Question 1

Women of high socioeconomic status and higher education also have a high incidence of breast cancer, most likely due to:

Accepted Answer

Breast cancer incidence is greater in women of higher education and socioeconomic background. This relationship is possibly related to lifestyle differences, such as age at first birth. Other risk factors for breast cancer include alcohol consumption (the equivalent of two drinks per day may increase risk by 21%). Women of Jewish Ashkenazic (eastern European) heritage also have higher incidences of BRCA1 and BRCA2 genetic mutations.

Question 2

Sarah Pergines, an 82-year-old woman, was referred to the breast surgery service by her gerontologist because of a large inflammatory mass in her left breast. Sarah stated that the lump has existed for several years and she believed it was just part of old age. The surgeon examined Sarah and found tumor nodules growing into the skin of the breast, with breast swelling and redness. Diagnostic imaging results described a tumor that had grown into the chest wall and may have spread to axillary lymph nodes and to other lymph nodes behind the breastbone and below the collarbone. Based on this description, what is Sarah Pergines' probable cancer stage?

Accepted Answer

Stage IIIc is a tumor of any size that has spread either to the lymph nodes behind the breastbone and axillary lymph nodes or to the lymph nodes above or below the collarbone.

Question 3

Ductal ectasia is a benign breast disorder that is difficult to distinguish from cancer, primarily because it presents with:

Accepted Answer

Ductal ectasia, generally seen in women approaching menopause, is described by a hard, irregular mass or masses with nipple discharge, enlarged axillary nodes, redness, and edema. It is difficult to distinguish from cancer.

Question 4

Many breast cancer patients subscribe to various complementary and integrative therapies to provide relief from anxiety, depression, pain, and chemotherapy and radiation therapy related complications and side effects. Quality of life issues become important in providing comfort and life balance. In addition to their oncology physicians and other health care providers, patients may also receive therapeutic assistance for their cancer care from which of the following?

Accepted Answer

Breast cancer patients are increasingly seeking and using complementary and alternative medicine (CAM) and integrative therapies to enhance their surgical and medical treatment (see Table 8-5). Besides using products such as green tea, vitamins E and C, and flaxseed, breast cancer patients are incorporating massage therapy and meditation and enlisting the help of dietitians and nutritionists as they battle breast cancer.

Question 5

The internal thoracic lymph nodes, which drain the inner half of the breast, can also be a channel for the:

Accepted Answer

Lymph drainage generally follows the course of the vessels. Lymphatics drain into two main areas represented by the axillary nodes and the internal thoracic chain of nodes (see Figure 8-3). The internal thoracic nodes are few, but are responsible for most lymph drainage from the inner half of the breast. Thus the lymph system can also be a channel for the spread of malignant disease from the breast to associated areas of the chest wall or to the axilla.

Question 6

In the past, radical procedures, which involved removal of the affected breast and all axillary and thoracic lymph nodes, were used to treat breast cancer. These procedures did not significantly lower mortality. What factor(s) may have contributed to mortality after these procedures?

Accepted Answer

Breast cancer may be a systemic condition at the time of diagnosis. Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection. External physical changes, such as dimpling of the skin, can also indicate the presence of a benign or malignant pathologic process. The older the patient, the more likely it is that a mass is malignant. The most common form of breast cancer is infiltrating ductal carcinoma . The cause of breast cancer remains unknown. The belief that breast cancer spreads by direct extension from its initial site in the breast to adjacent lymph nodes may not always be correct. This could explain why radical breast surgery of the past, which involved removal of the affected breast and all axillary and thoracic lymph nodes, did not greatly lower mortality. Tumor size can usually be correlated with involvement of lymph nodes. The larger a tumor is, the more likely it is that lymph nodes are involved.

Question 7

The mammary glands are affected by physiologic changes throughout a woman's life span. Select the option that best reflects the life cycle events that impact the anatomy and physiology of the breasts.

Accepted Answer

The mammary glands are affected by three types of physiologic changes: (1) those related to growth and development, (2) those related to the menstrual cycle, and (3) those related to pregnancy and lactation.

