Category: breast

natural history breast cancer

natural history breast cancer

Q. True about breast cancer is?

a) Doubling time of breast tumor is 1 month

b) Skip metastasis in level iii lymph nodes is common

c) Lungs are commonly involved by direct invasion

d) Dimpling of skin is due to shortening of cooper's ligaments

Ans 

CDH 1 mutation

CDH 1 mutation

Q ) Hereditary diffuse Gastric carcinoma is associated with which  breast cancer
A. Ductal carcinoma NOS subtype
B. Lobular carcinoma
C. DCIS
D. Metaplastic carcinoma

Answer for Q 79

Majority of Gastric Cancers are sporadic,

1–3% of GCs arise as a result of inherited cancer predisposition syndromes.

 Li-Fraumeni syndrome, Lynch syndrome, Peutz-Jeghers syndrome, hereditary breast and ovarian cancer,MUTYH-associated adenomatous polyposis (MAP), familial adenomatous polyposis,  juvenile polyposis syndrome and PTENhamartoma tumour syndrome (Cowden syndrome).

Read on for answer

Breast Cancer Management

Breast Cancer Management

Q) Management of occult breast cancer with N1 lymph nodes:

a) Modified radical mastectomy (MRM) with axillary dissection

b) MRM with radiotherapy to axilla

c) Only axillary dissection with radiotherapy and chemotherapy to axilla

d) Simple mastectomy with chemotherapy

Answer for premium members

Phyllodes tumor

Phyllodes tumor

Q) Which of the following is true about phyllodes tumor?

a) It has a fast spread and is locally invasive

b) It is benign proliferative in ANDI

c) Mammography is diagnostic

d) Young patients less than 20 years old are more commonly involved

answer for Premium members only-  

Discuss about Phyllodes tumor and their malignant potential.

Ductal carcinoma in situ

Ductal carcinoma in situ

Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as

a) <3,5 cm in size and 2mm free resection margin

b) <2.5 cm and 2mm margin

c) <3 cm size and 3 mm margin

d) <2.5 cm size and 3 mm margin

Answer - Free answers to surgery mcqs
d

Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.

Simple mastectomy is the standard of care but many centers now consider it over treatment.

Van Nuys system uses

  1. Age of the patient
  2. type of DCIS
  3. presence of microcalcification
  4. Size
  5. resection margin

On mammography this is seen as clustered clustered calcification

Treatment options are 

  1. Mastectomy
  2. Breast conserving therapy (Lumpectomy +radiation and hormonal)

More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.

 Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.

REF : Sabiston 853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334775/

 

Inflammatory Carcinoma breast

Inflammatory Carcinoma breast

Q) In terms of cure best results in inflammatory carcinoma breast  are seen with-

a) Surgery alone

b) Chemotherapy

c) Radiotherapy

d) All of the above

Surgery MCQ PDF - Free Answer

d) 

Inflammatory carcinoma of the breast is a rare aggressive tumor that blocks the sub dermal lymphatics as a result of which cutaneous edema is common . Differentiating it from a breast abscess is important and biopsy is diagnostic. It is also responsible to peau d orange

Treatment is multidisciplinary and involves, chemotherapy followed by surgery followed by radiotherapy.

 

 

 

Inversion of nipple

Inversion of nipple

Q) Simple nipple inversion is seen in?

a) Duct ectasia

b) Puberty

c) Peri ductal fibrosis

d) Carcinoma breast

Answer free

b

Inversion of nipple  is  seen in a lot of conditions, both benign and malignant. Common causes are 

  1. Duct ectasia
  2.  After breast Surgery
  3. Fat necrosis
  4. Mondor disease
  5. Chronic peri ductal mastitis
  6. Carcinoma breast 

Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.

Simple nipple inversion occurring at puberty  or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.

Suction pumps and cosmetic surgery can also help.

Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.

Ref - Bailey 801

Grading of benign nipple inversions for management

In grade I, the nipple is easily pulled out manually and maintains its projection quite well.  It has minimal fibrosis  thus, manual traction and a single, buried purse-string suture are enough for the correction.

Grade II (majority)  the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.

In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.

Ref https://www.ncbi.nlm.nih.gov/pubmed/10654681

 

 

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