Oncology 1 Breast Cancer

Lecture Outline
I. Signs and symptoms
II. Types of breast cancer
A. Infiltrating ductal carcinoma
B. Carcinoma in situ
III. Risk factors
IV. Prevention
V. Screening
A. Breast self exam (BSE)
B. Clinical breast exam (CBE)
C. Mammography
VI. Biopsy
A. Fine needle aspiration
B. Core needle biopsy
C. Hormone receptor and HER2 testing
VII. Treatment
A. Breast conserving therapy
B. Mastectomy
C. Adjuvant therapy
D. Chemotherapy

Signs and Symptoms

1. What are the signs and symptoms of breast cancer?

2. What form of breast cancer is characterized by breast erythema, scaliness, and peau dorange?

3. What are the signs and symptoms that suggest breast cancer metastasis?

Types of Breast Cancer

4. What is the most common type of breast cancer?

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5. What is ductal carcinoma in situ (DCIS)?

6. Why is lobular carcinoma in situ (LCIS) only found incidentally?

Risk Factors and Prevention

7. What are the risk factors for developing breast cancer?

8. What drugs can be given to high-risk women for breast cancer prevention?

Quick Review
9. What is the most common location of breast cancer?

10. What breast pathology fits the following description?

Most common breast mass in postmenopausal women
Small, mobile, firm mass with sharp edges in a 24-year-old woman
Most common breast mass in a premenopausal woman
Most common form of breast cancer
High level of estrogen receptor positive cells
Bloody unilateral nipple discharge
Eczematous patches on nipple
Multiple, bilateral, fluid-filled lesions with diffuse breast pain
Firm, fibrous mass in a 55-year-old woman

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11. How do DCIS and LCIS increase a womans risk of breast cancer?

12. A 40-year-old female has a friend that was recently diagnosed with breast cancer, and she is worried that this
might happen to her. She wants to be tested for BRCA1 and 2 because she heard that it could detect breast
cancer. When is BRCA1 and 2 testing indicated?

Screening
13. How often should women be instructed to do breast self exams (BSE)?

14. Why are mammograms used for breast cancer screening?

15. What is the recommended age to begin screening mammography?

16. What constitutes a suspicious lesion on a mammogram?

Biopsy
17. In a patient with a mammogram suspicious for breast cancer, or a palpable breast mass, what is the next step
in management?

18. What two tests need to be performed on all biopsies of breast cancer tissue?

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Treatment
19. What is the usual treatment for early stage breast cancer?

20. What is the next step in breast tumor resection given the following sentinel node results?
Negative sentinel node:
Positive sentinel node:

21. What tissue is removed in a modified radical mastectomy?

22. In general, what is the treatment for advanced breast cancer?

23. What adjuvant treatment is used for estrogen receptor (ER) positive or progesterone receptor (PR) positive
breast cancer?

24. What aromatase inhibitors are used as adjuvant therapy for hormone-receptor positive breast cancer?

25. What drug is used as adjuvant therapy for HER2 positive breast cancer?

26. What are the 4 most common sites of distant metastases in breast cancer?

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End of Session Quiz

1. A 24-year-old woman complains of a breast mass without nipple discharge or pain. On exam you are able to
palpate a 1.5 cm mass in the upper right quadrant of the right breast. Diagnostic mammogram does not
reveal any spiculations or microcalcifications. What are your next steps?

2. Although aromatase inhibitors do not increase the risk of DVT or endometrial cancer, they do increase the risk
of what disease?

3. A 55-year-old female patient with recent history of breast cancer undergoes a left modified radical
mastectomy and is treated with radiation. She presents 2 months post-op complaining of gradual onset
swelling in the left arm. What is the likely diagnosis, and how should this patient be managed?

4. What are the clinical consequences of damaging the long thoracic nerve while performing a radical
mastectomy?

5. A 45-year-old woman is found to have infiltrating ductal papilloma. What is the best initial therapy for this
patient?

6. A 50-year-old woman has her first screening mammogram that reveals a cluster of microcalcifications in the
right breast. What would be the next step in the management of this patient?

7. When should you consider using adjuvant therapy with aromatase inhibitors, tamoxifen, or an LHRH analogue
in the treatment of breast cancer?

8. What risks are associated with taking SERMs?

9. You receive the pathology report for a breast carcinoma that indicates the presence of the HER2 gene. What
agent would most likely be used in the management of this patients breast cancer?

10. With what two types of cancer are BRCA mutations associated?

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