Question 8

Talia Mendelson, a 27-year-old patient who had a lumpectomy for early-onset breast cancer, arrived at the ambulatory surgery center for infusion port insertion. She is scheduled to begin adjuvant chemotherapy next week. The catheter component of Talia's port system is inserted into what structure(s)?

Accepted Answer

A breast cancer patient who needs further medical treatment may opt to have an implanted venous access port placed under the skin in either the chest, the abdomen, or the upper arm.
The port has a soft, pliable plastic catheter that is threaded into the subclavian vein or right atrium by way of the subclavian or internal jugular vein under x-ray guidance.

Question 9

A breast biopsy, performed after the patient has received a local anesthetic, will require adjunct sedation and monitoring equipment. What relevant considerations should the surgical team member note during the preoperative assessment?

Accepted Answer

Patient allergies should be reviewed to avoid allergic or toxic reactions to local anesthetics. When adjunct sedation is also scheduled, monitoring equipment (e.g., electrocardiogram [ECG], pulse oximeter, blood pressure apparatus) should also be readied.

Question 10

Identify the marginal boundaries of the breasts.

Accepted Answer

The breasts extend from the second to the sixth rib horizontally and from the lateral edge of the sternum to the anterior axillary line.

Question 11

Breast screening guidelines are developed and published by the American Cancer Society (ACS) for asymptomatic women of various age and risk groups. Select the statement that best reflects the ACS guidelines for women at high risk for breast cancer.

Accepted Answer

The American Cancer Society Breast Cancer Screening Guidelines for Asymptomatic Women recommends breast self-examination (BSE) monthly and clinical breast examination (CBE) every 3 years for women ages 20 to 39. For women 40 and older, the guidelines recommend BSE monthly, CBE annually, and screening mammography (two views of each breast) annually. Asymptomatic women who are identified to be at higher risk need to have an individualized screening plan that may differ from these guidelines.

Question 12

Select the statement that best describes fine needle aspiration of a suspicious breast mass.

Accepted Answer

Once a mass is identified, the physician has multiple techniques to establish a diagnosis. Cytologic examination of the aspirate can assist in microscopic evaluation of the mass. During a fine needle aspiration biopsy (FNAB), the physician anesthetizes a small area of the breast with lidocaine. A 22- or 25-gauge needle attached to a 20-ml syringe is inserted into the mass, and a small amount of the contents is aspirated.

Question 13

The goal of breast cancer surgery is removal of the mass with a margin of normal tissue and a good cosmetic result. The choice of procedure depends on the size and site of the mass, the characteristics of the cells, the stage of the disease, and the patient's choice. Select the statement that best reflects the difference between minimally invasive excisional breast biopsy with stereotactic image-guided location and removal of tissue.

Accepted Answer

In an excisional biopsy, the entire tumor mass is excised along with a small margin of normal tissue for examination. Digital stereotactic imaging and use of minimally invasive instruments to locate and remove tissue allow for simultaneous biopsy and removal of mammographic densities. Masses located near the patient's areola, high in the axilla, or near the chest wall are not appropriate for this technique. The benefits to the patient include small incisions for cosmetic results, decreased disfigurement, shortened time between detection and diagnosis, and elimination of the need for more involved surgical intervention.

Question 14

Breast cancer is usually staged to measure the extent of the disease and to design a specific treatment plan, using the TNM (T = tumor; N = node; M = metastasis) classification system. Apply the description of a stage 0 carcinoma in situ to the appropriate disease description listed below.

Accepted Answer

Stage 0 is carcinoma in situ. Ductal carcinoma in situ (DCIS) is defined as abnormal cells that are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated. Lobular carcinoma in situ (LCIS) is defined as abnormal cells that are in the lining of a lobule. LCIS seldom becomes invasive cancer.

Question 15

Fibrocystic changes in the breast describe many different breast changes. These changes affect almost all women at some time in their lives. Nipple discharge is more commonly associated with benign lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and:

Accepted Answer

Discharge is usually significant only if it is spontaneous and persistent. Chronic unilateral nipple discharge, especially if bloody, should prompt an investigation for occult carcinoma.

Quiz 8: Breast Surgery