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?

    <p>Skin-sparing reconstruction</p> Signup and view all the answers

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

    <p>Up to 10%</p> Signup and view all the answers

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

    <p>Tamoxifen</p> 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?

    <p>Seroma</p> Signup and view all the answers

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

    <p>Atypical lobular hyperplasia (ALH)</p> Signup and view all the answers

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

    <p>Support the limb and avoid injury</p> Signup and view all the answers

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

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

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

    <p>&gt; 5 cm tumor size with skin or chest involvement</p> Signup and view all the answers

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

    <p>Neoadjuvant therapy followed by breast-conserving therapy (BCT)</p> 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?

    <p>Stage III</p> Signup and view all the answers

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

    <p>Simple mastectomy</p> Signup and view all the answers

    In breast cancer treatment, what does SLNB stand for?

    <p>Sentinel lymph node biopsy</p> Signup and view all the answers

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

    <p>Breast Conservative Therapy (BCT)</p> Signup and view all the answers

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

    <p>The extent of lymph node dissection</p> Signup and view all the answers

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

    <p>Breast Conservative Therapy (BCT)</p> 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.

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