Chapter 36 WS

Question 1

how many lymph nodes are in each axilla

Answer 1

10 - 38

Question 2

_______ are located caudal and lateral of the pectoralis minor and are the most superficial lymph nodes in the axilla. They often represent the first station of drainage from breast

Answer 2

level I lymph nodes

Question 3

_________ are located beneath the muscle.

Answer 3

level II lymph nodes

Question 4

___________ are located cranial and medial to the pectoralis minor.

Answer 4

Level III lymph nodes

infraclavicular lymph nodes

Question 5

At what level nodes is the sentinel node most commonly found?

Answer 5

Levels I and II

Question 6

List a minimum of 4 physical signs of a locally advanced breast cancer.

Answer 6

a. Enlarged or matted axillary or supraclavicular lymph nodes
b. Abnormal breast contours
c. Nipple discharge or retraction
d. Palpable mass with or without fixation to the chest wall or involvement of the skin
e. In addition, skin findings, sucah as erythema, thickening, peau d’orange, and ulcerations.

Question 7

What are the two views used in a routine screening mammogram?

Answer 7

Craniocaudal and mediolateral oblique

Question 8

What is the difference between a screening mammogram and a diagnostic mammogram?

Answer 8

A screening mammogram is performed in a patient with no clinical symptoms of breast cancer; a diagnostic mammogram is performed in a patient who presents with clinical suspicion.

Question 9

Which one of these types of breast cancer has a higher frequency of bilateral breast involvement (Invasive lobular carcinomas or Invasive ductal carcinoma

Answer 9

invasive lobular carcinomas

Question 10

Invasive lobular carcinomas are mostly __________________. (ER +or ER-)

Answer 10

ER +

Question 11

____________________ (Black Women, White women) are at higher risk for developing triple negative breast cancer than _______________________ (black women, white women)

Answer 11

black women

white women

Question 12

List three contraindications to breast-conserving surgery

Answer 12

a. Multicentric disease with 2 or more primary tumors in separate quadrants of the breast such that they cannot be encompassed in a single excision.
b. Diffuse malignant microcalcifications on mammography
c. Persistent positive resection margins after multiple attempts of re-excision

Question 13

List three indications for mastectomy for patients.

Answer 13

• Patients who are not candidates for breast-conserving therapy
• Patients who prefer mastectomy
• For prophylactic purposes in extremely high-risk populations

Question 14

What is removed in a Radical mastectomy?

Answer 14

the breast with overlying skin, the pectoralis muscles, and all the axillary lymph nodes

Question 15

What is removed in a modified radical mastectomy

Answer 15

the breast and the underlying fascia together with removal of the level I and II axillary lymph nodes.

Question 16

what is removed in a total mastectomy

Answer 16

The entire breast without removal of level I and II lymph nodes

Question 17

Eighty-five percent of lymphatic drainage from the breast goes to which lymph nodes

Answer 17

axillary lymph nodes

Question 18

What level nodes are removed in an axillary dissection?

Answer 18

Levels I and II

Question 19

advantages of immediate breast reconstruction

Answer 19

The streamline of surgical procedures (mastectomy and reconstructive surgery), which decreases the overall surgical time and also provides benefits in preserving the normal body image in women.

Question 20

disadvantages of immediate breast reconstruction

Answer 20

The potential heightened post-reconstruction complications from adjuvant chemotherapy and radiation therapy.

Question 21

advantages of delayed breast reconstruction

Answer 21

Allows for the completion of adjuvant treatments, and therefore may limit the immediate post-reconstruction complications.

Question 22

disadvantages of delayed breast reconstruction

Answer 22

Limited reconstructive options because of tissue fibrosis after radiation therapy or chemotherapy

Question 23

What endocrine therapy drug is given to premenopausal women after chemotherapy who have ER+ breast cancer? And how long will this drug be taken?

Answer 23

tamoxifen; 5 years

Question 24

What are the advantages of treating the breast with the patient in the prone position

Answer 24

Minimizes lung and/or heart tissue in the treatment field as the breast falls away from the chest wall.

Question 25

what patients should not be treated in the prone position?

Answer 25

Women with small breast or with breast implants. If the chest wall needs to be included in the treatment field. If regional lymph nodes need to be treated.

