P&p Onc Breast Cancer Exam 1

Front 1

Risk factors involved in developing breast cancer (7)

Back 1

Gender (100:1 women to men)
Age (older, avg. 55)
Family History (1-2 genes)
Hormonal Factors (early menarche & late menopause)
History of malignancy in opposite breast
History of benign breast disease
Gene mutations found from blood tests

Front 2

What is the most important prognostic indicator for breast cancer?

Back 2

The number of axillary lymph nodes involved by a tumor.

Front 3

What is the most common histopathology for breast cancer?

Back 3

Ductal carcinoma

Front 4

Which part of the breast do most breast cancers occur?

Back 4

Upper Outer Quadrant, and in the left breast is more common.

Front 5

Distant metastases from breast cancer usually occur where?

Back 5

Most commonly found in the bone.

Front 6

What is the "3-step breast health program"?

Back 6

1. Breast Self-Examination
2. Clinical breast exam
3. Mammographic screening

Front 7

What does ACS recommend for screening mammograms?

Back 7

Women ages 35-39 who are asymptomatic and at avg. risk for developing b.c. should take a BASELINE mammography.

At age 40 women should take yearly mammograms.

Front 8

What are the three node chains most commonly involved in breast ca.?

Back 8

1. Axillary
2. Internal Mammary (IM)
3. Supraclavicular

Front 9

Name five common presenting symptoms of breast cancer.

Back 9

1. Breast mass
2. Nipple discharge or retraction
3. Skin changes and alterations in breast contour
4. Lymphadenopathy
5. Mammographic abnormality

Front 10

What is the most common presenting symptom for breast cancer?

Back 10

A breast mass

Front 11

What is radical mastectomy? How is it different than modified radical mastectomy?

Back 11

Radical mastectomy: the removal of the breast, skin, axillary lymph nodes ans the pectoralis major and minor muscles.

A modified rad. mast. spares the major pectoral muscle and usually spares the pectoralis minor. Also preserves muscle, some skin, lymphatics and blood vessels.

Front 12

A positive estrogen/progesterone status indicates that the tumor is more likely to respond to what kind of therapy?

Back 12

Hormone therapy

Front 13

What are the traditional field arrangements for breast cancer?

Back 13

Tangential (glancing) fields

Front 14

Are breast cancers treated isocentrically or nonisocentrically?

Back 14

A typical dose to the whole breast is treated with an isocenter.
A boost treatment may be treated nonisocentrically.

Front 15

The typical dose to the whole breast is:

Back 15

4500-5000 cGy

Front 16

The boost dose to the breast is typically:

Back 16

1000-1600 cGy.
(This brings the total dose to between 6000 and 6600 cGy)

Front 17

When treating breast ca, the most important dose-limiting structure to consider in treatment planning is the

Back 17

lungs AND heart.

However, the lungs can't take as much radiation as the heart.

Front 18

What condition may delay the patient's simulation for a few days?

Back 18

The patient's arm motion following a mastectomy or an axillary dissection.

Front 19

Describe the treatment position for breast cancer.

Back 19

Supine, both arms above the head, head straight forward (unless treating peripheral lymphatics), feet banded, sponge under knees, may be inclined.

Front 20

Superior field border for breast cancer treatment:

Back 20

First intercostal space, as far cephalad as possible, superior extent of palpable breast, ceph. >2 cm of mass.

Front 21

Inferior field border for breast cancer treatment:

Back 21

Caudad 1-2 cm to the inframammary fold.
For a postmastectomy patient, this can extend to inframammary fold of contralateral breast.

Front 22

Medial field border for breast cancer treatment

Back 22

Midline of patient (suprasternal notch/xiphoid process) or further if mass extends to beyond midline.

Front 23

Lateral field border for breast cancer treatment

Back 23

Midaxillary line, including drain sites or incisions considered at risk, original tumor bed, and appropriate amount of lung margin.

Front 24

Why are wedges used in the treatment of breast cancer? What field are they often not used in? Why?

Back 24

Wedges are used often to improve the dose homogeneity b/c of the irregular shape of the breast. Thinner parts (toward the nipple) may get burnt without the wedge.

The AO/medial field often does not use a wedge in order to reduce scatter radiation to the contralateral breast.

Front 25

What is an important consideration when treating a superclavicular and/or internal mammary node along the whole breast treatment?

Back 25

It's important to remember that these fields cannot overlap the whole breast treatment field because his can lead to hot spots and an overdose of radiation.

Front 26

What can a surgeon do to help in the planning of the breast boost treatment?

Back 26

Place a clip on the tumor bed at the time of resection so that the position and size of the electron field can be optimized.

