Surgery Breast

Question 1

malignant breast carcinoma

Answer 1

malignant phyllodes tumor

Question 2

nonmodifiable risk factors for breast cancer

Answer 2

• increasing age
• previous history of breast/ovarian ca
• 1st degree relative with breast ca
• onset of menstruation <12 yo
• onset of menopause >55 yo
• race
• never been pregnant

Question 3

modifiable risk factors for breast ca

Answer 3

• age at 1st birth > 30 yo
• ocps >/= 5 years
• previous radiation treatment
• alcohol
• obesity

Question 4

most common breast cancer presentation

Answer 4

breast mass

Question 5

other symptoms of breast ca

Answer 5

• axillary mass or metastasis (<1%)
• nipple discharge (5%) (serous is most suspicious)
• microcalcifications
• nipple retraction (tumor infiltrates lactiferous ducts)
• skin dimpling
• skin changes: peau d’orange

Question 6

standard mammographic views

Answer 6

mediolateral oblique (superior and inferior aspects)

craniocaudal (medial and lateral aspects)

Question 7

indications of tomosynthesis (3d mammogram)

Answer 7

• extremely dense breasts
• strong fhx of breast ca
• previously had breast ca

Question 8

uses of ultrasound

Answer 8

• determine if mass is solid or cystic
• shows borders, margins, vascularity, hardness, muscle invasion
• cannot see microcalcifications

Question 9

what is fnab

Answer 9

• uts guided
• needle draws sample fluid and tissue (gauge 23)
• minimally invasive
• can be used for sus axillary nodes
• cannot see tissue architecture

Question 10

what is core needle biopsy

Answer 10

• recommended for solid lesions
• uts guided + large bore needle (gauge 14)
• can get immunohistochemistry

Question 11

what is excision biopsy

Answer 11

• no longer recommended initial biopsy

- makes incision

Question 12

indication for mammogram guided needle localization excision biopsy

Answer 12

• non palpable microcalcifications
• hook wire
• specimen mammogram to make sure microcalcifications are taken out

Question 13

what is mammotome excision biopsy

Answer 13

• percutaneous way to take out mass
• makes 1 mm incision + large bore needle through mass -> slice the tissue
• no need for stitches

Question 14

what is stereotactic mammotome excision biopsy

Answer 14

• make incision and insert needle

- take out cores of calcifications under mammography

Question 15

types of mastectomy

Answer 15

• total mastectomy (skin and breast)
• modified radical mastectomy (skin, breast, level 1 and 2 ln)
• radical mastectomy (skin, breast, pectoralis)
• toilette mastectomy with split thickness skin graft (when cannot be primarily closed)

Question 16

what is breast conservation surgery

Answer 16

• remove breast mass + gross margin of 1 cm

- depression over the area of resection is seen post-op

Question 17

what is mastectomy with reconstruction

Answer 17

• skin / nipple sparing
• immediate or delayed
• skin or nipple is spared depending on indications for the patient
• work with plastic surgeon to reconstruct breast: tram flap or latissimus dorsi flap

Question 18

what are surgery options for lymph nodes

Answer 18

axillary node dissection and sentinel node biopsy

Question 19

axillary node dissection is not done anymore because of ___

Answer 19

lymphedema

Question 20

what is sentinel node biopsy

Answer 20

• guard nodes is where tumor drains before axillary ln
• negative biopsies of sn = cancer has not spread
• representative of the status of the rest of the axillary nodes
• done in the early stages of breast ca

Question 21

procedure for sentinel node biopsy

Answer 21

• inject radioactive colloid with blue dye
• gamma probe is used to identify where nodes are by making a noise
• biopsy nodes

Question 22

indications for chemo

Answer 22

• to decrease or prevent systemic recurrence
• neo-adjuvant therapy
• to assess response from her2 + and triple negative breast ca
• post op adjuvant
• primary treatment for stage 4

Question 23

types of targeted therapy

Answer 23

her2: herceptin (trastuzumab)

kinase-i, mtor-i, p13k-i, parp-i

Question 24

immunotherapy in breast ca

Answer 24

• boosts immune response of nk cells

- pd-1 / pdl-1: atezolizumab

Question 25

criteria for radiation therapy

Answer 25

- >5 cm tumor - >4 nodes - lymphovascular invasion complication: bird skin, fibrosis of lungs

Question 26

hormonal therapy in breast ca

Answer 26

- blocks endogenous substances, blocks synthesis of hormones - tamoxifen, aromatase inhibitors if + = take for 10 years if - not required

Question 27

annual mammogram should start at ___

Answer 27

40 yo, can also use breast uts (but must still do mammogram)

Question 28

clinical breast exam should start at ___

Answer 28

30 yo