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Oncology – ABIM

Breast Cancer

Inheritance pattern of malignant hyperthermia autosomal dominant
rapid rise in temp (up to 40C) upon induction of anesthesia Malignancy Hyperthermia
What anesthetic agents associated with malignant hyperthermia? succinylcholine, inhaled halogens
What is the best treatment for malignant hyperthermia? Prevention
Steps of clinical problem solving 1. make the diagnosis, 2. establish severity, 3. tailoring the treatment to stage of disease, 4. monitor tx response/efficacy
Most common cause of serosanguinous unilateral breast dc? Intraductal papilloma
Intraductal papilloma small, noncancerous (benign) tumor that grows in a milk duct of the breast
What is the main concern in a pt with serosanguinous unilateral breast dc? breast cancer
How can you r/o intraductal papilloma on physical exam? Palpate for involvement of more than one breast duct. If more than one involved, or a breast mass is palpated, most likely breast cancer.
Most common cause of serosanguinous unilateral breast dc in the presence of a breast mass? breast cancer
33 yo woman w 3cm palpable L brst masa; L axilla and R breast are nl; what to do next? tissue bx; if malignancy, then stage which would inc BL mammography
33 yo woman w 3cm palpable L brst masa; L axilla and R breast are nl; if breast CA, how to tx? If CA, most likely stage Iia --> best managed by 1. surg, 2. adjuvant therapy OR NEOADJUVANT: 1. systemic chemo to shrink tumor, 2. locoregional surgical therapy
What is adjuvant therapy? Chemo or radiation AFTER surgery.
What is neoadjuvant therapy? Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy.
Metastatic w/u for br ca CBC, LFT's, CXR
What should a pt with breast ca get before consideration of breast conservation therapy? Breast MRI to help delineate the local extent of ca
Br Ca TNM Staging Stage 0 Tis (in situ), N0, M0
Br Ca TNM Staging Stage 1 T1 =<2cm , N0, M0
Br Ca TNM Staging Stage 2A T0-1, N1, M0; T2, N0, M0
Br Ca TNM Staging Stage 2B T2, N1, M0; T3, N0, M0
Br Ca TNM Staging Stage 3A T0-T2, N2, M0; T3, N1-N2, M0
Br Ca TNM Staging Stage 3B T4, N0-2, M0; Tany, N3, M0
Br Ca TNM Staging Stage 4 Tany, Nany, M1 (distant mets)
Br Ca TNM Staging T1 T1 =<2cm
Br Ca TNM Staging T1a T1a =<0.5cm
Br Ca TNM Staging T1b 0.5cm < T1b =< 1cm
Br Ca TNM Staging T1c 1cm < T1b =< 2cm
Br Ca TNM Staging T2 2cm < T2 =< 5cm
Br Ca TNM Staging T3 T3 >5cm
Br Ca TNM Staging T4 T4 - extension to chest wall or skin
Br Ca TNM Staging T4a T4a - extension to chest wall
Br Ca TNM Staging T4b Edema or ulceration of the skin
Br Ca TNM Staging T4c extension to chest wall + skin
Br Ca TNM Staging T4d inflammatory carcinoma
What is inflammatory breast carcinoma? rare but very aggressive - cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.” diagnosed at younger age.
Br Ca TNM Staging N0 no regional nodal mets
Br Ca TNM Staging N1 mobile ipsilateral axillary nodal mets
Br Ca TNM Staging N2 fixed ipsilateral axillary nodal mets
Br Ca TNM Staging N3 ipsilateral internal mammary nodal mets
What is the limitation of FNA of a breast mass? What would be better and why? identify CA cells but cannot differentiate invasive CA from in situ; need core needle bx to determine the histology of tumor and assess receptor status and tumor biology of the cancer
Breast conservation therapy partial mastectomy with axillary staging by sentinel LN bx or axillary dissection. Usually, radiation to chest wall after surgery to decreased local recurrance.
Triple Receptor Negative BrCa; what are the receptors? Slow vs. aggressive? What demographic? Prognosis? Percentage of all BrCa. no estrogen/progesterone/HER2-neu receptors; aggressive, more in AA and premenopausal; poor prognosis; 10-15% of all BrCA's
Three steps in management of BrCa 1. Diagnosis, 2. Locoregional therapy, 3. Systemic therapy
How do you diagnose Br Ca? Hx, exam, imaging, bx
What imaging is used for diagnosis of BrCA? US/Mammography, MRI in some
What kind of bx's done for BrCA? (3) FNA, core needle bx, excisional
If stage I or stage II tumor (T1-2), what 3 things to stage? CBC, LFT's, CXR
If BrCA + bone pain and/or abdominal sx's and/or HA or neuro complaints, what should staging be done with? CBC, LFT's, CXR + bone scan, abd CT, brain CT or MRI, depending on sx's (common: full body PET plus MRI brain)
With proper pt f/u, which offers greater survival benefits? BCT or mastectomy? they offer equivalent survival benefits
Which technique for nodal staging is preferred? Axillary LN dissection (levels 1 and 2 - lateral and deep to the pec muscles) vs. sentinel LN bx SLNBx because it provides satisfactory staging and produces less morbidity. However, when SLN is + for metastases, a complete dissection of Level 1 and 2 axilla is performed
Systemic therapy given to what stages in BrCA? those at risk of mets - stages 3 and 4
What are the options for pt in stages 3 or 4 BrCA? surgery followed by chemo or neoadjuvant chemo followed by surg
BrCA pts with stage 2 disease - what is the risk of recurrance at 20 y if pt got locoregional tx only? 33 to 44%
BrCA pts with stage 2 or greater are offered what kind of therapy and why? systemic chemo in addition to locoregional control, with radiation therapy for breast conserving surgery
which is associated with improved survival? Neoadjuvant or adjuvant therapy? no survival difference between the two; advantage of neoadjuvant theraly includes improvements in breast conservation rate --> improved cosmetic results
Tamoxifen associated with development of what? given to tx BrCa recurrence, but develop uterine CA
Who are good candidates for aromatase inhibitors? postmenopausal women who have BrCA with estrogen-receptor-positive tumors
What is locoregional tx for brCa Surgery and radiation therapy
What is systemic tx for BrCA chemo, anti-estrogen therapy
Created by: christinapham