Questions and Answers
What is the recommended treatment for a patient with pleomorphic-type LCIS?
Prophylactic mastectomy
For patients with invasive breast cancer, which factors are most important in determining risk?
Family history
In patients with E-cadherin negative breast lesions, what is the most likely diagnosis?
Ductal carcinoma in situ (DCIS)
What is the preferred reconstruction method after bilateral prophylactic mastectomy?
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In patients with ALH, what is the risk of synchronous invasive cancer?
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Which treatment is found to be effective in preventing invasive breast cancer?
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What is the most common complication after mastectomy that can be managed by leaving drains until the output is less than 30 cc/24 hours?
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Which of the following conditions is a contraindication for radiation therapy in breast cancer management?
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What is the recommended precaution to avoid lymphedema after axillary lymph node dissection (ALND) in breast cancer surgery?
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Which type of breast cancer treatment involves insertion of a drain postoperatively to avoid seroma formation?
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In the management of locally advanced breast cancer, which criterion defines a tumor as locally advanced?
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What is the main principle of therapy in managing stage 3 invasive breast cancer?
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In early breast cancer, which stage is characterized by a tumor size of more than 5 cm and involvement of fixed lymph nodes?
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Which surgical procedure for breast cancer involves removal of the entire breast but spares the pectoralis major muscle?
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In breast cancer treatment, what does SLNB stand for?
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Which therapy for breast cancer has a higher local recurrence rate, around 10% compared to 2% for mastectomy?
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What is the main difference between Simple Mastectomy and Modified Radical Mastectomy (MRM) for breast cancer?
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What is the recommended surgical intervention for early stage breast cancer patients with no lymph node involvement?
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Study Notes
Contraindications for Breast Conservation Therapy (BCT)
- Previous radiation to breast or chest wall
- Connective tissue disease (SLE or scleroderma)
Indications for Mastectomy
- T3, T4 tumors, N+ or M1
- Large or central tumors in small breast
- Multicentric disease
- Extensive in situ component
Complications of Mastectomy
- Seroma
- Infection or bleeding (hematoma)
- Nerve injury
- Lymphedema (up to 10% compared to 5% for SLND)
Precautions to Avoid Lymphedema
- Support the limb
- Avoid injury
- Avoid the use of needles or razors on the limb
- Refer to physiotherapy
Definition of Locally Advanced Tumor
- Extensive LN involvement (fixed or supraclavicular LN)
- Large tumor (> 5 cm) with skin or chest involvement
- Inflammatory breast cancer (IBC) is the main criteria
Principles of Therapy
- Neoadjuvant therapy followed by BCT vs. MRM
- MRM is more common
Lobular Carcinoma In Situ (LCIS)
- Diagnosed incidentally (no mass, no calcification)
- Classic or pleomorphic type
- E-cadherin negative (ductal origin is positive)
- No need for LN biopsy (no risk of LN metastases)
- No need for re-excision for positive margins
- Tamoxifen is effective in preventing invasive cancer
- Radiation: no sufficient data to support it in pure LCIS
Invasive Breast Cancer
- T1: ≤ 2 cm, T2: 2-5 cm, T3: > 5cm, T4: local invasion
- N1: 1-3, N2: 4-9 LN, N3: 10 or more LN, N0: no LN
- M0: no metastasis, M1: Metastatic disease
- Stage I: Tumor ≤ 2 cm, no LN. No metastasis
- Stage II: < 5 cm with N1 or > 5 cm with no LN
- Stage III: > 5 cm with N1 or < 5 cm with fixed LN, N2
- Stage IV: Distal metastases (M1)
Management of Breast Cancer
- Local management: lumpectomy with RT, or mastectomy
- Axillary LN management: SLNB vs. ALND
- Surgical Rx in three ways:
- BCT
- Simple mastectomy and SLN biopsy
- Modified Radical Mastectomy (MRM)
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