Surgery Marrow Pg 61-70 (Breast)

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Questions and Answers

Which treatment modality is mandatory for local recurrence prevention in Breast Conserving Surgery (BCS)?

Chemotherapy

Surgery

Hormonal therapy

Radiotherapy (correct)

A Mastectomy typically results in a higher local recurrence rate compared to Breast Conserving Surgery.

False

What percentage of breast volume resection is considered volume displacement in oncoplasty?

10-15%

In breast oncoplasty, a resection of _____% or more of breast volume is classified as volume replacement.

15 Signup and view all the answers

Match the type of surgical treatment with its definition:

Surgery = A method to remove cancerous tissue Chemotherapy = Use of drugs to kill cancer cells Radiotherapy (RT) = Use of high-energy waves to target cancer Hormonal therapy (HT) = Treatment that blocks hormones fueling cancer growth Signup and view all the answers

Which technique combines blue dye and radionuclide for the best identification of hot nodes?

Radionuclide Technique Signup and view all the answers

The Indocyanine Green Technique involves the use of radiation for lymph node visualization.

False Signup and view all the answers

What is the primary advantage of the Sentimag Technique?

Zero radiation exposure Signup and view all the answers

In the Radionuclide Technique, ________ tagged sulphur colloid is injected.

Tc99m Signup and view all the answers

Match the following techniques with their primary features:

Radionuclide Technique = Tc99m-tagged sulphur colloid Indocyanine Green Technique = No radiation exposure Sentimag Technique = Magnetic scanning Best Technique = Combination of blue dye and radionuclide Signup and view all the answers

What is the primary purpose of lymphedema massages after breast surgery?

To reduce swelling Signup and view all the answers

Phantom breast syndrome occurs because patients feel pain in the area where the breast was removed.

False Signup and view all the answers

What is one major advantage of the DIEP flap compared to the TRAM flap?

Less abdominal complications Signup and view all the answers

The condition where the cancer covers the chest wall like armor is referred to as _____ en cuirasse.

cancer Signup and view all the answers

Match the following conditions or procedures with their descriptions:

TRAM = Involves muscle removal, higher risk of hernia DIEP = Does not involve muscle removal, fewer abdominal complications Phantom breast syndrome = Patient feels breast is still present Lymphedema = Swelling due to lymphatic fluid accumulation Signup and view all the answers

What is a common risk factor that increases the incidence of post-mastectomy lymphedema?

Lymph node clearance Signup and view all the answers

Flap necrosis is primarily caused by infection.

False Signup and view all the answers

What is the most common complication after mastectomy related to fluid accumulation?

Seroma Formation Signup and view all the answers

The _____ nerve injury can lead to winging of the scapula.

long thoracic Signup and view all the answers

Match the following complications with their descriptions:

Bleeding = Occurs in three types: primary, reactionary, secondary Nerve Injury = Can cause numbness in the axilla Flap Necrosis = Results from compromised blood supply Seroma Formation = Fluid accumulation beneath the flap Signup and view all the answers

What is the primary purpose of a Sentinel Lymph Node Biopsy (SLNB)?

To assess the first draining lymph node from the cancer site Signup and view all the answers

SLNB is commonly used for all types of cancer.

False Signup and view all the answers

What common nerve is often injured during the Sentinel Lymph Node Biopsy procedure?

ICBN Signup and view all the answers

The __________ technique involves injecting methylene blue into the subcutaneous plane during SLNB.

blue dye Signup and view all the answers

Match the type of cancer with its inclusion for SLNB:

Malignant melanoma = Included Breast cancer = Included Lung cancer = Not included Vulvar carcinoma = Included Signup and view all the answers

What is the typical radiation dose for Whole Breast Irradiation (WBI)?

50-54 Gy Signup and view all the answers

Accelerated Partial Breast Irradiation (APBI) is indicated for tumors that are unifocal and have negative lymphovascular invasion.

True Signup and view all the answers

What type of hormonal therapy is typically used in pre-menopausal women with breast cancer?

Selective estrogen receptor modulator (SERM): Tamoxifen Signup and view all the answers

Tamoxifen must be taken for _____ years before a patient can consider pregnancy.

2 Signup and view all the answers

Match the following hormonal therapy drugs with their respective categories:

Tamoxifen = Selective estrogen receptor modulator (SERM) Letrozole = Aromatase inhibitor Anastrozole = Aromatase inhibitor Signup and view all the answers

What is the main purpose of a chemoport?

To deliver chemotherapy drugs. Signup and view all the answers

Chemotherapy should be avoided in patients with a poor performance status.

