MANAGEMENT
In the neoadjuvant setting, the role of MRI in breast cancer management is best described as:
A) Only used to evaluate distant metastasis during follow-up
B) A tool to guide surgical resection in patients not responding to therapy
C) A method to assess tumor response, especially in large or multifocal tumors
D) A tool for definitive diagnosis and biopsy guidance
C) A method to assess tumor response, especially in large or multifocal tumors
Which of the following should not receive tamoxifen after surgery for DCIS (NCCN guidelines)?
A) Premenopausal patients with ER positive tumors
B) Premenopausal patients with ER negative tumors
C) Postmenopausal patients with ER negative tumors who had an episode of DVT three years ago
D) Postmenopausal patients with ER positive tumors who have had post-op radiation
E) Patients who are ER negative and have no family history of breast cancer
C) Postmenopausal patients with ER negative tumors who had an episode of DVT three years ago
What is the definition of a pathological complete response (pCR) in neoadjuvant breast cancer treatment?
A) No evidence of cancer cells in the blood
B) Absence of invasive cancer in the breast and lymph nodes after treatment
C) Reduction in tumor size by 50%
D) Reduction in tumor size by 30% with no metastasis
B) Absence of invasive cancer in the breast and lymph nodes after treatment
Triple-negative cancers are more likely to metastasize to:
A) Bone and brain
B) Bone and viscera
C) Brain and viscera
D) Brain
C) Brain and viscera
Skin-sparing mastectomy (SSM) is considered oncologically safe in the following clinical settings EXCEPT:
A) Risk reduction surgery in high-risk patients
B) Early stage
C) Invasive breast cancer or Ductal Carcinoma In-Situ (DCIS)
D) Inflammatory breast cancer
D) Inflammatory breast cancer
What role does the Oncotype DX assay play in the management of early-stage breast cancer in the neoadjuvant setting?
A) It helps to assess the HER2 status of tumors
B) It predicts the likelihood of chemotherapy benefit in hormone receptor-positive, HER2-negative breast cancer
C) It guides the decision for radiation therapy in early-stage disease
D) It is used to predict pathological complete response after neoadjuvant chemotherapy
B) It predicts the likelihood of chemotherapy benefit in hormone receptor-positive, HER2-negative breast cancer
Which of the following is NOT involved in the mechanism of action of pertuzumab?
A) Inhibits ligand-dependent signaling
B) Causes dimerization of HER2 and HER4
C) Prevents resistance to anti-HER2
D) Activates the PI3K pathway
B) Causes dimerization of HER2 and HER4
For patients receiving neoadjuvant chemotherapy for breast cancer, which factor is most likely to predict a poor response to treatment?
A) Older age
B) Higher tumor grade
C) Hormone receptor positivity
D) Low HER2 expression
C) Hormone receptor positivity
Which imaging technique is most appropriate for diagnosing an intraductal papilloma in a woman under 30?
A) X-ray
B) Ultrasound
C) CT scan
D) MRI
B) Ultrasound
A 45 year old lady has wide excision for a screen detected BIRADs V lesion which on guided biopsy was reported as ER negative DCIS. The histopathology reports the lesion to be DCIS with a 1 mm clear margin and an invasive focus of 0.5 mm. Which of the following is true about this case?
A) The clear margins achieved are acceptable
B) The invasive focus is not significant and can be labeled as microinvasion
C) Endocrine therapy will reduce the event of recurrence in this case, so reexcision of the cavity is not required
D) The choice of further treatment is between radiotherapy and endocrine therapy depending on facilities available
C) Endocrine therapy will reduce the event of recurrence in this case, so reexcision of the cavity is not required
When planning for oncoplastic breast surgery in a patient with large, ptotic breasts, which of the following is a key consideration in choosing between volume displacement and volume replacement techniques?
A) The need for nipple-areolar complex preservation
B) Tumor size and location
C) The patient's desire for reconstruction versus conservation
D) The patient's prior history of breast cancer treatment
B) Tumor size and location
During axillary dissection, which of the following is not true?
A) Damage to thoracodorsal nerve causes winging of the scapula
B) Thoracodorsal pedicle should be preserved for future TRAM flap reconstruction
C) Long thoracic nerve can be identified running transversely across the axilla and should be preserved
D) Exposure of axillary nerve should be avoided
E) All of the above
E) All of the above
Which of the following factors does the Oncotype DX test NOT assess in determining the recurrence score?
