MCQ - Treatment of breast cancer

• I - Below or lateral - Anterior, posterior, lateralQ
• II - Posterior (behind) - Central, InterpectoralQ
• III - Medial or above – ApicalQ

• DCIS, Stage I and Stage II invasive breast cancerQ.
• LCIS is contraindication for BCT

• Microcalcification - absolute contraindication
• Intermediate calcification – relative contraindication

• Axillary vein and cephalic veinQ
• Long thoracic nerve of Bell (Nerve to serratus anterior) [@ ABC]

10 mg BD X 5-yearsQ•

• While tamoxifen blocks estrogen receptors on the breast, it stimulates these receptors in the uterus (because tamoxifen is a partial against of ER), may lead to endometrial hyperplasia and endometrial cancerQ
• It is partial agonist in the uterus, bone, liver and pituitaryQ•

• Retinal deposits, decreased visual acuity and cataracts in occasional patientsQ•
• Increases the risk of thromboembolic eventsQ

Quadrantectomy + Axillary LN dissection + RadiotherapyQ

• • Locally Advanced Breast CancerQ (to decrease recurrence rate)
• • After breast conservation surgeryQ
• • Margin is positive after mastectomyQ
• • Metastases to 4 or more lymph nodesQ

• − Laterally: Axillary skin
• − Superiorly: Lower border of axillary veinQ
• − Posteriorly: Lattisimus dorsi, Teres major and Subscapularis
• − Anteriorly: Pectoralis muscle
• − Medially: Chest wall

• • First-generation regimen such as a 6-monthly cycle of cyclophosphamide, methotrexate and 5-fluorouracil (CMF)Q will achieve a 25% reduction in the risk of relapse over a 10- to 15-year periodQ.
• • CMF is no longer considered adequate adjuvant chemotherapyQ

• Modern regimens include an anthracycline (doxorubicin or epirubicin) and taxanes.

1 cm of normal tissue

• 1. Ovarian suppression or ablation:
• −−Bilateral oophorectomyQ
• −−Medically by LHRH agonist (Goserelin, Leuperolide)Q
• 2. SERM: Tamoxifen and RaloxifeneQ
• 3. Aromatase Inhibitors:−
• −Non-steroidal: Letrozole and AnastrazoleQ−
• −Steroidal: ExmestaneQ
• 4. Anti-estrogens: FulvestrantQ
• 5. Progestins: Megesterol and Medroxyprogesterone acetate

• The lymph node status is the most important prognostic indicator for tumor localized to breastQ
• In case of metastasis, the prognosis no more depends upon the lymph node status, it depends on estrogen and progesterone receptor statusQ (ER and PR status)

• It is used for breast cancer. It consists of
• 1. Tubule formationQ
• 2. Nuclear pleomorphismQ
• 3. Mitotic countQ

• Luminal A – ER, PR positive, HER2 negative
• Luminal B – ER, PR – positive, HER2 positive (Triple positive)
• Her-2 type - HER2 positive, ER, PR – Negative
• Basal like – ER negative, PR negative, HER2 negative , (Triple negative) EGFR and CK5/6 positive
• Normal breast-like - Well-differentiated, ER-positive
• Unclassified

Portrayal of global gene expressionQ is called heat map

• Seroma formation .
• Catheter is retained until drainage is <30 ml/day

• Lymphangiosarcoma of the upper extremity in women with ipsilateral lymphedema after radical mastectomy.
• The average interval between MRM or radical mastectomy and the development of an angiosarcoma is 10.5 yearsQ

• Pre-operative chemotherapy and radiotherapy followed by surgical excision (radical amputation)Q
• Associated with poor prognosisQ

• Autogenous – TRAM flap (MC), LD flap, Gluteal flap, Ruben’s flap, Lateral thigh flap
• Alloplastic – Siliconn gel Implant, Silicon implant with Saline refill
• Combined - Lattisimus dorsi flap with implantQ, TRAM flap with implantQ

Submuscular plane beneath the pectoralis majorQ, superior portion of the rectus abdominis, and serratus anterior muscles provides better protection against implant extrusion, as well as decreased risk for capsular contracture and implant displacementQ

Implants (silicon implants)Q•

• Characterized by the skin changes of brawny induration, erythema with a raised edge, and edema (rapid onset peau d’orange) involving >33% of skin of breastQ.
• More than 75% of women present with palpable axillary lymphadenopathyQ
• Distant metastases at diagnosis in 25% of white women with IBC.

sixth decade

• Lump.
• Breast cancer in men more commonly involves the pectoralis major muscleQ due to scanty breast tissue
• Most common type in infiltrating ductal carcinoma.

Breast carcinoma

A variant of thrombophlebitis involving the superficial veins of the anterior chest wallQ and breast. Also known as “string phlebitis,” a thrombosed vein presenting as a tender, cord-like structure

NSAIDs and application of warm compressesQ

• Intraductal pailloma are true polyps of epithelium lined breast ducts.
• BenignQ lesions (not pre-cancerous)
• Mostly solitaryQ, located under the areola (within 4-5 cm of nipple orifice)
• MC presentation: Bloody nipple dischargeQ
• Intraductal papilloma is MC cause of bloody nipple dischargeQ

Microdochectomy: Complete excision of the involved duct along with tumorQ

• • First stage - dilatation in one or more of the larger lactiferous ducts, which fill with a stagnant brown or green secretionQ, this may discharge.
• • These fluids irritate surrounding tissue leading to periductal mastitis or even abscess and fistula formation.
• • Dilatation of the breast ducts, which is often associated with periductal inflammation.
• • Pathogenesis is obscure, more common in smokersQ
• • Fibrosis eventually develops, which may cause slit-like nipple retraction.

• Hadfield’s operationQ: Excision of all of the major ducts
• Cessation of smokingQ

Biphasic proliferation of stroma and mammary epithelium Q

• Stroma of a phyllodes tumor has greater cellular activity than fibroadenoma.
• Stromal cells of fibroadenomas - Either polyclonal or monoclonalQ
• Stromal cells of phyllodes tumors - Always monoclonal

The diagnosis is suggested by the larger size, a history of rapid growthQ, and occurrence in older patients.

No fixity to skin and pectoralis, no nipple retraction, no LN involvementQ

Anabolic steroids, Diazepam, Marijauna, Ketoconazole, Digoxin, Isoniazide, Spironolactone, Cimetidine, Oestrogen, Antineoplastic agents (A Dai, Gaja Khau, DISCO aau)

Enlarged male breast due to growth of ductal tissue and stromaQ

• 1. Gynecomastia of longer duration (>1 year) Q
• 2. Continued growthQ
• 3. Psychological or cosmetic problemQ
• 4. TendernessQ
• 5. Suspected malignancyQ

Dermal manifestation of underlying ductal carcinomaQ (in situ or invasive)

CEA positivityQ in pagets disease

Large, pale staining with round nuclei and large nucleoliQ