True Signup and view all the answers

Name one chemotherapy regimen currently used for Her 2 neu negative breast cancer.

AC/EC Signup and view all the answers

The Oncotype Dx is a _____ assay used to determine the risk of recurrence.

21 gene Signup and view all the answers

Match the following chemotherapy drugs with their correct category:

5-Fluorouracil = F Methotrexate = m Paclitaxel = T Epirubicin = E Signup and view all the answers

Which of the following is NOT an indication for chemotherapy?

Well-differentiated tumors Signup and view all the answers

HER 2 neu positive tumors can benefit from neoadjuvant chemotherapy.

True Signup and view all the answers

What is the primary objective of using RECIST criteria in chemotherapy?

To evaluate the response of solid tumors to treatment Signup and view all the answers

The abbreviation PCR stands for _____ in the context of tumor response.

Pathological Complete Response Signup and view all the answers

Match the response evaluation criteria to their definitions:

CR = Disappearance of all lesions & pathological lymph nodes PR = ≥30% reduction in single largest diameter SD = Stable disease with no significant changes PD = Progression of disease with new lesions Signup and view all the answers

Which type of mastectomy removes the entire breast along with the nipple areola complex and lymph nodes?

Radical mastectomy Signup and view all the answers

Nipple-sparing mastectomy preserves the nipple and areola.

True Signup and view all the answers

What structure is typically not removed during a simple mastectomy?

Lymph nodes Signup and view all the answers

A modified radical mastectomy uses an __________ incision.

elliptical Signup and view all the answers

Which structures are included in the removal during a radical mastectomy?

Breast, nipple areola complex, pectoralis major, and axillary lymph nodes Signup and view all the answers

Match the following types of mastectomy with their characteristics:

Nipple-sparing mastectomy = Preserves the nipple and areola Skin-sparing mastectomy = Preserves the skin Radical mastectomy = Includes removal of pectoralis muscles Simple mastectomy = Does not include lymph node removal Signup and view all the answers

The technique known as Auchincloss - Patey - Scanlon is used in some types of mastectomies.

True Signup and view all the answers

How many lymph nodes are generally removed during axillary clearance?

At least 10 Signup and view all the answers

Which of the following is an absolute contraindication for Breast Conserving Surgery?

Pregnancy Signup and view all the answers

Breast Conserving Surgery can be performed after neoadjuvant chemotherapy.

True Signup and view all the answers

Name one relative contraindication for Breast Conserving Surgery.

Prior radiation therapy, collagen vascular diseases, multifocal tumors, diffuse microcalcifications/DCIS, locally advanced breast cancer, or large tumor: breast ratio. Signup and view all the answers

The technique involves the presence of large tumors relative to the breast, termed ______.

Large tumor: Breast ratio Signup and view all the answers

Match the following types of tumors with their respective categories:

Multicentric tumors = Technical considerations Locally advanced breast cancer (LABC) = Contraindication Diffuse microcalcifications/DCIS = Relative contraindication Large tumor: Breast ratio = Technical considerations Signup and view all the answers

Study Notes

Breast Cancer Treatment Modalities

Surgery, Chemotherapy, Radiotherapy (RT), Hormonal Therapy (HT) are the primary modalities used to treat breast cancer.
Surgical options involve Breast Conserving Surgery (BCS) and Mastectomy.
BCS leads to a 3-4% local recurrence rate, making RT mandatory.
Mastectomy has a 1% local recurrence rate.
Oncoplasty combines cancer surgery with plastic surgery techniques.
Two types of Oncoplasty are Volume Displacement and Volume Replacement.
Volume Displacement removes 10-15% of breast volume.
Volume Replacement removes ≥ 15% of breast volume.

Managing Breast Cancer Treatment Side Effects

Skin care, lymphedema massages and stockings are important for post-operative recovery.
Regular exercise can promote lymphatic drainage and reduce the risk of lymphedema.

Local Recurrence

Repeat biopsy is crucial to confirm diagnosis.
Immunohistochemistry (IHC) marker analysis helps identify changes in tumor expression.
Extensive local recurrences can lead to Cancer en cuirasse, a condition where the chest wall is covered by tumor.

Phantom Breast Syndrome

Patients experience the sensation of the breast being present.
Caused by Intercostobrachial Nerve (ICBN) entrapment.
Associated with pain.

Reconstructive Surgery

TRAM and DIEP flaps are common techniques.
TRAM (Transverse rectus abdominus myocutaneous flap) involves removing skin, fat, and muscle, increasing the risk of incisional hernia.
DIEP (Deep inferior epigastric artery perforator flap) involves removing skin and fat, minimizing abdominal complications as muscle is not removed.