A) Tumor size
B) Tumor grade
C) Estrogen receptor status
D) Lymph node involvement
D) Lymph node involvement
There are different "scoring systems" available for determining the grade of a breast cancer. One of these systems is the Nottingham Histologic Score system (also termed “the Elston-Ellis modification of Scarff-Bloom-Richardson grading system”). According to this scoring system what will be the grade of a tumor if the score is 6-7?
A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4
B) Grade 2
If there is residual disease after neoadjuvant HER2 targeted agents, what is the next line of action?
A) Pertuzumab
B) Trastuzumab Deruxtecan
C) Trastuzumab Emtansine
D) Trastuzumab
C) Trastuzumab Emtansine
According to the NCCN panel, preoperative systemic therapy is indicated for which of the following groups of patients?
A) Patients with operable, stage T1N0, triple-negative breast cancer (TNBC)
B) Patients with inflammatory breast cancer and bulky or matted cN2 axillary nodes
C) Patients with well-defined tumors and no regional lymph node involvement
D) Patients with estrogen receptor (ER)-positive breast cancer, stage T1N0
B) Patients with inflammatory breast cancer and bulky or matted cN2 axillary nodes
In which group of Breast Cancer patients, in whom neoadjuvant chemotherapy is indicated, will the incorporation of platinum agents increase pathologic complete response (pCR) rate according to the European Society Guidelines?
A) Elderly patients with BRCA-associated HER2neu positive tumors
B) Elderly patients with BRCA-associated triple-negative tumors
C) Young patients with BRCA-associated HER2neu-positive tumors
D) Young patients with BRCA-associated triple-negative tumors
E) Platinum agents are not considered in breast cancer patients
D) Young patients with BRCA-associated triple negative tumors
What is a key consideration when using preoperative systemic therapy to improve breast conservation outcomes in breast cancer patients?
A) Clear surgical margins may not always be obtained, and follow-up mastectomy may be required
B) Preoperative therapy is only used for patients with HER2-positive disease
C) A higher likelihood of response is expected in tumors with poor delineation
D) Preoperative systemic therapy is contraindicated in patients with large tumors relative to breast size
A) Clear surgical margins may not always be obtained, and follow-up mastectomy may be required
FEELING LUCKY?
Which famous scientist was born on the same day that Charles Darwin died?
A) Nikola Tesla
B) Albert Einstein
C) Isaac Newton
D) Marie Curie
B) Albert Einstein (born on March 14, 1879)
For what duration is trastuzumab used for stage III Breast Cancer?
A) 6 months
B) 9 months
C) 12 months
D) 18 months
C) 12 months
According to the NCCN panel, which patients with HER2-positive breast cancer are considered appropriate candidates for preoperative therapy with pertuzumab?
A) Patients with less than cT2 and cN0 disease
B) Patients with cT2 or greater, or cN1 or greater disease
C) Only patients with inflammatory breast cancer
D) Only patients with tumors smaller than 2 cm
B) Patients with cT2 or greater, or cN1 or greater disease
Which of the following effects of trastuzumab is Fc-mediated?
A) Induction of apoptosis
B) Inhibition of angiogenesis
C) Antibody-dependent cell mediated cytotoxicity
D) Down-regulation of HER2 on the plasma membrane
C) Antibody-dependent cell mediated cytotoxicity
Which of the following statements is true regarding the correlation between pathologic response and long-term outcomes in early-stage breast cancer?
A) Pathologic response has the strongest correlation with long-term outcomes in hormone receptor-positive breast cancer.
B) Pathologic response is most strongly correlated with long-term outcomes in HER2-positive breast cancer.
C) Pathologic response is least correlated with long-term outcomes in triple-negative breast cancer.
D) Pathologic response has the strongest correlation with long-term outcomes in triple-negative breast cancer.
D) Pathologic response has the strongest correlation with long-term outcomes in triple-negative breast cancer.
Drug for adjuvant therapy for high-risk, early-stage breast cancer that is HER2 -ve, BRCA-mutated, and has previously been treated with chemotherapy?
A) Pembrolizumab
B) Olaparib
C) Tamoxifen
D) Dostarlimab
B) Olaparib
40 year old female; invasive ductal carcinoma grade 3; cT3N1M0; right breast carcinoma; HR negative, HER2 positive
What is the first line management for this patient?
A) MRM
B) Lumpectomy
C) Radiation
D) Pre-operative chemotherapy + targeted therapy
D) Pre-operative chemotherapy + targeted therapy