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Breast > Malignant and Premalignant lesions > Flashcards

Malignant and Premalignant lesions Flashcards

1
Q

Workup of bloody nipple discharge

A

women under 30 - ultrasound +/- mammo
women over 30 - ultrasound and mammo

if initially imaging is negative proceed with MRI and/or ductogram or reimage and reexamine in 6 months

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2
Q

What stage is inflammatory breast cancer

A

at least stage IIIa, or higher

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3
Q

Pathologic features of infiltrating lobular carcinoma

A

hormone receptor positive, epidermal growth factor receptor 2 negative; lacks cadherin expression

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4
Q

bilateral breast pain and green nipple discharge in young female

A

fibrocystic breast disease

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5
Q

Z11 trial inclusion criteria

A
  1. clinically node negative
  2. no greater than 2 positive nodes and no extranodal extension after lumpectomy and total breast radiation
  3. T1 or T2 tumor
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6
Q

surveillance regimen for patients with ADH or LCIS

A

clinical exam every 6-12 months plus annual digital mammography

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7
Q

Work up of new breast mass during pregnancy

A

start initially with ultrasound

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8
Q

How do you stage the axilla for breast cancer during pregnancy?

A

technetium 99 is safe

methylene blue dye is contraindicated during pregnancy

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9
Q

Benefits of radiotherapy after BCT for DCIS

A

decreases local recurrence but NO survival benefit

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10
Q

autologous breast reconstruction after radiation has ____ complications and failure than implant reconstruction

A

lower

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11
Q

indications for surgical evaluation of bloody nipple discharge

A
  1. there is an associated mass
  2. there are imaging findings
  3. uniductal and unilateral
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12
Q

true or false. practice guidelines recommend biopsy for all BIRADS 4 & 5 lesions

A

true

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13
Q

what is the standard of care for treatment of inflammatory breast cancer?

A

induction chemo followed by surgical resection (MRM) and then radiation to prevent locoregional recurrence

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14
Q

true or false. there is a role for BCT in inflammatory breast cancer

A

false

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15
Q

risk factors for locoregional recurrence in breast cancer:

A

4 or more positive axillary lymph nodes
primary tumor >5cm in size
T4 disease
positive or very close margins

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16
Q

true or false. post-mastectomy radiation should be considered for patients at high risk for locoregional recurrence

A

true

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17
Q

what type of reconstuction should be recommended for patients requiring post mastectomy radiation?

A

autologous reconstruction - better complication rates than implant based

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18
Q

BRCA 1 is characterized by _____ tumor grade and cell proliferation.

A

higher

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19
Q

BRCA 2 is characterized by _____ tumor grade and cell proliferation.

A

lower

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20
Q

BRCA 1 has a ____ frequency of hormone receptor positive tumors (triple positive)

A

lower

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21
Q

BRCA 2 has a ____ frequency of hormone receptor positive tumors.

A

higher

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22
Q

BRCA ___ has a higher occurrence of medullary thyroid cancer.

A

BRCA 1

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23
Q

BRCA ___ has a higher occurence of tubulolobular invasive carcinoma and invasive cribriform cancer.

A

BRCA 2

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24
Q

breast and ovarian cancer screening regimen recommended for BRCA positive women:

A

annual breast MRI starting at age 25
clinical exam every 6-12 months starting at 25
annual breast mammography starting at age 30
annual ovarian cancer screening with tumor markers and transvaginal US starting at age 30

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25
Q

atypical lobular hyperplasia, lobular carcinoma in situ, and invasive lobular cancer have reduced or absent expression of what protein?

A

E cadherin

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26
Q

true or false. ADH and ALH occur with equal frequency and confer similar risks of later breast cancer

A

true

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27
Q

which BRCA subtype is associated with a higher risk of male breast cancer, prostate cancer, and pancreatic cancer

A

BRCA 2

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28
Q

what drug improves survival for men with ER+ breast cancer

A

tamoxifen

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29
Q

most common cause of familial breast cancer

A

BRCA 2

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30
Q

true or false. re-excision is not required for presence of DCIS at margin

A

false

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31
Q

true or false. DCIS is usually unilateral

A

true

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32
Q

true or false. re-excision is not required for presence of LCIS at margin

A

true

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33
Q

true or false. LCIS is often bilateral and multicentric

A

true

34
Q

true or false. atypical ductal hyperplasia increases the risk of breast cancer 3-5 fold in both breasts

A

true

35
Q

when can chemo be given during pregnancy

A

second and third trimesters; never first

36
Q

when can radiation be given during pregnancy

A

never

37
Q

treatment of breast cancer in first trimester:

A

modified radical mastectomy; no chemo until second trimester

38
Q

treatment of breast cancer in early second trimester:

A

modified radical mastectomy plus select chemo

39
Q

treatment of breast cancer in late second and third trimesters:

A

lumpectomy with SLNB, chemo, and then radiation after delivery

40
Q

most important prognostic factor after treatment for breast cancer

A

axillary node status

41
Q

protein kinase involved in DNA damage repair and apoptosis; associated with breast, colorectal, and bladder cancer