Question 26

During simulation of the whole breast, the radiation oncologist may place wire at the borders of the possible treatment field. Indicate where these wires are to be placed.

Answer 26

medially at the mid-sternum, laterally at the level of mid-axilla, superiorly at the level of clavicular head, and inferiorly approximately 2 cm below the inframammary fold.

Question 27

What are the two most important critical structures to consider in the design of breast radiation treatments?

Answer 27

lung and heart

Question 28

DIBH is used when treating the _______________ (left or right) breast in order to minimize dose to which critical structure.

Answer 28

left; heart

Question 29

Whole breast tangent field border: superior, at the most cephalad of the following points:

Answer 29

• superior extent of the palpable breast tissue

- edge of the head of the clavicle

Question 30

Whole breast tangent field border: inferior

Answer 30

• 2 cm below the inframammary fold or 2 cm below lower edge of the breast

Question 31

Whole breast tangent field border: medial

Answer 31

• at midline of patinet, as determined with palpation of suprasternal notch and xiphoid process
• exclusion of contralateral breast in the treatmnet field is important

Question 32

Whole breast tangent field border: lateral

Answer 32

• midaxillary line or 2 cm beyond breast tissue

Question 33

Whole breast tangent field border: anterior

Answer 33

• flash to include entire breast

Question 34

Whole breast tangent field border: posterior

Answer 34

• include the chest wall; this often may include 1 to 2 cm posterior to edge of the ribcage

Question 35

What is the relationship between estrogen and breast cancer?

Answer 35

Increased estrogen levels increase the risk of breast cancer.

Question 36

The removal of the entire lesion.

Answer 36

excisional biopsy

Question 37

Similar to a fine needle biopsy but using a larger gauge needle to aspirate a core of tissue from the breast mass. The pathologist then examines the tissue histologically. It offers a more definitive histologic diagnosis compared with Fine needle biopsy

Answer 37

core needle biopsy

Question 38

Using a small-gauge needle attached to a syringe where blood or tissue is collected from a suspicious tissue in the breast. This material is prepared on slides for cytologic evaluation. Can also be used with ultrasound guidance to confirm the disease status in the axilla

Answer 38

fine needle biopsy

Question 39

Explain what DCIS is:

Answer 39

Ductal carcinoma in situ.

It is confined to the preexisting duct system of the breast without penetration of the basement membrane and invasion of surrounding tissues on microscopic examination.

Question 40

What are the two most common types of invasive breast cancers?

Answer 40

Invasive ductal carcinoma (also called infiltrating ductal carcinoma) and Invasive lobular carcinoma

Question 41

What age group has the worst prognosis for breast cancer?

Answer 41

younger age (under 35 in age)

Question 42

What are triple-negative breast cancers?

Answer 42

Breast cancers that are ER negative(estrogen receptor), PR negative (Progesterone receptor), and HER2 negative (human epidermal growth factor receptor 2). Triple negative breast cancers are more aggressive than breast cancers with positive receptors because there is a lack of targeted treatment. For example, if the cancer grows in the presence of estrogen, then the cancer can be targeted with anti- estrogen treatment therapy.

Question 43

Explain what a sentinel node biopsy is and how is it used in the diagnoses of breast cancer.

Answer 43

A blue dye, radioactive substance is injected near the tumor site. The tracer enters the lymphatic channels and flows to the lymph nodes that are first in line to receive the drainage from the tumor. The node is then more easily identified by the surgeon so it can be removed and examined for cancer cells. If there are no cancer cells present, an axillary lymph node dissection may not be necessary. For patients with 3 or more nodes, axillary dissection is generally recommended.

Question 44

Explain what BRCA1 and BRCA2 are and their relationship to Breast cancer

Answer 44

BRCA1 and BRCA2 are tumor suppresser genes that repair damaged DNA to help prevent malignant tumors. Sometimes these genes become mutated and do not function properly. Gene mutations of the BRCA1 and BRCA2 are inherited. Women with these mutations are at a very high risk of development of breast cancer. Risk is 60% by age 70 if carrier of the BRCA1 gene mutation and 55% risk if carrier of BRCA2 gene mutation. Also increase risk for men.

Question 45

In patients with BRCA1 and BRCA2 mutations, Prophylactic mastectomies reduce the risk of development of breast cancer by __________ percent.

Answer 45

more than 90%