OnlineMedEd: Surgery: General - "Breast Cancer"

Question 1

Explain the pathogenesis of breast cancer.

Answer 1

Excessive estrogen exposure:

• Early menarche
• Late menopause
• HRT (but not OCPs because the dose of estrogen is not high enough)
• Nulliparity

Genetics (BRCA)

Radiation

Question 2

The three ways that breast cancer is diagnostic are _______________.

Answer 2

asymptomatic screen, lump, or skin changes

Question 3

It is no longer recommended to perform _______________.

Answer 3

self-exam or MD-exam of breasts

Question 4

What are the current recommendations for breast cancer screening?

Answer 4

• ACS/NCI: Q1Y mammograms starting at 40
• USPSTF: Q2Y mammogram starting at 50

The USPSTF recommendation is newer so if you had to pick one pick that.

Question 5

In what situation would you not use a mammogram to screen?

Answer 5

In someone with high risk, use MRI.

Question 6

Diagnose breast cancer with ______________.

Answer 6

FNA with core biopsy

Question 7

Why don’t mammograms work in women younger than 30?

Answer 7

Two reasons: (1) women younger than 30 have dense breasts that are difficult to image and (2) there is a very low likelihood of cancer

Question 8

Describe what to do in a woman younger than 30 with a breast mass.

Answer 8

• First, wait a couple cycles. If the mass goes away with her cycles, then it was a fibroadenoma and no workup was needed.
•If the mass persists through her cycles, then get an US. This will show either mass or cyst.
•Also get an FNA:
- Bloody: suspicious for cancer
- Pus: abscess
- Cyst: benign

•If the US shows a mass, if the cyst is bloody, if the woman is older than 30, or if the cyst recurs, then get a core biopsy.

Question 9

For early stage cancers, ______________ works just as well as total mastectomy.

Answer 9

lumpectomy with axillary node dissection with radiation

Question 10

What chemotherapies are used in breast cancer?

Answer 10

• Daunorubicin /doxorubicin
• Paclitaxel
• Cyclophosphamide

Question 11

Review the targeted breast cancer therapies.

Answer 11

• Her2/neu+ = trastuzumab

* Estrogen/progesterone + = SERMs (raloxifene)

Question 12

Which marker is a bad one?

Answer 12

Her2/neu

Estrogen/progesterone are good.

Question 13

What are the recommendations for BRCA-+ women?

Answer 13

•Bilateral mastectomy and BSO

or

•Yearly MRIs at 25.

Question 14

Neoadjuvant therapy is usually given to ________________.

Answer 14

women with advanced disease