
Q

stellate/speculated mass on mammography

A
  • can be a radial scar…can also be cancer
24
Q

on histology showing abundant stromal and epithelial growth from breast biopsy

A

fibroadenoma

25
Q

breast biopsy shows fat disruption, lipid laden macrophages and chronic inflammation

A

fat necrosis

26
Q

breast biopsy shows complex and branching fronds lined with epithelial cells

A

intraductal papilloma

27
Q

Atypical ductal hyperplasia increases risk of cancer by what?

A

3-5 fold increase

28
Q

Which genetic mutation is male breast cancer most commonly associated with?

A

BRCA2

29
Q

Cells on breast biopsy show cytologic dyshesion, are small uniform round-to-oval nuclei, with variably distinct borders, what may this be?

A

DCIS or LCIS depending on location of lesion

30
Q

how does radial scar show up on biopsy?

A

fibroelastic core with entrapped ducts and surrounding adenosis

31
Q

fibroelastic core with entrapped ducts and surrounding adenosis on breast biopsy

A

Radial scar

32
Q

infiltrating cells surrounded by thin rim of epithelium on breast biopsy

A

invasive ductal carcinoma

33
Q

small lesion with mixed stromal and glandular elements on Breast biopsy

A

fibroadenoma

34
Q

why are most breast cancers seen in the upper outer quadrants?

A

most of the epithelial tissue is located here

35
Q

when would you do a terminal duct incision in a woman?

A

if they have pathologic nipple discharge, without a lesion seen on mammography

36
Q

patient who is getting post mastectomy radiation, what would you recommend regarding operative planning if an autologous graft is used?

A

plan for reconstructive surgery 6-12 months after radiation

37
Q

patient who is getting post mastectomy radiation would like immediate breast reconstruction, what is the best option?

A

tissue expander followed by implant

38
Q

drugs that can cause gynecomastia

A
  • thiazides
  • digoxin
  • estrogen
  • theophylline
39
Q

biopsy of breast with dermal lymph-vascular invasion

A
  • inflammatory breast cancer
40
Q

scaly, itchy, eczematous, ulcerated crust around areola

A

Paget disease

41
Q

what is the clinical significance of Paget Disease

A

95% of the time it is associated with underlying malignancy either IDC or DCIS

42
Q

biopsy of paget disease shows what?

A
  • clear cytoplasm
  • large nucleoli with oval nuclei
  • cells located between the normal keratinocytes of the nipple epidermis
43
Q

injury to long thoracic nerve

A
  • winged scapula

- inability to raise arm above shoulder

44
Q

injury to thoracodorsal nerve

A
  • weakened arm pull ups

- weakened adduction

True Learn Studying 2021 (27 decks)

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