Question 11#

Which of the following is true regarding breast cancer metastasis? 

A. Metastases occur after breast cancers acquire their own blood supply

At approximately the 20th cell doubling, breast cancers acquire their own blood supply (neovascularization). Thereafter, cancer cells may be shed directly into the systemic venous blood to seed the pulmonary circulation via the axillary and intercostal veins or the vertebral column via Batson plexus of veins, which courses the length of the vertebral column. These cells are scavenged by natural killer lymphocytes and macrophages. Sixty percent of the women who develop distant metastases will do so within 60 months of treatment. 

Question 12#

All of the following are true concerning breast LCIS EXCEPT:

A. Develops only in the female breast

LCIS originates from the terminal duct lobular units and develops only in the female breast. Cytoplasmic mucoid globules are a distinctive cellular feature. The frequency of LCIS in the general population cannot be reliably determined because it usually presents as an incidental finding. The average age at diagnosis is 45 years, which is approximately 15 to 25 years younger than the age at diagnosis for invasive breast cancer.

Question 13#

Which of the following concerning breast cancer staging is correct?

A. Stage I tumors have no metastases to either lymph nodes or distant sites

Question 14#

Factors that determine the type of therapy offered to patients after diagnosis of breast cancer include all of the following EXCEPT:

A. Whether or not a therapy has been proven effective in clinical trials

Once a diagnosis ofbreast cancer is made, the type of therapy offered to a breast cancer patient is determined by the stage of the disease, the biologic subtype, and the general health status of the individual.

Question 15#

Which of the following statements about the management of distal carcinoma in situ (DCIS) is true?

A. DCIS treated by mastectomy has a local recurrence rate of 2%

Women with DCIS and evidence of extensive disease (>4 em of disease or disease in more than one quadrant) usually require mastectomy. For women with limited disease, lumpectomy and radiation therapy are generally recommended. For nonpalpable DCIS, needle localization or other image-guided techniques are used to guide the surgical resection. Specimen mammography is performed to ensure that all visible evidence of cancer is excised. Adjuvant tamoxifen therapy is considered for DCIS patients with estrogen-receptor (ER)-positive disease. The gold standard against which breast conservation therapy for DCIS is evaluated is mastectomy. Women treated with mastectomy have local recurrence and mortality rates of <2%.