Breast Cancer

Question 1

How is breast cancer found in asymptomatic patients?

Answer 1

Screening mammography or palpation of breast

Question 2

Is breast cancer usually painful or painless?

Answer 2

painless

Question 3

How does a palpable mass in cancer usually feel?

Answer 3

Hard to touch

Question 4

What is the best initial test for breast cancer?

Answer 4

Biopsy

Question 5

What is the best initial type of Biopsy?

Answer 5

Fine Needle Aspiration (FNA)

Question 6

What can a FNA not test for?

Answer 6

ER, PR HER 2/neu

Question 7

What is an advantage of Core needle biopsy over FNA?

Answer 7

Larger sample: can test for ER, PR and HER 2/neu

Question 8

What is the most accurate biopsy type?

Answer 8

Open Biopsy: allows for frozen section to be done while the patient is in the OR followed by immediate resection and sentinel node biopsy

Question 9

When is a mammogram indicated for screening in the general population?

Answer 9

50 years of age

Question 10

When do you use an US in breast cancer workup?

Answer 10

Clinically indeterminant mass lesions to evaluate cyst vs lesion
-Lesion is painful
-varies in size or pain with menstruation
-patient is <30

Question 11

When do you use a PET scan for breast cancer workup?

Answer 11

Determine content of abnormal nodes that are not easily accessible to biopsy: cancer has increased uptake on PET scan

Question 12

What gene is associated with an increased risk of Breast cancer?

Answer 12

BRCA

Question 13

What other cancers are associated with the BRCA gene?

Answer 13

Ovarian and pancreatic

Question 14

When is Sentinel Node Biopsy performed in the breast cancer workup?

Answer 14

All patients at the time of lumpectomy or mastectomy

(-) sentinel node eliminates the need for axillary node dissection

Question 15

When are Estrogen receptors and progesterone receptors tested in the breast cancer workup?

Answer 15

Alwsys

Question 16

What is equal in efficacy to modified radical mastectomy but less deforming?

Answer 16

Lumpectomy + Radiation

Question 17

What is indispensable in preventing recurrence in the breasts?

Answer 17

Radiation

Question 18

What is Lumpectomy contraindicated?

Answer 18

If the cancer is multifocal or if radiation is contraindicated

Question 19

What is always the wrong answer regarding breast cancer treatment?

Answer 19

Radical Mastectomy

Question 20

What should all ER (-) or PR(+) patients receive?

Answer 20

Tamoxifen, raloxifene or an Aromatase Inhibitor

Question 21

What is the mechanism of Tamoxifen?

Answer 21

Selective Estrogen Receptor Modulator (SERM)

Question 22

What is a common side effect of Tamoxifen?

Answer 22

Endometrial cancer and clots

Question 23

What are common Aromatase inhibitor drugs?

Answer 23

Anastrozole, Letrozole, exemestane

Question 24

What are common side effects of Aromatase Inhibitor Drugs?

Answer 24

osteoporosis

Question 25

What population is Tamoxifen better for?

Answer 25

Premenopausal patients

Question 26

What patient population are aromatase inhibitors better for?

Answer 26

Postmenopausal patients

Question 27

When do you use Trastuzumab?

Answer 27

Those who are positive for HER-2/neu

Question 28

What is the mechanism of Trastuzumab?

Answer 28

Anti-HER-2/neu antibodies

Question 29

What is the benefit of Trastuzumab?

Answer 29

decreases the risk of recurrence and increases survival

Question 30

What is the major side effect of Trastuzumab?

Answer 30

Cardiotoxicity

Question 31

What do you use to treat when the patient is ER(-), PR(-) and HER-2/neu (-) Triple Negative?

Answer 31

Atezolizumab

Question 32

When is adjuvant chemotherapy the right answer?

Answer 32

Lesion >1cm or with positive axillary nodes

Question 33

What is Adjuvant Chemotherapy?

Answer 33

Additional therapy to clean up presumed microscopic cancer cells too small in amount to be detected