Metastatic Breast Cancer (5)

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| By Medicinemcq
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Medicinemcq
Community Contributor
Quizzes Created: 10 | Total Attempts: 24,855
Questions: 5 | Attempts: 326

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Breast Cancer Quizzes & Trivia

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Questions and Answers
  • 1. 

    Which of the following is a potential symptom of breast cancer's metastatic spread?

    • A.

      Nipple discharge

    • B.

      Jaundice

    • C.

      Edema or peau d'orange

    • D.

      Dilated leg veins

    Correct Answer
    B. Jaundice
    Explanation
    Jaundice is a late sign in patients who have metastasis to the liver when hepatobiliary obstruction happens. The liver enzymes and alkaline phosphatase are often elevated. A complete examination includes assessment of the axillae and supraclavicular fossae, examination of the chest and sites of skeletal pain, and abdominal and neurologic examinations. The clinician should be alert to symptoms of metastatic spread, such as the following:

     


    Breathing difficulties
    Bone pain
    Symptoms of hypercalcemia
    Abdominal distention
    Jaundice
    Localizing neurologic signs
    Altered cognitive function
    Headache


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  • 2. 

    Which study may be used to identify nonaxillary lymph node metastasis in patients with breast cancer?

    • A.

      MRI

    • B.

      Ultrasonography

    • C.

      Scintimammography

    • D.

      PET-CT scanning

    Correct Answer
    D. PET-CT scanning
    Explanation
    When PET is combined with CT scanning to assist in anatomic localization, scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences.

    Scintimammography is not indicated as a screening procedure for the detection of breast cancer. However, it may play a role in various specific clinical indications, as in cases of nondiagnostic or difficult mammography and in the evaluation of high-risk patients, tumor response to chemotherapy, and metastatic involvement of axillary lymph nodes.

    Ultrasonography can provide valuable information about the nature and extent of solid masses and other breast lesions and can often provide useful information regarding the staging of the axilla.

     

    The following are current indications for MRI:

     


    Patients with known hereditary gene for breast cancer such as BRCA1 or BRCA2 mutations
    Characterization of an indeterminate lesion after a full assessment with physical examination, mammography, and ultrasonography
    Detection of occult breast carcinoma in a patient with carcinoma in an axillary lymph node
    Further evaluation of suspected multifocal or bilateral tumor
    Evaluation of invasive lobular carcinoma, which has a high incidence of multifocality
    Evaluation of suspected extensive high-grade intraductal carcinoma
    Detection of occult primary breast carcinoma in the presence of metastatic adenocarcinoma of unknown origin


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  • 3. 

    Which is a contraindication to sentinel lymph node biopsy?

    • A.

      Women with ductal carcinoma in situ (DCIS) planning on breast-conserving surgery

    • B.

      Women with DCIS who will be undergoing mastectomy

    • C.

      Women who previously underwent breast and/or axillary surgery

    • D.

      Women who received preoperative/neoadjuvant systemic therapy

    Correct Answer
    A. Women with ductal carcinoma in situ (DCIS) planning on breast-conserving surgery
    Explanation
    Sentinel lymph node biopsy may be offered to the following patients:

     


    Women with operable breast cancer and multicentric tumors
    Women with DCIS who will be undergoing mastectomy
    Women who previously underwent breast and/or axillary surgery
    Women who received preoperative/neoadjuvant systemic therapy


     

    Sentinel lymph node biopsy should not be performed in patients with any of the following:

     


    Large or locally advanced invasive breast cancer (tumor size T3/T4)
    Inflammatory breast cancer
    DCIS (when breast-conserving surgery is planned)
    Pregnancy


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  • 4. 

    Recommended as first-line treatment of estrogen receptor (ER)-positive metastatic breast cancer?

    • A.

      Chemotherapy

    • B.

      Endocrine therapy

    • C.

      Combination chemotherapy and endocrine therapy

    • D.

      None of the above

    Correct Answer
    B. Endocrine therapy
    Explanation
    For patients who have hormone receptor (ER and/or progesterone receptor)-positive disease without life-threatening disease or systemic symptoms requiring immediate palliation for comfort, in general, hormone manipulation is the initial treatment of choice. Response rates are higher with chemotherapy, but so is the incidence of potentially dangerous toxicity, and there is no evidence that patients live longer as a result of receiving initial chemotherapy.

    For ER-positive metastatic breast cancer, using endocrine therapy is recommended rather than chemotherapy as first-line treatment, except in patients with immediately life-threatening disease or those with endocrine resistance.

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  • 5. 

    Which of the following statements is accurate regarding chemotherapy for metastatic breast cancer?

    • A.

      Single-agent regimens are the standard of care

    • B.

      Taxanes are cardiotoxic, which makes substitution of one taxane for another difficult

    • C.

      Combinations of cytotoxic agents may be preferable in patients with life-threatening disease and/or severe symptoms

    • D.

      Any targeted agents other than hormone therapy should be only administered as monotherapy

    Correct Answer
    C. Combinations of cytotoxic agents may be preferable in patients with life-threatening disease and/or severe symptoms
    Explanation
    Cytotoxic chemotherapy for metastatic breast cancer initially consisted of single-agent regimens. Combination therapy is currently considered up front, depending on the patient's performance status, because of higher response rates. When the patient has life-threatening disease and/or severe symptoms that require quick relief, combinations of cytotoxic agents may be preferable because of their high response rate and early onset of clinical benefit. Targeted agents often have low response rates when given as monotherapy, but they provide added benefit when given in combination with cytotoxic chemotherapy.

    Treatment of breast cancer with a taxane in the metastatic setting after treatment in the adjuvant setting may be difficult because of residual toxicity. Although taxanes are not cardiotoxic, they can produce lingering neuropathy (especially paclitaxel) or problems with edema (docetaxel especially), which makes further administration problematic. Substitution of one taxane for another is possible, depending on the nature of the chronic toxicity.

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 20, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Dec 24, 2018
    Quiz Created by
    Medicinemcq
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