Lecture 82 - management of early stage breast carcinoma

Question 1

risk factors for breast cancer:

Answer 1

Reproductive factors - prolonged exposure to endogenous estrogens, such as early menarche, late menopause, late age at 1st childbirth are among the most important risk factors.

Exogenous hormones

Not breast feeding

Age

Personal FmHx

previously received high does radiation therapy (hodgkins lymphoma)

Obesity, lack of exercise, excessive alcohol

Question 2

true or false – breast feeding has a protective effective on bc

true or false – the western lifestyle may be contributing to increasing incidnce of BC in developed countries

Answer 2

true

True – lower parity and shorter breast feeding; higher rates of obesity

Question 3

features that might indicate hereditary breast cancer (BRCA)?

Answer 3

Breast cancer before age of 40

• Bilateral BC
• History of both breast & ovarian cancer

2 or more family members

Question 4

how is “high risk” defined?

Answer 4

> 10% risk of harboring mutations

Question 5

true or false – majority of bc cases are identified at early stage?

true/false – majority of cases are found by patients?

Answer 5

true – 60% BC confined to the primary site (localized stage);

False – majority of cases found on imaging

Question 6

local manifestations of breast cancer besides abn mammograpm

Answer 6

palpable mass
skin thckening
pain

axillary pain (rare)

Nipple discharge (bloody, unilateral) or retraction

Edema or erythema of the skin

Question 7

how are biopsies optained ?

Answer 7

Stereotactic-Mammogram guided core needle biopsy

Ultrasound-guided core needle biopsy

MRI-guided core needle biopsy

Fine Needle Aspiration (FNA)

Incisional/Excisional Biopsy

Question 8

two forms of surgical options for breast cancer

Answer 8

Lumpectomy

Mastectomy

+/- Axillary LN dissection or Sentinel LN Bx

Question 9

nodal areas of local spread

Answer 9

Supraclavicular, subclavicular

Axillary – upper, middle and lower

Question 10

when is axillary LN dissection needed?

Answer 10

If there is positive Sentinel LN bx

Question 11

who needs adjuvant radiation therapy?

Answer 11

*All patients who have lumpectomy/partial mastectomy need radiation therapy to the involved breast.

If the patient needs chemo, the chemo is given first

Question 12

window for risk of recurrence

how does nodal involvement help predict recurrence ?

what about ER status?

Answer 12

highest risk of recurrnce in 1-3 years after treatment

increased risk of recurrence in patients with >4 positive LN

Higher risk of recurrence in ER negative patients (but eventually higher risk of recurrence ~4 years after treatment in ER+ patients)

Question 13

chemotherapy side effects ?

Answer 13

Myelosuppression
Mucositis
Alopecia
GI-Nausea vomiting diarrhea
Ovarian Failure
Neuropathy
Fatigue
Skin & nail changes
Acute Leukemia -- rare 
Congestive heart Failure -- rare