L3: Breast Cancer - Pt 4

Question 1

Hisopathological INVx in Breast Cancer

Answer 1

Question 2

Hisopathological INVx in Breast Cancer

• cytology

Answer 2

Question 3

Cytology of in Breast Cancer

• Exfoliative cytology

Answer 3

From nipple discharge (for malignant cells).

Question 4

Cytology of in Breast Cancer

• Scrape Cytology

Answer 4

for paget’s disease.

Question 5

INVx in Breast Cancer
- Biopsy

Answer 5

Question 6

Biopsy in Breast Cancer

• Significance

Answer 6

The most important single diagnostic investigation

Question 7

Biopsy in Breast Cancer

• Types

Answer 7

Question 8

Biopsy in Breast Cancer

• Next Step

Answer 8

Then, specimens are diagnosed through:
- Frozen section: (Intraoperative).
- Paraffin section: (Postoperative).

Question 9

Biopsy in Breast Cancer

• In Paget’s Disease

Answer 9

Wedge biopsy is taken

Question 10

Biopsy in Breast Cancer

• Why do we do Biopsy?

Answer 10

Its importance is to know

• Pathologic type
• Hormonal receptor status (ER,PR)
• Her2
• Ki67

For prognosis and ttt.

Question 11

Labs (Special INVx) in Breast Cancer

Answer 11

Question 12

Labs (Special INVx) in Breast Cancer

• tumor Markers

Answer 12

(They are prognostic than diagnostic)

• CA 15-3 (more accurate) - CEA

Question 13

Labs (Special INVx) in Breast Cancer

• Hormonal receptors status (ER, PR)

Answer 13

▪ Value: Affects the prognosis and line of treatment
▪ Results: 50% → ER +ve & PR +ve

Question 14

Labs (Special INVx) in Breast Cancer

• Gene Study

Answer 14

• BRCA1
• BRCA2
• P53
• HER2/neu

Question 15

Labs (Special INVx) in Breast Cancer

• Gene signatures for breast cancer

Answer 15

For

• Luminal A
• Node negative
• > 0.5 cm

to determine their need to adjuvant chemo

• Done By Oncotype Dx & MammaPrint test

Question 16

INVx to detect metastases in Breast Cancer

Answer 16

Question 17

INVx to detect metastases in Breast Cancer

• Bone

Answer 17

Question 18

INVx For Pre-Operative Assesment in Breast Cancer

Answer 18

CBC - Liver function test - Renal function test - Random blood sugar - ECG/ ECHO

Question 19

Testing for BRCA gene indication (US Preventive Services Task Force)

Answer 19

Question 20

TTT of Breast Cancer

Question 21

TTT of Breast Cancer

• Aim

Answer 21

• Local control
• Regional control
• Metastasis control
• Cosmosis

Question 22

TTT of Breast Cancer

• Acc to Stage

Answer 22

Question 23

TTT of Stage 0 (CIS)

Answer 23

Question 24

TTT of Stage 0 (CIS)

• DCIS

Answer 24

Question 25

TTT of **DCIS** - Localized carcinoma in situ (<4 cm – not multicentric)

Answer 25

Question 26

TTT of **DCIS** - Widespread carcinoma in situ (>4 cm - multicentric - central)

Answer 26

Question 27

TTT of **Stage 0 (CIS)** - TTT of LCIS

Answer 27

Question 28

TTT of **Stage 0 (CIS)** - Paget's Disease

Answer 28

Question 29

TTT of **Stage I & II Breast Cancer**

Answer 29

- Breast Conserving Surgery (BCS) - Mastectomy ± Breast reconstruction

Question 30

TTT of **Stage I & II Breast Cancer** - Breast Conserving Surgery (BCS)

Answer 30

Question 31

Types of **BCS** in Breast Cancer Stage I & II

Answer 31

Question 32

CI of **BCS** in Breast Cancer Stage I & II

Answer 32

Question 33

CI of **BCS** in Breast Cancer Stage I & II - Absolute

Answer 33

Question 34

CI of **BCS** in Breast Cancer Stage I & II - relative

Answer 34

Question 35

**BCS** in Breast Cancer Stage I & II - Margins

Answer 35

Question 36

**Mastectomy ± Breast reconstruction** in Breast Cancer Stage I & II

Answer 36

Question 37

**Mastectomy ± Breast reconstruction** in Breast Cancer Stage I & II - Indications

Answer 37

- Cases contraindicated for conservative breast surgery - Patient preference

Question 38

Mastectomy in **Breast Cancer** - Techniques

Answer 38

- Modified radical mastectomy - Skin reducing/sparing mastectomy - Nipple & areola sparing - Toilet mastectomy

Question 39

Mastectomy in **Breast Cancer** - Modified radical mastectomy

Answer 39

- **Patey** preserves P.Major - **Auchen-closs** preserves both major & minor

Question 40

Mastectomy in **Breast Cancer** - Historical Methdos

Answer 40

- Radical mastectomy - Extended radical - Super radical

Question 41

Historical Methdos of Mastectomy in **Breast Cancer** - Radical Mastectomy

Answer 41

- Halstedt - Meyer: Axilla then breast **obsolete**

Question 42

Historical Methdos of Mastectomy in **Breast Cancer** - Extended radical

Answer 42

**radical mastectomy + removal of**: - Internal mammary LNs and supraclavicular LNs (Iverson) - Supraclavicular LNs only (Urban)

Question 43

Historical Methdos of Mastectomy in **Breast Cancer** - Super Radical

Answer 43

As Iverson + - removal of mediastinal LNs through thoracotomy

Question 44

Breast Reconstruction after Mastectomy in **Breast Cancer**

Answer 44

- Autologous (Autogenous) Tissue Reconstruction - Prosthetic Reconstruction

Question 45

Breast Reconstruction after Mastectomy in **Breast Cancer** - Autologous (Autogenous) Tissue Reconstruction

Answer 45

- **(LDMF)** Latissimus Dorsi Myocutaneous Flap: **Based on thoracodorsal artery** - **(TRAM)** Transverse Rectus Abdominus Myocutaneous Flap: **Based on superior epigastric artery** - Microvascular free flap

Question 46

Breast Reconstruction after Mastectomy in **Breast Cancer** - Prosthetic Reconstruction

Answer 46

- Silicon implants/Tissue expander - Lipomodelling

Question 47

Axillary Surgery in **Breast Cancer**

Answer 47

Question 48

Axillary Surgery in **Breast Cancer** - Benefit

Answer 48

- Staging - Selection of ttt - Single best prognostic factor - Locoregional control

Question 49

Axillary Surgery in **Breast Cancer** - Technique

Answer 49

Question 50

When to omit further syrgery with **+ve SLNB**?

Answer 50

- Micromets - Clinical N0 “T1-2” - 1-2 LNs +ve only - No pre-operative chemo - RTH planned