Sentinel Lymph Node Biopsy (SLNB)

Developed for penile cancer.
Identifies the first lymph node draining from the cancer site.
Usually located in level 1 of the axilla.
ICBN is a commonly injured nerve during this procedure.

SLNB - Applications & Techniques

SLNB is utilized for various cancers, including malignant melanoma, breast cancer, penile cancer, vulvar carcinoma, and head & neck cancer.
Blue dye technique involves injecting methylene blue/isosulfan blue into the periareolar region to localize lymph nodes.

Axillary Clearance

Not required for some cancers, reducing the incidence of lymphedema.

SLNB Complications

Skin tattooing, anaphylaxis, bluish discoloration of urine, and skin necrosis are potential complications.

Radiotherapy in Breast Cancer

Indications: Positive lymph nodes, tumor size > 5 cm, locally advanced breast carcinoma, after breast conserving surgery.
Types of RT: Whole Breast Irradiation (WBI) and Accelerated Partial Breast Irradiation (ABPI).
ABPI is suitable for T1, ER, PR-positive, negative lymphovascular invasion, unifocal tumors with negative margins and patients over 250 years old.

Hormonal Therapy

Indications: ER/PR-positive tumors.
Pre-menopausal: Tamoxifen (SERM) for 5 years, can be extended to 10 years.
Post-menopausal: Aromatase inhibitors (Letrozole, Anastrozole) for 5-10 years.

Pregnancy Planning with Tamoxifen

2 years of continuous Tamoxifen therapy are required before pregnancy planning.
Tamoxifen should be stopped 3 months before conception.

Different Types of Mastectomy

Simple mastectomy: Removes the breast and nipple-areola complex, but not lymph nodes.
Modified radical mastectomy (MRM): Removes the breast, nipple-areola complex, pectoral fascia, and level 1, 2, 3 axillary lymph nodes.
Radical mastectomy: Removes the breast, nipple-areola complex, pectoral major and minor muscles, and level 1, 2, 3 axillary lymph nodes.

Additional Mastectomy Techniques

Nipple-sparing mastectomy preserves the nipple and areola.
Skin-sparing mastectomy preserves the skin.

Axillary Clearance Boundaries

Medial boundary: Halstead Ligament
Lateral boundary: Thoraco-dorsal pedicle
Superior boundary: Axillary vein
Inferior boundary: Angular vein
Long thoracic nerve: Saved, not a boundary.

Chemoport

Inserted below the clavicle.
Delivers chemotherapy drugs.
Reduces risk of thrombophlebitis.

Chemotherapy Regimens

CAF/CMF: Not currently used.
Her 2 neu-negative: 4 cycles of AC/EC followed by paclitaxel.
Her 2 neu-positive: 6 cycles of TCH + P.

Avoiding Chemotherapy

Patients with poor performance status.
Tumors with specific characteristics: T₁ or T₂ and ER, PR, or HER2 status.

Molecular Testing for Breast Cancer

Predicts risk of recurrence.
Low risk: Avoid chemotherapy.
High risk: Chemotherapy is recommended.
Available tests: Oncotype Dx, PAM 50, mammo print, Endopredict, and CAN assist (Indian test)

Chemotherapy and Radiotherapy

Indications for Chemotherapy: Positive lymph nodes, locally advanced breast cancers, ER, PR-negative tumors, HER 2 neu-positive tumors, metastasis.
Neoadjuvant Chemotherapy (NACT) Indications: Locally advanced breast cancer, triple-negative breast cancer, HER 2 neu-positive tumors, large tumors with patient desiring breast conservation surgery.
NACT Advantages: Downstages/downsizes the tumor, reduces micrometastasis, provides an in vivo indicator of chemosensitivity.
RECIST Criteria: Standardized evaluation criteria for assessing tumor response to chemotherapy.

Contraindications for Breast Conserving Surgery (BCS)

Absolute Contraindication: Pregnancy.
Relative Contraindications: Previous radiation therapy to the chest wall, collagen vascular diseases, multifocal tumors, diffuse microcalcifications/DCIS, locally advanced breast cancer, large tumor: breast ratio.

Technical Considerations for BCS

Multicentric tumors, multifocal tumors, diffuse microcalcifications/DCIS, locally advanced breast cancer, large tumor: breast ratio.
BCS can be performed after neoadjuvant chemotherapy.

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Description

This quiz focuses on the various treatment modalities for breast cancer, including surgery, chemotherapy, radiotherapy, and hormonal therapy. It also explores oncoplasty techniques and the management of treatment side effects. Test your knowledge on the effectiveness and recurrence rates of different surgical options.