Quiz 2: Diagnostic, Interventional, and Treatment Procedures Flashcards
what is the first step in the fight against breast cancer
detection
the microscopic examination of cell samples
cytological analysis
the microscopic examination of tissue samples
histological analysis
the removal of the content of a cyst for testing of analysis
fine needle aspiration (FNA)
for a biopsy on a nonpalpable lesion, how would you determine its exact location
stereotactic imaging
what is done to triangulate a lesion for a stereotactic biopsy?
the tube is angled 15° to the left & right of the x axis for 2 scout images.
are used to position a biopsy probe within the breast at the calculated coordinates
stereotactic calibrations
what are the 2 machine options for stereotactic breast biopsies?
add on attachment to regular mammogram machine or
a dedicated prone biopsy system
what is done when stereotactic breast biopsy is not available?
preoperative needle localization
how much guide wire is left in the lesion after a preoperative needle localization?
5 mm
the taking of a sample specimen for cytological or histological analysis
breast biopsy
is used to obtain cellular material from the area in question for cytological analysis
fine needle biopsy
can be used to diagnose both cystic and solid lesions, such as fibroadenomas
fine needle biopsy (FNB)
the most commonly performed, minimally invasive technique
core biopsy
removes a sample of tissue, unlike FNB
core biopsy
what gauge needle is used during core biopsies?
11-14 gauge or larger
which 2 types of biopsies involve cutting the skin by <1/4”?
Automatic or Mechanical Core “Gun”
Vacuum Core Biopsy
a hollow probe is inserted and guided to the area of interest. A cylinder of tissue is then suctioned out and pulled through a hole in its side. a rotating knife inside the probe cuts the tissue sample from the rest of the breast
Vacuum Core Biopsy
is used to remove parts of a lesion
incisional biopsy
is used to remove the entire lesion
excisional biopsy
which type of biopsy has the lowest false negative rates?
open surgical biopsy
which surgery is the most invasive and has the highest complication rate?
open surgical biopsy
what false negative rate has been reported for core biopsies?
4%-10%
what is the false negative rate for FNB’s?
5%-20%
what are the surgical clips made of that are placed at the biopsy site of the breast?
stainless steel or collagen based products
true or false: a specimen radiograph should be performed after every biopsy to confirm that the lesion was removed and that the margins are clean
true
t/f: technologists should always use compression and magnification when radiographing biopsy specimens
true
can be performed to evaluate suspicious nipple discharge
ductography
The general term used when describing reshaping of the breast
Mammoplasty
Includes any reconstruction of the breast for nonmedical reasons
Cosmetic intervention
What is it called when an implant is placed in front of the pectoral muscle?
Subglandular or retromammary implants
What is it called when an implant is placed behind the pectoral muscle?
Subpectoral or retropectoral implants
The surgical removal of the entire breast
Mastectomy
Involves the removal of the entire breast, lymph nodes, in the chest wall muscles under the breast
Radical mastectomy
Is rarely performed today because the modified mastectomy is just as effective and is less debilitating and deforming
Radical mastectomy
Involves the removal of the entire breast, including the nipple/areola region and some of the under arm lymph nodes
Modified radical mastectomy
Involves the removal of the breast tissue, but the nipple-areola complex remains.
Nipple-sparing mastectomy
This procedure can be used by women with relatively small tumors or non-aggressive cancers or as a prophylactic procedure
Nipple – sparing mastectomy
Involves the removal of a healthy breast when the individual has a high risk factor for developing breast cancer
Prophylactic mastectomy
Involves the removal of the malignant tumor in the margins of the surrounding normal breast tissue
Lumpectomy
Is often combined with other therapy options, such as radiation treatment, chemotherapy, or hormonal treatment.
Lumpectomy
How many weeks of radiation therapy is usually given if a lumpectomy is followed by radiation therapy?
6 weeks
How long does it usually take to begin radiation treatment after surgery?
1 month (to allow for healing)
What two options can be given to control the systemic spread of breast cancer after a lumpectomy?
Chemo therapy or treatment with the drug tamoxifen
Clear fluid trapped in the wound
Seroma
This procedure to remove the under arm lymph nodes during mastectomy or lumpectomy
Axillary node dissection
Involves the removal of only one to three sentinel lymph nodes in the axillary area
Sentinel lymph node biopsy
What is taken into consideration when staging breast cancer?
