Gyn/Onc Breast Cancer

Question 1

What is the number one cause of cancer in women

Answer 1

breast cancer

Question 2

Median age of dx for breast cancer is

Answer 2

63 yo

Question 3

Risk factors for breast cancer

Answer 3

early menarche
late menopause
HRT
OCP use
older age at first pregnancy, nulliparity
+FH (with or without mutation)
radiation exposure
central obesity
moderate ETOH use
personal hx of breast cancer
high dietary fat intake

Question 4

Breast cancer is usually found in what location on the breast

Answer 4

primarily in the upper outer quadrant

Question 5

Breast cancer can be classified by

Answer 5

histologic type and hormone responsiveness
hormone responsiveness significantly impacts treatment and prognosis
histologic type usually does not affect treatment

Question 6

In breast cancer you have a better prognosis if the

Answer 6

hormone receptors are present

Question 7

Breast cancer:
Histologic types

Answer 7

Noninvasive types: Ductal carcinoma in situ, Lobular carcinoma in situ

Invasive types: Infiltrating ductal carcinoma, invasive lobular

Paget carcinoma (associated with infiltrating ductal carcinoma or ductal carcinoma in situ)

Inflammatory carcinoma (commonly confused with mastitis)

Question 8

Breast cancer:
Hormone responsiveness

Answer 8

HER2/neu (human epidermal growth factor receptor 2 - too much = rapid growth)
Estrogen receptors
Progesterone receptors

Question 9

Breast cancer genetics

Answer 9

BRCA 1 > BRCA 2
P53 - tumor suppressor gene also contribute

Question 10

Indications for BRCA screening

Answer 10

breast cancer in 2+ first degree relatives
+FH of breast ca bx prior to age 50
ashkenazi jewish ancestry

Question 11

Breast cancer symptoms

Answer 11

70% present with palpable lump
usually painless, firm/hard, poorly defined margins
Nipple d/c - if milky consider other dx
lymph node involvement = metz
Peau d’orange

Question 12

Breast cancer:
Paget carcinoma specific sxs

Answer 12

starts as nipple itching/ burning; superficial erosions/ulcerations
often no discrete breast mass

Question 13

Breast cancer:
Inflammatory carcinoma specific sx

Answer 13

rapidly growing, occasionally painful mass
breast enlargement
often no discrete breast mass

Question 14

Breast self exams and clinical exam recommendations

Answer 14

USPSTF recommends against teaching breast self exams
do recommend women and men be aware of their normal and promptly report and changes from baseline

Question 15

Gold standard for screening for breast cancer

Answer 15

Mammography - looking for abnormal densities, calcifications, irregular borders

Question 16

2016 USPSTF recommendation for BCA screening

Answer 16

women age 40-49 shared decision making
should likely get screening if - +FH, other risk factors

Question 17

Screening vs Diagnostic imaging

Answer 17

Screening - asymptomatic
Diagnostic - presenting with sx, mets identified from breast CA, etc

Question 18

Most commonly identified abnormality on mammogram for breast cancer workup

Answer 18

calcifications - more likely malignant if > 0.5mm, various sizes shapes and clustered in one area
may also see abnormal densities with irregular or ill defined borders

Question 19

Who gets an MRI for Breast Cancer workups?

Answer 19

negative mammogram but still suspicious
we want more information on new BCA dx
Breast implants
adjunct to mammogram if high risk

Question 20

If the patient notes a mass but is not confirmed when in the office you should re-examine

Answer 20

in 2-3 months –> preferably 1-2 weeks after onset of menses (could be cyclic breast tissue changes with periods)

Question 21

If there is a suspicious masses on mammography what should you do next

Answer 21

bx
(make sure that the mammogram is done on both sides)

Question 22

FNA vs core needle bx which one is preferred and why?

Answer 22

core needle preferred - less prone to sampling error, can test for HER2/neu, ER,PR

Question 23

Bx is done under mammography guidance when

Answer 23

mass is non-palpable

Question 24

Most common mets sites for breast cancer

Answer 24

liver
lungs
brain
bone

Question 25

Breast Cancer treatment

Answer 25

surgical resection - lumpectomy –> stage 1,2
mastectomy –> major advantage = may not need radiation
Chemotherapy - reduces recurrence and mortality for all stages except 4, 3-4 months
Anti-HER2 treatments - “mab”, “tinib”(kinase inhibitors)
SERMS (selective estrogen receptor modulators) - tamoxifen
Aromatase inhibitors - “zole” reduce estrogen production
bisphosphonates (dronate) - early stage BCA

Question 26

Common side effects of chemotherapy

Answer 26

nausea/ vomiting
infertility
premature ovarian failure
cognitive dysfunction
neutropenia

Question 27

Tamoxifen side effects

Answer 27

DVT, uterine cancer
antagonist in breast tissue, agonist in other tissues

Question 28

More aggressive and worse prognosis is

Answer 28

younger patients

Question 29

How often should a BCA patient follow up

Answer 29

recurrences often in the first 2-5 years
examination every 6 months x 2 years
annual exam thereafter

Question 30

Breast Cancer in men symptoms

Answer 30

may experience gynecomastia
nipple discharge less commonly seen
average age - 70
increased risk in men with prostate cancer

Question 31

Treatment for breast cancer in men

Answer 31

treatment the same but move directly to mastectomy instead of lumpectomy
>95% ER positive -> tamoxifen used widely for men