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: Tis > Flashcards

Breast Cancer: Tis Flashcards

1
Q

Breast cancer

What are the three non-invasive histopathologic entities classified as Stage Tis?

A

-Paget disease of the nipple,
-lobular carcinoma in situ (LCIS) and
-ductal
carcinoma in situ (DCIS)

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

Breast cancer

LCIS has been reported to be multicentric in up to 10% of mastectomy speciments, with bilateral involvement in 35% to 59%.

TRUE or FALSE?

A

False.

multicentric in 90%

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

Breast cancer

LCIS cells are commonly ______ receptor positive.

A

Estrogen.

although overexpression of
c-erbB-2 and p53 are uncommon

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

Breast cancer

The loss of this adhesion molecule may explain the
growth pattern seen with LCIS.

What is this adhesion molecule?

A

E-cadherin

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

Breast cancer

LCIS represents ____ of all noninvasive breast cancer.
The majority of
women are ___menopausal at diagnosis, with an average age of __ years.

A

<15%
pre
45

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

Breast cancer

Why is LCIS not seen in males?

A

Because the male breast lacks lobular elements

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

Breast cancer

What is the most common presentation of LCIS?

A

As there are no clinical or mammographic
indicators that are characteristic of LCIS, it is often detected as an incidental
biopsy finding.

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

Breast cancer

In
excisional biopsy specimens, DCIS or invasive carcinoma are frequently
identified even when LCIS is the sole histologic entity seen on core biopsy.

TRUE or FALSE?

A

True.

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

Breast cancer

LCIS is considered a marker of increased risk for the subsequent development
of invasive (usually ductal) carcinoma that may be greatest for high-grade
or more extensive lesions.
This risk appears to be “nearly equal” for both
breasts

TRUE or FALSE?

A

True.

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

Breast cancer

In 2009, what imaging modality was recommended by the NCN to be part of the annual screening for patients with LCIS.

A

Breast MRI.

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

Breast cancer

What is the management for a breast which has an LCIS component and an invasive component?

A

the most widely
accepted treatment approach is to manage the breast according to the dominant
malignant histology (DCIS or invasive carcinoma) and disregard the LCIS. In
such circumstances, it is not necessary to pursue additional surgery to obtain
clear margins for LCIS

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

Breast cancer

What is the management for a breast which has LCIS as the sole histologic diagnosis?

A

obtain excision biopsy first.
pure LCIS on core biopsy sometimes reveal an invasive component.

If none, the most
widely accepted clinical practice is close observation with regular physical
examination and mammographic surveillance

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

Breast cancer

When do you do prohylactic bilateral mastectomy in LCIS patients?

A

young age, diffuse high-grade

lesion, and significant family history.

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

Breast cancer

What other prophylactic options can be given to patients with LCIS except mastectomy?

A

Tamoxifen.

Tamoxifen has
demonstrated efficacy in the prevention of invasive carcinoma and, in the
context of LCIS, has been shown to reduce risk by 56%

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

Breast cancer

What are the common presenting signs and symptoms of Paget disease?

A

burning and itching of nipple and areola.

crusting and eczematioid changes of the nipple and areola.

a palpable mass (50%) usually associated with invasive carcinoma in >90% of cases.

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

Breast cancer

What is the management for Paget disease?

A

mastectomy or breast-conserving techniques (surgery + rt)

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

Breast cancer

What is the most common mammographic findings in DCIS?

A

Microcalcifications

Linear and branching
calcifications frequently are associated with high-grade DCIS and necrosis,
whereas fine and granular calcifications are associated more commonly with
low-grade DCIS

18
Q

Breast cancer

What imaging modality has the highest sensitivity to detect DCIS?

A

Breast MRI

particularly high-grade DCIS. MRI has
additionally been shown to better establish the extent of DCIS, thus aiding
treatment planning.
In cases that present with nipple discharge and a negative
mammogram, galactography may be helpful in determining the likelihood of
underlying DCIS versus papilloma

19
Q

Breast cancer

Enumerate the 5 most common subtypes of DCIS.

A
  • comedo
  • solid
  • cribriform
  • micropapillary
  • papillary
20
Q

Breast cancer

Estrogen receptor expression rate is higher in high-grade lesions,
HER2/neu and p53 is higher in low grade lesions.

TRUE or FALSE?

A

False.

It’s the other way around

21
Q

Breast cancer

An occult microinvasive tumor (one that does not exceed 0.1 cm in diameter)
may be seen with some cases of DCIS.
Such cases are classified as
microinvasive breast cancer and are generally treated according to the
guidelines for invasive disease.

Occult microinvasive tumors are most common in what circumstances involving DCIS?