Invasive or non-invasive, determine size and location, determines whether there is lymph node involvement, and determines whether the cancer has spread to other parts of the body
During the American joint committee on Cancer staging system, what does the TN & M stand for?
Tumor size, lymph node spread, assess distant metastasis
Usually begins one month after surgery, giving the breast time to heal. Treatment time is typically 15 to 30 minutes with radiation given five times per week for 5 to 8 weeks
External beam radiation
Involves applying radiation from inside out. Treatment can be reduced from eight weeks to 5-9 days
Internal beam radiation
What is another name for internal beam radiation?
Brachytherapy
How soon can internal beam radiation therapy begin after a lumpectomy?
Immediately
Is an adjuvant therapy and involves the use of drugs to treat cancer that may have spread beyond the breast
Chemotherapy
Is given before surgery to help shrink the cancerous tumor
Neoadjuvant chemotherapy
Is given in addition to another breast cancer treatment, for example, mastectomy
Adjuvant chemotherapy
How long does chemotherapy treatment last?
3-6 months
Will determine the exact genetic profile of the altered cancer cells & design a treatment plan based on the nature of these cells or subcells
Molecular treatment
What drug class is often used during molecular treatment?
SERMs (selective estrogen receptor modulators)
Are used to shrink or stop the recurrence of breast cancer or lower the risks of breast cancer recurrence in postmenopausal women
Selective Estrogen Receptor Modulators (SERMs)
what are the 3 drug options for molecular treatment?
tamoxifen, raloxifene (Evista), and Fulvestrant (Faslodex)
which SERM has fewer adverse effects?
Raloxifene (Evista)
which SERM is antiestrogen?
Fulvestrant (Faslodex)
slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones or by interfering with hormone action.
hormone therapy
what is used to treat tumors if they are hormone insensitive?
aromatase inhibitors
used to treat estrogen-receptor-positive (ER+) cancers
aromatase inhibitors
can be used to block the activity of an enzyme called aromatase
aromatase inhibitors
the body uses this enzyme to make estrogen in the ovaries and other tissues
aromatase
are used primarily in postmenopausal women because the ovaries in premenopausal women produce too much aromatose
aromatase inhibitors
what are the 3 drugs used for aromatase inhibitation?
exemestane (Aromasin), anastrozole (Arimidex), and letrozole (Femara)
effective therapy for HER2/neu aggressive cancers
Trastuzumab (Herceptin)
what is a major adverse effect of trastuzumab?
damage to the heart muscle
effective in the treatment of HER2 aggressive cancers and cancers that are both HER2+ and ER+
Lapatinib (Tykerb)
major side effect of this drug causes liver damage
Lapatinib (Tykerb)
can show inherited mutations that predispose a woman to cancer
Gene Therapy
what are 3 uses of gene therapy?
- inserts specific genes into cells to restore missing function or give new function
- prevents cancer from developing
- stops other genes that allow cancer cells to metastasize
seeks to create an immune system response within each patient and to prime the body to kill cancer cells or to strengthen the immune systems ability to recognize and attack cancer cells
immunotherapy or biotherapy
what percent of cancer patients experience pain?
30%
what percent of patients are undertreated for cancer pain
50%
what are the 2 types of breast reconstruction done after breast cancer reconstruction?
immediate reconstruction and delayed reconstruction
why may it be necessary to do a delayed reconstruction after post-breast cancer breast reconstruction?
if radiation immediately follows a mastectomy or if the skin is damaged by the radiation
what are the modern techniques for breast implants?
behind the pectoral muscle (subpectoral or retropectoral)
what are the older techniques for breast implants?
in front of the pectoral muscle (subglandular or retromammory placement)
flap surgery that removes skin and fat from the abdomen, back, or buttocks and uses it to form a new breast
autologous tissue
what does TRAM flap stand for?
transverse rectus abdominis myocutaneous flap
when muscle, fat, and skin from abdomen is used to create a new breast mound
TRAM flap
further surgery needed to make the nipple and areola after reconstruction
TRAM flap
the flap is completely removed, and microsurgery is needed to recreate blood supply when the flap is positioned as a breast mold
free flap
the flap remains attached to its original blood supply, and it is tunneled under skin to the breast area
pedicle flap
what are the 3 autologous tissue ariations?
DIEP (deep inferior epigastric perforator), SIEP (superficial inferior epigastric perforator), latissimus flap
what is the recovery time for most flap reconstruction?
4-6 weeks
for flap reconstruction, how long are patients usually required to have a drain for?
1-2 weeks
