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RGU 2 > Surgical Approach to Breast Cancer > Flashcards

Surgical Approach to Breast Cancer Flashcards

1
Q

What is the gold standard for breast cancer screening?

A
  • mammogram (two views: CC and MLO) of each breast.
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2
Q

What is the only difference between a screening and diagnostic mammogram?

A
  • diagnostic is looked at by the pathologist on the same day it is performed.
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3
Q

*** What is the chance of a screening mammogram missing a breast cancer?

A
  • 15%
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4
Q

What is the good/bad thing about breast MRI?

A
  • very SENSITIVE, but not very specific. Use for known BRCA mutation.
  • so higher false positive rate and much more expensive.
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5
Q

Is breast ultrasound a good tool to check a breast lump?

A

YES to evaluate PE findings, the axilla, and to guide biopsy.

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6
Q

What is the rationale for using ultrasound?

A
  • mammograms detect 98% of cancers in fatty breast but less than half in dense breast tissue.
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7
Q

Why do we also do clinical breast exams?

A
  • to pick up cancers missed on mammography.
  • pick up interval cancers (between mammograms).
  • pick up cancer in a population who isn’t getting regular mammograms.
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8
Q

What are the elements of a good clinical breast exam?

A
  • observation (retraction, asymmetry, edema, erythema).
  • palpation
  • multi-positional study (upright and supine of all 4 qudrants).
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9
Q

What are some elements of a good breast exam?

A
  • documentation of size, distance from nipple, and location on the clock.
  • document plan of action: imaging and referrals.
  • make sure there is a follow up.
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10
Q

How large must a tumor be to be detected by mammography?

A
  • 1 cm
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11
Q

Should we still encourage self breast exams?

A

YES bc it encourages good self-health and care.

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12
Q

What is the gold standard biopsy modality?

A
  • minimally invasive biopsy

* will place marker to help us guide future biopsies if needed.

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13
Q

What is a stereotactic biopsy?

A
  • uses mammography to precisely identify and biopsy an abnormality within the breast. It is done with the patient prone with a stereotactic piece of titanium placed as a marker.
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14
Q

What is the basic staging of breast cancer?

A
  • 0= noninvasive (DCIS)
  • 1= less than 2 cm
  • 2= greater than 2 cm or positive nodes.
  • 3= locally advanced
  • 4= metastatic
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15
Q

What labs/imaging should we order for breast cancer?

A
  • CXR, LFTs, +/- bone scan

- CT chest, abdomen, pelvis or Pet/CT for stage III

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16
Q

What is the first step for LOCAL breast cancer treatment?

A
  • surgery and/or radiation
17
Q

What is the treatment for SYSTEMIC control of breast cancer?

A
  • chemo and hormonal therapy
18
Q

** What is NSABP study?

A
  • National Surgical Adjuvant Breast and Bowel Project= led to the establishment of LUMPECTOMY (breast conserving surgery bc only a portion of the breast is removed) plus RADIATION over radical mastectomy as the standard surgical treatment for breast cancer.
19
Q

If a patient is not a good candidate for radiation, should you consider lumpectomy?

A

NO, bc radiation should be included with lumpectomy.

20
Q

*** What is mastectomy?

A
  • removal of all the breast tissue under the skin +/- nipple. Also lymph node evaluation.
  • 80% will also get reconstruction.
21
Q

*** What is breast conservation?

A
  • lumpectomy (partial mastectomy) to negative margins with breast radiation. Also lymph node evaluation.
22
Q

*** Do studies show the same overall survival with lumpectomy (partial mastectomy) as mastectomy?

A

YES :)

*also NO difference in the use of chemo.

23
Q

How do we evaluate the margins of a tumor?

A

by marking them with ink

24
Q

What is the risk of recurrence after mastectomy for local control?

A

1-3%

*loss of sensation :(

25
Q

What is the risk of recurrence after breast conservation (partial mastectomy; lumpectomy) for local control?

A

5-7%

*minimal loss of sensation :)

26
Q

Why do we do axillary lymph node evaluation?

A
  • staging
  • determination of additional treatment
  • type and duration of chemo and hormonal therapy
  • us of radiation
27
Q

** What are the levels of the axilla?

A
  • level 1= LATERAL to pec
  • level 2= BELOW the pec
  • level 3= MEDIAL to pec
28
Q

What is the problem with axillary node dissection?

A
  • LYMPHEDEMA (Stewart-Teves syndrome)

- some sensory loss along intercostal brachial nerve distribution.

29
Q

What do we do now first instead of axillary node dissections?

A
  • SENTINEL LYMPH NODE= inject dye and remove only the dyed lymph node(s) to test, thereby sparing the effects of lymphedema if the node turns out to be negative.
  • NSABP B-32 trial
30
Q

What did a recent trial suggest about axillary lymph node dissection in relation to sentinel nodes?

A
  • it is SAFE to AVOID axillary lymph node dissection for patients with 2 or less positive sentinel lymph nodes.

RGU 2 (24 decks)

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