A

-in patients with DCIS lesions that are >2.5 cm in diameter
-those presenting
with palpable masses or nipple discharge
-and those with high-grade DCIS or
comedonecrosis

22
Q

Breast cancer

Women with DCIS in one breast are at risk for a second tumor (either invasive or in situ) in the contralateral breast; the rate at which such tumors develop is similar to that among women with primary invasive cancer at approximately 0.5% to 1% per year.

TRUE or FALSE?

A

True

23
Q

Breast cancer

What is the recommended margin for BCS in DCIS?

A

2 mm (ASTRO/ASCO/SSO)

24
Q
A
25
Q

Breast cancer

Which of the following trials in DCIS featured a split course RT arm (54 Gy/2Gy) delivered with a 2-week break?

A

SweDCIS

26
Q

Breast cancer

Which of the following trials in DCIS featured a split course RT arm (54 Gy/2Gy) delivered with a 2-week break?

A

SweDCIS

27
Q

Breast cancer

In the meta-analysis done by EBCTCG on the four major DCIS trials, the addition of RT reduces the risk of IBRT by how much?

A

50%

28
Q

Breast cancer

In the meta-analysis done by EBCTCG on the four major DCIS trials,
the absolute benefit from RT is greater in women at increased risk for tumor recurrence such as?

A
  • involved surgical margins
  • younger women
  • high-grade/comedogenic
29
Q

Breast cancer

In the UK/ANZ DCIS trial, what was the benefit of adding tamoxifen?

A

The addition of tamoxifen offered no benefit
toward overall ipsilateral local control when administered in addition to
radiotherapy; however, tamoxifen reduced the ipsilateral recurrence rate of DCIS
(but not invasive carcinoma) in the absence of radiotherapy

30
Q

Breast cancer

In DCIS, what is the Van Nuys Prognostic Index

A

a scoring system using histopathologic features including
tumor size,
grade,
and margin width in an attempt to stratify patients according to local failure risk after excision plus or minus WBRT.

31
Q

Breast cancer

In DCIS, adjuvant RT has lessened local failure even in low-risk groups.

TRUE or FALSE?

A

True

The Radiation Oncology Group (RTOG) published the results of a
prospective randomized trial of 585 women who were defined as having goodrisk
DCIS (low or intermediate grade, <2.5 cm size primary, and ≥ 3 mm
margins) treated with adjuvant whole breast irradiation (50.4 Gy in 28 fractions
and later amended to allow 42.5Gy in 16 fractions without a boost) or
observation. The use of tamoxifen was optional. The study was closed early
because of low accrual (expected accrual 1,790). With a median follow up of >7
years, the rate of local failure was 6.7% and 0.9% for the observation and
radiation groups, respectively. Grade 1 to 2 acute toxicity was higher in the XRT
arm, 76% versus 30%, with no difference in grade 3 to 4 toxicity in either arm.
Despite the lower than expected accrual in this good-risk population, adjuvant
XRT improved local failure. Additional follow up is needed to determine long
term benefits.

32
Q

Breast cancer

What is the schedule of posttreatment mammogram in DCIS?

A

6 to 12 months after initial therapy and at least annually thereafter

33
Q

Breast cancer

What is the treatment of choice for DCIS patients with recurrence after BCT?

A

Mastectomy

34
Q

Breast cancer

What is the treatment of choice for DCIS patients with recurrence after BCS?

A

Excision + RT

35
Q

Breast cancer

What is the risk of further recurrence after salvage mastectomy in DCIS?

A

<1%

36
Q

Breast cancer

This study is presently investigating the role of Her2neu targeted treaatment for DCIS.

A

NSABP B-43

37
Q

Breast cancer

This study showed benefit in reducing local recurrence with the use of tamoxifen for DCIS, in contrast to the UK/ANZ DCIS trial’s results.

A

NSABP B-24

38
Q

Breast cancer
(DCIS)

This study showed that breast cancer-free
interval improved with the use of anastrazole, 7.8% versus 5.7%, with no
significant difference in regard to the rates of in-breast recurrence, contralateral
breast cancer, or distant disease. Improvement in disease-free survival was
reported in women under the age of 60 years with the use of anastrazole
compared to the tamoxifen arm, 89.8% versus 85.7%.

A

NSABP B-35

39
Q

Breast cancer
(DCIS)

Define “multicentric”

A

the presence of two or more tumors in separate

quadrants of the breast

40
Q

Breast cancer
(DCIS)

*contraindication to BCT

A

-multicentric
-diffuse disease, suspicious microcalcifications
-women in whom negative margins or acceptable cosmesis
cannot be achieved with the use of breast-conserving surgery

41
Q

Breast cancer

When is sentinel node mapping required/advised in DCIS?

A

in selected patients with a higher likelihood of occult invasive cancer—those with extensive, high-grade DCIS or palpable masses—and those undergoing mastectomy as sentinel node mapping cannot be performed afterward if an invasive tumor is identified

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