BRST 2 Flashcards
Dose delivered by conventional mammography
0.1cGy
What mammographic view shows the greatest volume of breast tissue?
MLO view
mediolateral oblique
What is the advantage of CC
(craniocaudal) view?
provides better visualization of the medial aspect of the breast and permits greater breast compression
Specific mammographic features that suggest a diagnosis of breast cancer (3)
Solid mass with or without stellate features
Asymmetric thickening of breast tissues
Clustered microcalcifications
NCCN guideline for breast exam for normal-risk women >=20 years
Breast exam at least every 3 years
NCCN guidelines for breast exam/mammogram at age 40 years
yearly breast exam and mammogram
Primary indication for ductography
nipple discharge
Breast Ultrasound does not reliably detect breast lesions of this size
<= 1 cm in diameter
Who among the following patients will benefit from Breast MRI in characterizing mammographic findings
a. 30 y.o female, no family history of breast cancer, 2cm palpable mass
b. 25 y.o. female, strong family history of breast cancer, nulliparous, early menarche, obese
c. 40 y.o. female, newly diagnosed Invasive carcinoma of the breast
d. A and B
e. B and C
E
Clinical determination of axillary lymph node metastases has an accuracy of only
33%
True of axillary lymph node disease EXCEPT
a. The number of axillary lymph nodes involved with metastatic disease is one of the most important predictors of 10- and 20 year survival
b. The internal mammary node or a low axillary node when positive alone carried the same prognostic weight
c. Drainage to the internal mammary nodes is more frequent with lateral quadran cancers
d. NOTA
C
In postmenopausal women, hormone replacement therapy consisting of estrogen plus progesterone increases the risk of breast cancer by _____
26%
Tumors positive for ER and PR have a response rate to estrogen therapy of
> 50%
Tumors negative for both er/pr have a response rate to estrogen therapy of
10%
Tumors positive for either estrogen or progesterone receptors have a response rate to estrogen therapy of
33%
True about HER2/neu receptor positivity
a. associated with mutated p53, ki67 overexpression, ER negativity
b. An important prognostic and predictive factor in breast cancer
c. the receptor Promotes growth and proliferation and increases invasive and metastatic capabilites
d. correlated with a more aggressive type of cancer
e. NOTA
f. AOTA
F
GIve 2 indices of proliferation of breast cancer
Ki67
PCNA
Her2/neu receptor: Trastuzumab as VEGF receptor:______
Bevacizumab
Patients not suitable or sentinel lymph node (SLN)
biopsy include all o the following EXCEPT
A. Inflammatory carcinoma o the breast.
B. Prior axillary surgery.
C. Biopsy-proven distant metastases.
D. Lower inner quadrant o breast primary carcinoma.
E. Pregnancy
D and E
The following are prognostic and predictive tumor factors for invasive breast cancer EXCEPT
a. Nodal status
b. Tumor size
c. Vascular invasion
d. Hormone receptor status
e. AOTA
f. NOTA
F
nodal status tumor size histologic/nuclear grade lymphatic/vascular invasion pathologic stage hormone receptor status DNA content Extent of intraductal component Her-2/neu expression
The following are prognostic and predictive Host factors for invasive breast cancer EXCEPT
a. Age
b. menopausal status
c. Previous benign breast mass
d. Nutrition
e. Immunosuppression
f. AOTA
g. NOTA
C
Age manopausal status family history previous breast cancer immunosuppression Nutrition Prior chemotherapy Prior radiation therapy
diagnostic studies for breast cancer patients Stage 0
a. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status
b. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu
c. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test
d. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR
A
In Stage 0 breast CA, workup involves Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status. What test is added to this list for Stage I?
Her 2/neu expression
What diagnostic workup is required for Stage II Breast CA
Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR
What diagnostic workup is required for Stage III and IV breast CA?
Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR, Bone scan, abdominal CT or UTS, or MRI (with or without pelvis)
Treatment options for LCIS cancer
observation
chemoprevention
bilateral total mastectomy
True about LCIS EXCEPT
a. goal of treatment is to prevent or detect at an early stage the invasive cancer that subsequently develops in 25% to 35% of these women.
b. Excising LCIS is prevents cancer formation
c. Tamoxifen as risk reduction strategy should be conisdered
d. ATOA
e. NOTA
B; no benefit
Indication for mastectomy in DCIS
extensive disease (>4cm of disease or disease in more than one quadrant)
Treatment recommendations for women with limited DCIS
Lumpectomy and radiation therapy
T/F adjuvant tamoxifen is considered for all DCIS patients
F; those with ER-positive disease
Gold standard treatment for DCIS
mastectomy
Duration of tamoxifen treatment in women with ER-positive DCIS, after surgery and radiation therapy
5 years
What are the equivalent treatments for patients with stage I and II breast cancer?
Mastectomy with axillary staging or
Breast conserving surgery with axillary staging and radiation therapy
What are relative contraindications to breast conservation therapy? (4)
PMS
Prior radiation therapy to the breast or chest wall
Persistently positive surgical margins after re-excision
Multicentric disease
Scleroderma or lupus erythematosus
T/F patients who are planned for postmastectomy radiation therapy are not ideal candidates for nipple-sparing mastectomy
T
What are the benefits of SLN dissection for those qualified?
Decreased morbidity (arm swelling and range of motion) Improved quality of life vs. patients who underwent ALND
What is the most common immediate effect of SLN dissection?
Axillary seroma
Indications for adjuvant chemotherapy for patients with early stage invasive breast cancer
node positive cancers
patients with cancers >1cm
patients with node negative cancers of >0.5cm when an adverse prognostic factor is present
What are the adverse prognostic factors of early stage breast cancer?
NB(H3) Negative hormone receptor blood vessel or lymph vessel invasion high nuclear grade high histologic grade Her-2/neu overexpression or amplification
What does “switch” regime for adjuvant hormonal therapy for breast cancer?
3 years aromatase inhibitor + 2 years tamoxifen;
but 5 years AI regimen is preferred
What is the treatment for Stage III breast cancer?
Neoadjuvant chemotherapy
Surgery
Radiation
Adjuvant Chemotherapy
