Breast Cancer Surgery Basics

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Questions and Answers

What is the recommended treatment for a patient with pleomorphic-type LCIS?

Prophylactic mastectomy (correct)

Lumpectomy

Radiation therapy

No surgery needed

For patients with invasive breast cancer, which factors are most important in determining risk?

Radiation therapy

Family history (correct)

Negative margins after lumpectomy

Positive E-cadherin status

In patients with E-cadherin negative breast lesions, what is the most likely diagnosis?

Lobular carcinoma in situ (LCIS)

Atypical lobular hyperplasia (ALH)

Invasive breast cancer

Ductal carcinoma in situ (DCIS) (correct)

What is the preferred reconstruction method after bilateral prophylactic mastectomy?

Skin-sparing reconstruction Signup and view all the answers

In patients with ALH, what is the risk of synchronous invasive cancer?

Up to 10% Signup and view all the answers

Which treatment is found to be effective in preventing invasive breast cancer?

Tamoxifen Signup and view all the answers

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?

Seroma Signup and view all the answers

Which of the following conditions is a contraindication for radiation therapy in breast cancer management?

Atypical lobular hyperplasia (ALH) Signup and view all the answers

What is the recommended precaution to avoid lymphedema after axillary lymph node dissection (ALND) in breast cancer surgery?

Support the limb and avoid injury Signup and view all the answers

Which type of breast cancer treatment involves insertion of a drain postoperatively to avoid seroma formation?

Simple mastectomy with axillary lymph node dissection (ALND) Signup and view all the answers

In the management of locally advanced breast cancer, which criterion defines a tumor as locally advanced?

> 5 cm tumor size with skin or chest involvement Signup and view all the answers

What is the main principle of therapy in managing stage 3 invasive breast cancer?

Neoadjuvant therapy followed by breast-conserving therapy (BCT) Signup and view all the answers

In early breast cancer, which stage is characterized by a tumor size of more than 5 cm and involvement of fixed lymph nodes?

Stage III Signup and view all the answers

Which surgical procedure for breast cancer involves removal of the entire breast but spares the pectoralis major muscle?

Simple mastectomy Signup and view all the answers

In breast cancer treatment, what does SLNB stand for?

Sentinel lymph node biopsy Signup and view all the answers

Which therapy for breast cancer has a higher local recurrence rate, around 10% compared to 2% for mastectomy?

Breast Conservative Therapy (BCT) Signup and view all the answers

What is the main difference between Simple Mastectomy and Modified Radical Mastectomy (MRM) for breast cancer?

The extent of lymph node dissection Signup and view all the answers

What is the recommended surgical intervention for early stage breast cancer patients with no lymph node involvement?

Breast Conservative Therapy (BCT) Signup and view all the answers

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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Description

This quiz covers essential information about breast cancer surgery, including different tumor types, contraindications for radiation, surgical procedures like simple mastectomy and axillary lymph node dissection, postoperative care such as drain insertion, and potential complications like seroma, infection, nerve injury, and lymphedema.