A

CHEK2

42
Q

treatment of malignant phyllodes:

A

excise with 1 cm margin; radiation recommended after lumpectomy if margin is less than 1 cm or if post mastectomy there is concern for close margins, fascial/chest wall involvement, or a tumor that was >5cm

43
Q

true or false. bloody nipple discharge from a single duct is considered pathologic

A

true

44
Q

management of bloody nipple discharge in women under 30

A

ultrasound

45
Q

management of bloody nipple discharge in women over 30

A

dx mammo + ultrasound

46
Q

if no etiology is identified for uniductal bloody nipple discharge on mammography or ultrasound, further evaluation should be performed with what?

A

MRI breast or ductography

47
Q

genetic testing for breast cancer is indicated for which patients?

A

any male breast cancer; 3 first degree relatives over 2 generations

48
Q

pleomorphic calcifications on mammography are suspicious for ____

A

DCIS

49
Q

benign breast lesion fall into three categorise which are

A

nonproliferative (no increased risk of breast cancer)
proliferative (1.5-2.0 relative risk of breast cancer)
proliferative with atypica (4.5-5.0 relative risk of breast cx)

50
Q

examples of nonproliferative lesions:

A

microcysts, macrocysts, duct ectasia, simple fibroadenoma, mastitis, squamous or apocrine metaplasia, mild hyperplasia

51
Q

examples of proliferative lesions:

A

papilloma, sclerosing adenosis, complex fibroadenoma, moderate to severe hyperplasia

52
Q

examples of proliferative lesions with atypia:

A

atypical ductal hyperplasia; atypical lobular hyperplasia

53
Q

BIRADS category: nondiagnostic

A

BIRADS 0

54
Q

BIRADS category: no pathology

A

BIRADS 1

55
Q

BIRADS category: probably benign, short term FU every 6 months recommended

A

BIRADS 3

56
Q

BIRADS category: benign

A

BIRADS 2

57
Q

BIRADS category: suspicious for malignancy; needs bx

A

BIRADS 4

58
Q

BIRADS category: highly suggestive of malignancy; needs bx

A

BIRADS 5

59
Q

BIRADS category: known cancer

A

BIRADS 6

60
Q

most aggressive type of LCIS; all margins of excisional bx need to be negative as this subtype behaves more like DCIS

A

pleomorphic LCIS

61
Q

true or false. nonpleomorphic LCIS needs excision to negative margins

A

false

62
Q

follow up for ADH or LCIS:

A

clinical exam every 6-12 months with annual digital mammography

63
Q

recommended margin for DCIS

A

2mm

64
Q

recommended margin for invasive breast cancer

A

no ink on tumor

65
Q

what is breast implant associated anaplastic large cell lymphoma:

A

rare complication of implant based recon; presents years after implant; dx by needle aspiration of peri-implant seroma with fluid cytologic and pathologic eval

66
Q

contraindications to nipple sparing mastectomy:

A

tumors that extend to the nipple
microcalcifications close to the subareolar region
nipple retraction

67
Q

findings of punch biopsy for inflammatory breast cancer:

A

dermal lymphovascular tumor emboli

68
Q

What is breast conservation therapy?

A

removal of primary tumor with surrounding margin of normal tissue followed by whole-breast irradiation

69
Q

Treatment of inflammatory breast cancer:

A

anthracycline based neoadjuvant chemo, MRM, postop radiation

70
Q

Most common location of accessory breast tissue

A

axilla

71
Q

Management of biopsy proven LCIS:

A

lumpectomy to evaluate adjacent breast tissue not sampled on core biopsy followed by tamoxifen (premenopausal) or raloxifene (postmenopausal); annual mammogram

72
Q

Margin of excision for phyllodes tumors:

A

1 cm

73
Q

What imaging is recommended after occult axillary breast cancer is identified

A

breast MRI

74
Q

In patients with suspicious lymph nodes, if ultrasound guided aspiration confirms malignancy _____

A

axillary lymph node dissection is indicated

75
Q

True or false. For patients over the age of 70 with node negative breast cancer, adjuvant radiation showed no improvement in overall survival

A

True

76
Q

True or false. Mammography is a requirement before breast reduction surgery

A

False

77
Q

Workup of patient suspected of having inflammatory breast cancer?

A

mammography and ultrasound

78
Q

True or false. full thickness skin biopsy is needed to confirm diagnosis of inflammatory breast cancer .

A

false

79
Q

3D mammography for patients with dense breasts at high risk for cancer.

A

digital breast tomosynthesis

80
Q

Risk factors for recurrence of DCIS after excision:

A

presence of comedo necrosis, margin positive, high nuclear grade, poor architecture, tumor size >1 cm, and initial detect by palpation

81
Q

What adjuvant therapy is recommended for women with triple negative breast cancer before age 60 with BRCA?

A

olaparib

Breast (2 decks)

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