Podcast
Questions and Answers
What is the recommended treatment for a patient with pleomorphic-type LCIS?
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?
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?
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?
What is the preferred reconstruction method after bilateral prophylactic mastectomy?
In patients with ALH, what is the risk of synchronous invasive cancer?
In patients with ALH, what is the risk of synchronous invasive cancer?
Which treatment is found to be effective in preventing invasive breast cancer?
Which treatment is found to be effective in preventing invasive breast cancer?
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?
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?
Which of the following conditions is a contraindication for radiation therapy in breast cancer management?
Which of the following conditions is a contraindication for radiation therapy in breast cancer management?
What is the recommended precaution to avoid lymphedema after axillary lymph node dissection (ALND) in breast cancer surgery?
What is the recommended precaution to avoid lymphedema after axillary lymph node dissection (ALND) in breast cancer surgery?
Which type of breast cancer treatment involves insertion of a drain postoperatively to avoid seroma formation?
Which type of breast cancer treatment involves insertion of a drain postoperatively to avoid seroma formation?
In the management of locally advanced breast cancer, which criterion defines a tumor as locally advanced?
In the management of locally advanced breast cancer, which criterion defines a tumor as locally advanced?
What is the main principle of therapy in managing stage 3 invasive breast cancer?
What is the main principle of therapy in managing stage 3 invasive breast cancer?
In early breast cancer, which stage is characterized by a tumor size of more than 5 cm and involvement of fixed lymph nodes?
In early breast cancer, which stage is characterized by a tumor size of more than 5 cm and involvement of fixed lymph nodes?
Which surgical procedure for breast cancer involves removal of the entire breast but spares the pectoralis major muscle?
Which surgical procedure for breast cancer involves removal of the entire breast but spares the pectoralis major muscle?
In breast cancer treatment, what does SLNB stand for?
In breast cancer treatment, what does SLNB stand for?
Which therapy for breast cancer has a higher local recurrence rate, around 10% compared to 2% for mastectomy?
Which therapy for breast cancer has a higher local recurrence rate, around 10% compared to 2% for mastectomy?
What is the main difference between Simple Mastectomy and Modified Radical Mastectomy (MRM) for breast cancer?
What is the main difference between Simple Mastectomy and Modified Radical Mastectomy (MRM) for breast cancer?
What is the recommended surgical intervention for early stage breast cancer patients with no lymph node involvement?
What is the recommended surgical intervention for early stage breast cancer patients with no lymph node involvement?
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.
