Neoplasms - Breast CA

Question 1

when is Inflammatory breast cancer normally diagnosed

Answer 1

at an advanced stage

average age = 59

Question 2

sx Inflammatory breast cancer

Answer 2

rapidly enlarging (within the past 6 months) area of breast erythema and induration, occupying at least one-third of the breast

pruritus, pain, swollen lymph nodes, and nipple changes

Question 3

signs of mets for inflammatory breast CA

Answer 3

right upper quadrant pain, confusion, or bone pain

Question 4

PE inflammatory breast CA

Answer 4

swollen, edematous breast with peau d’orange (skin edema causing pores to be noticeably enlarged), erythema, a tender mass, and nipple changes, such as retraction, flattening, crusting, or blistering

localized spread to axillary lymph node

Question 5

what fraction of pts will have distant mets at time of dx of inflammatory breast CA

Answer 5

1/3 of pts

Question 6

definitive dx inflammatory breast CA

Answer 6

breast ultrasound and mammography of bilateral breasts

a week-long course of antibiotics may be prescribed if you don’t know if infection or CA

Question 7

what if sx do not resolve w abx in case where it might be inflammatory breast CA or infection

Answer 7

core needle biopsy should be performed

Question 8

Treatment of inflammatory breast cancer that is nonmetastatic

Answer 8

neoadjuvant chemotherapy followed by mastectomy and radiation

Question 9

tx inflammatory breast CA that is metastatic

Answer 9

chemotherapy

Question 10

RF for breast CA

Answer 10

BRCA 1 or 2 genetic mutations, obesity, and prolonged exposure to estrogen (i.e., early menarche, nulliparity after age 30, late menopause, and postmenopausal hormone therapy)

personal or family history of breast, endometrial, or ovarian cancer

history of atypical hyperplasia on prior breast biopsies

fibrocystic breast dz

Question 11

most common type of breast cancer

Answer 11

infiltrating ductal carcinoma, which comprises over two-thirds of breast cancer diagnoses in the United States

Question 12

second MC subtype of breast CA

Answer 12

Lobular carcinomas

Question 13

is clinical exam sensitive in ruling out breast CA

Answer 13

no

Question 14

what should be performed on all patients with breast masses that are suspected to be cancerous

Answer 14

Diagnostic mammography and ultrasonography

Question 15

After mammography, the diagnosis of suspected breast cancer is typically confirmed with

Answer 15

ultrasound-guided core needle biopsy

Question 16

what does ultrasound-guided core needle biopsy reveal for breast CA

Answer 16

tumor grade, type, and hormone receptivity

Question 17

women with biopsy-proven breast cancer should undergo

Answer 17

genetic testing for the BRCA1 and 2 mutations

Question 18

what should be performed before considering the removal of the regional axillary lymph nodes in breast CA

Answer 18

Sentinel lymph node biopsy

Question 19

Primary treatment of early-stage (stages I, IIA, IIB) breast cancer

Answer 19

surgical excision with either lumpectomy or total mastectomy

Question 20

tx for breast CA that are estrogen or progesterone hormone receptor-positive

Answer 20

aromatase inhibitors (i.e., letrozole or anastrozole) and selective estrogen receptor modulators (i.e., tamoxifen or raloxifene) is indicated after surgical intervention for a duration of 3–5 years to reduce the rate of breast cancer recurrence

Question 21

tx for breast CA that are HER2 positive

Answer 21

trastuzumab, a monoclonal antibody to the HER2 receptor after surgical excision

radiation therapy may be indicated as well

Question 22

tx for locally advanced breast cancers (stages IIB-IIIA, IIIB) and triple-negative (estrogen, progesterone, and HER2 receptor negative) breast cancer

Answer 22

neoadjuvant chemotherapy is indicated before mastectomy or lumpectomy.

Locally advanced and triple-negative breast cancers are also treated post-surgically with radiation therapy and appropriate adjuvant therapies

Question 23

tx for metastatic breast CA - stage IV

Answer 23

palliation

Question 24

United States Preventive Services Task Force recommends breast cancer screening with

Answer 24

mammography biennially in women aged 50 to 74 years. Consideration for screening women earlier than age 50 should be based on risk factors and shared decision-making

or biennially starting at the age of 40 years old for women with increased risk

Question 25

what is the second most common cancer diagnosis in women worldwide and is the second leading cause of cancer-related death in women

Answer 25

breast CA

Question 26

what is the single most important risk factor for developing breast cancer

Answer 26

age

Question 27

protective factors for breast CA

Answer 27

age younger than 30 years at the time of their first birth, breastfeeding, or those with limited alcohol consumption, short height, or low socioeconomic status

Question 28

Breast cancer is classified histologically as

Answer 28

ductal, lobular, or nipple, with most breast cancers being invasive ductal carcinomas

Question 29

for breast CA: presence of these tissue markers is associated with better prognosis

Answer 29

estrogen and progesterone receptor tissue markers

Question 30

BBW tamoxifen

Answer 30

endometrial hyperplasia and uterine malignancy

Question 31

ADE tamoxifen

Answer 31

vasodilation, hot flashes, irregular menses, and fluid retention

Question 32

what is a clinical risk tool that can estimate a woman’s 5-year and lifetime risk of developing invasive breast cancer

Answer 32

The Gail Model

Question 33

Women are considered high risk for breast CA

Answer 33

with a 5-year risk at or exceeding 1.7%

Question 34

tx for high risk women breast CA

Answer 34

prophylactic therapy, including treatment with selective estrogen receptor modulators (tamoxifen, raloxifene) or prophylactic mastectomy

Question 35

what is the best screening tool to diagnose breast cancer and can detect breast cancer as early as 2 years prior to a mass palpated on physical exam

Answer 35

screening mammogram

Question 36

American Cancer Association screening guidelines for breast CA

Answer 36

annual screening with a mammogram for all women ages 45 through 54, followed by biennial screening for those older than 55 years of age

Question 37

American College of Obstetrics and Gynecologists (ACOG) screening guidelines for breast CA

Answer 37

annual screening for all women 40 years of age and older

Question 38

Women with the BRCA1 gene mutation are more likely to be diagnosed with what form of breast cancer?

Answer 38

Medullary carcinoma

Question 39

The following features further increase the risk that a breast mass is cancerous

Answer 39

poorly defined borders, fixed to the underlying chest wall, new retraction of nipple, orange-peel skin, and palpable axillary lymph nodes

Question 40

Pathologic evaluation of infiltrating ductal carcinoma

Answer 40

hard, grayish, gritty masses with an irregular, stellate shape

Question 41

what is the most common type of breast cancer found in postmenopausal women

Answer 41

Infiltrating lobular carcinoma

Question 42

what is the most common type of breast cancer found in younger women with a BRCA1 mutation

Answer 42

medullary breast CA

Question 43

what is less common than other types of breast cancer but it is more aggressive and has a worse prognosis

Answer 43

inflammatory breast CA

Question 44

Serosanguinous nipple discharge is a common presentation in

Answer 44

papillary breast CA

Question 45

Peau d’orange changes and blistering are physical exam findings that are most consistent with

Answer 45

inflammatory breast CA

Question 46

Available chemotherapeutic options for breast CA include

Answer 46

doxorubicin, cyclophosphamide, and paclitaxel

Question 47

Mammography is generally avoided in patients

Answer 47

< 40 years old due to the increased density of breast tissue