GYN/ONC - Breast Cancer - collins

Question 1

what are possible risk factors for breast cancer

Answer 1

mostly related to increased lifetime exposure to estrogen
early menarche (prior to age 12)
late menopause (after age 55)
older age at first pregnancy (>30) or nulliparity
OCP use
etc.

Question 2

what are protective factors for breast cancer

Answer 2

lack of ovaries
no prior HRT
early menopause
longer duration of breastfeeding
earlier age at 1st pregnancy
low dose ASA

Question 3

what is the primary location of breast cancer

Answer 3

upper outer quadrant

Question 4

what are the histologic types of breast cancer

Answer 4

• noninvasive types: ductal and lobar carcinoma in situ
• invasive types: infiltrating ductal carcinoma, invasive lobular
• paget carcinoma
• inflammatory carcinoma

Question 5

What is HER2

Answer 5

Human epidermal growth factor receptor 2

Question 6

what can significantly impact the treatment course and prognosis of BCA

Answer 6

hormone responsiveness

Question 7

What are the hormone responsiveness receptors

Answer 7

HER2/neu (+ or -)
Estrogen receptor (+ or -)
progesterone receptors (+ or -)

Question 8

what tumors are more indolent, better progrnosis

Answer 8

ER/PR Positive tumors

Question 9

What are BRCA mutations associated with

Answer 9

higher likelihood of developing breast cancer

Question 10

what is a P53 mutation

Answer 10

tumor suppressor gene mutation

Question 11

what are the indications for BRCA screening

Answer 11

breast cancer in 2+ first degree ralatives
+fh of BCA dx prior to age 50
+fh of ovarian CA
+fh of male breast CA
fist degree relative with bilat BCA
ashkenazi jew ancestery

Question 12

what are typical symptoms of BCA

Answer 12

70% present with palpable lump - usu. painless, firm/hard, poorly defined margins
pain, asymmetry, nipple discharge, erosion, retraction, itching/enlargement of nipple, Peau d’orange

Question 13

what are symptoms of Paget carcinoma

Answer 13

starts as nipple itching/burning; superficial erosions/ulceration
often misdiagnosed as bacterial infection/dermatitis
often no discrete breast mass

Question 14

what are symtpoms of inflammatory carcinoma

Answer 14

rapidly growing, occasionally painful mass
breast enlargement
often misdiagnosed as infection
often no discrete breast mass

Question 15

what is the gold standard screening test for breast cancer

Answer 15

mammography

Question 16

what is BIRADs score

Answer 16

Breast imaging reporting and data system: mammography results

Question 17

when are calcifications more likely to be malignant

Answer 17

<0.5mm, various sizes and shapres and clustered in one area

Question 18

what are clustered calcifications in the breast called

Answer 18

clustered pleomorphic microcalcifications

Question 19

who is recommended to get mammogram

Answer 19

women ages 40-74 years old get screened every 2 years
women age 40-49- shared decision making

Question 20

who gets MRI for BCA workup

Answer 20

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

Question 21

what is a BIRAD score of 0

Answer 21

inconclusive tests, needs further imaging

Question 22

what is a BIRAD score of 2

Answer 22

known benign lesion

Question 23

what is a BIRAD score of 5

Answer 23

highly suggestive of malignancy
mgmt: tissue diagnosis

Question 24

what is BIRAD score of 6

Answer 24

known biopsy proven malignancy
mgmt: sx excision when clinical appropriate

Question 25

what is the workup if there is concern for advanced disease/metastasis

Answer 25

CXR or chest CT to eval for lung mets
abdominal CT or US to eval for liver mets
+/- PET/PET-CT
+/- bone scan (if symptoms/labs consistent with bone mets)

Question 26

what are common metastatic sites for BCA

Answer 26

liver, lung, bones, brain

Question 27

what type of cancers are more likely to have brain mets

Answer 27

Triple negative and HER2+

Question 28

how is breast cancer staged

Answer 28

0 - 4
0= no spread
1=early stage - small area spread
2= localized (btwn 20-50mm and some lymph nodes)
3 = regional spread (larger than 50mm)
4 = distant spread to other body parts

Question 29

what are the primary treatment strategies for BCA

Answer 29

surgical resection + axillary lymph node dissection or sentinel node biopsy
radiation (breast and lymph nodes)

Question 30

what are adjuvant systemic strategies for tx of BCA

Answer 30

started about 4-8 weeks post op
antiestrogen therapies
anti-HER2 therapies
systemic chemo
bisphosponates
BRCA targeted tx
ER/PR receptor tx

Question 31

what is the first line procedure for stage 1 and 2

Answer 31

lumpectomy - shared decision

Question 32

what are common side effects of Chemo

Answer 32

N/V
infertility
premature ovarian failure

neutropenia, cardiomyopathy, peripheral neuropathy, leukemia/myelodysplasia, cognitive dysfunction

Question 33

What are contraindications of lumpectomy

Answer 33

size >4cm
multifocal tumors
fixation to chest wall
skin involvement

Question 34

what are hormonal treatment for BCA

Answer 34

Tamoxifen : SERM (5-10 year course)
aromatase inhibitors: 5-10 year course - post menopausal women

Question 35

what is the 5 year survival rate for stage 3 BCA

Answer 35

30-55%

Question 36

what is the 5 year survival rate for stage 4 BCA

Answer 36

5-10%

Question 37

what should be avoided with BCA diagnosis

Answer 37

hormone replacement with hx of hormone receptor + cancers

Question 38

what men are at a higher risk of developing breast cancer

Answer 38

men with prostate cancer

Question 39

what are male symtpoms of breast cancer

Answer 39

gynecomastia
nipple discharge less commonly seen

Question 40

what is the treatment for male breast cancer

Answer 40

same except rarely utilize breast conserving therapies
- move directly to mastectomy
tamoxifen widely used for men