Front 27

Adriamycin

Back 27

A chemotherapy agent which is toxic to the heart

Front 28

Incisional biopsy

Back 28

Partial removal of the breast mass

Front 29

Ultrasound

Back 29

Imaging modality that differentiates between a solid or cystic mass

Front 30

Multifocal

Back 30

More than one tumor element, but in the same quadrant

Front 31

Fine-needle aspiration

Back 31

Small needle and syringe collect tumor "juice"

Front 32

Aneuploid

Back 32

Cells with an abnormal number of chromosomes; detected by flow cytometry

Front 33

Tamoxifen and megace

Back 33

Type(s) of endrocrine therapy

Front 34

Multicentric

Back 34

Tumors occer in more than one quadrant of the breast

Front 35

Mammographic views

Back 35

Cranio-caudal and medial-lateral

Front 36

Peau d' orange

Back 36

Orange-peel appearance of skin

Front 37

MRI

Back 37

This imaging modality may be appropriate for very dense breasts or silicone implants

Front 38

Excisional biopsy

Back 38

Removal of entire mass for biopsy

Front 39

Coplanar fields

Back 39

The deep border of the medial tangent and the deep border of the lateral tangent form a single plane

Front 40

Core-needle biopsy

Back 40

Larger needle takes a piece of the tumor

Front 41

Name 3 absolute contraindications for breast cancer conservation treatment:

Back 41

Pregnancy, Multicentric disease and Scleroderma

Front 42

Name 3 potential contraindications for breast cancer conservation treatment:

Back 42

A history of vascular disease, Large tumor in a small breast, Extremely large breasts

Front 43

Anatomical superior border/junction that defines the breast:

Extends into the?

Back 43

2nd rib

Axillae

Front 44

Anatomical inferior border/junction that defines the breast:

Back 44

6th rib

Front 45

Anatomical medial border/junction that defines the breast:

Back 45

sternochondral junction

Front 46

Anatomical lateral/posterior border/junction that defines the breast:

Back 46

Midaxillary line

Front 47

The pathological staging system for breast cancer incorporates (3):

Back 47

1. Lymph node status
2. Tumor extent
3. Distant metastasis

Front 48

Proper patient advice for clothing, deodorant and sun exposure during radiation:

Back 48

Wear loose clothing
Avoid commercial deoderants
Avoid sun exposure to skin of treated area

Front 49

TD 5/5 refers to:

Back 49

The minimal tolerance dose for a specific organ/tissue

Front 50

What is the TD 5/5 for the spinal cord (in cGy)?

Back 50

4500 cGy

Front 51

What are the current standard techniques for breast surgery? (2)

Back 51

Modified radical mastectomy and lumpectomy (aka tylectomy)

Front 52

Chemotherapy for breast cancer may consist of:

Back 52

Drug therapy, endocrine therapy, and immunotherapy
???????? WE DIDN'T FIND THIS ONE!!!???????????? should be 1 and 3

Front 53

The standard fractionated schedule for whole breast treatment, including boost, is? (cGy)

Back 53

6000-6600 cGy

Front 54

What is the first skin reaction from radiation therapy?

Back 54

Erythema

Front 55

Chemotherapy consists of 3 cancer-killing agents:

Back 55

Cyclophosphamide (C)
Doxorubicin (Adriamycin) (A)
Paclitaxel

Front 56

Common hormone therapies: (2)

Back 56

Tamoxifen and aromitase inhibitors

Post menopausal (or cause menopause)

Front 57

How many lymph nodes should be examined for an accurate prognosis?

Back 57

Ten or more.
Low risk if less than 3 nodes are positive
High risk if more than 4 nodes are positive

Front 58

Tumor extent-- what is the measurement (in cm) that determines the survival rate?

Back 58

.5 cm
A tumor less than .5 has a 99% 5-year survival.
More than .5 cm has 82%

Front 59

What percentage of breast cancers are ER positive?

Back 59

60%

Front 60

Flow cytometry

Back 60

The evaluation of DNA and ploidy status (aneuploid/diploid) using cells passing a laser

Front 61

Diploid

Back 61

2 sets of chromosomes

Front 62

"S" phase cell cycle indicator

Back 62

if more cells are in the "S" phase (DNA synthesis phase) the tumor may be more aggressive

Front 63

How long can it take a patient to relapse?

Back 63

20 years!

Front 64

What are the two types of lymph nodes surrounding the breast?
What percentage of breast drainage does each account for?

Back 64

Axillary (10-38 on each side) and Internal Mammary.

Drainage: 70% and 30%, respectively.

Front 65

Breast quadrants in order of breast cancer occurance

Back 65

Upper Outer
Upper Inner
Lower Outer
Lower Inner

Front 66

Distant metastases can occur where?

Back 66

Bone, liver, lungs, eyes, ovaries, adrenal glands and pituitary gland

Front 67

What are the techniques for mammography?

Back 67

cranio-caudal and medial-lateral

Front 68

What is the usual route of spread for breast cancer?

Back 68

1st to regional lymph nodes
2nd to internal mammary nodes
3rd to distant mets

Front 69

Tran Flap Procedure

Back 69

reconstructed breast using tissue, muscle, fat and vessels from the abdomen.

Front 70

Chemotherapy can be used when?

What drug should NOT be used during radiation therapy?

Back 70

Before, during, or after OR or RT.

Adriamycin should not be used during RT because of the effects on the heart.