Mc cause of cancer in female in developed countries : Ca breast

Mc cause of cancer in female in India : Ca cervix

2
nd
mc cause of cancer death in female : Breast ca
Mc cause of cancer death in females : Ca lung
Mc type of breast ca : Scirrous type of Infiltrating (Invasive) Ductal Adenocarcinoma
Scirrous type infiltrating adenocarcinoma is also called as : Not otherwise specified type
Mc site of breast ca : Upper Outer Quadrant
Mc site of distant mets : Bone
Mc sign & Symptom of Breast ca : Palpable mass
Most reliable diagnostic test for breast ca : Open excisional biopsy
Inspection of breast is done in position : Sitting
Palpation is done in position : Supine
Recent onset of nipple inversion may be asign of : breast ca
Recommended frequencies of breast Phy exam : 20-30yrs Every 2-3yrs, >40yrs Annual
examination of breast
Most useful technique to detect early breast ca : Mammography
Only reliable means of detecting breast cancer before a mass can be palpated : Mammography
Most easily recognisable mammographic abn : Calcifications
Mc mammographic abn ass with carcinoma : Clustered Polymorphic microcalcifications (each <1mm)
Most curable of all breast cancers are : those with microcalcifications on mammography
Sensitivity of mammography is : 60-90%
Specificity of mammography is : Nonpalpable 30-40%, Palpable 85-90%
Recommended frequency of breast mammography : 1)Baseline mammography b/w 35-40yrs in all
women 2)Every 1-2yrs in women aged 40-49yrs 3)Annual mammogram for >50yrs, 4) No mammography
less than 35yrs
Mammography failure occurs in : Clinical ca in dense breast, Young woman wih mammary dysplasia,
Medullary type of breast ca
Mc type of mammography used is : ~Film Screen mammography~
Dose of radiation in mammography : 500 mill Roentgen
Some imaging modalities for breast ca : Automated breast USG, Thermography, Diaphanography,
Ductography
What is simple/Total mastectomy : Removal of Breast + Small amount of skin
What is radical mastectomy (Halsted Operation) : Breast + Axillary contents including LN removed
enbloc
Structures preserved in Radical mastectomy : Axillary vein, Cephalic vein, Long thoracic nerve of bell
What is MRM : Total mastectomy + Axillary LN dissection
Structures preserved in MRM : Pectoralis major muscle, Long thoracic nerve, Thoracodorsal nerve, Blood
supply to lattismus dorsi muscle
What are forms of MRM : Patey procedure, Scanlon modification of Patey, Auchincloss procedure,
Madden mastectomy
What is Pateys procedure : Preserve Pectoralis major, remove minor
What is Scanlon modification of pateys : Division of pectoralis minor(not removal)
What is Auchincloss procedure : No removal/division of pectoralis minor
What is madden procedure : Both pectoralis major & Minor preserved
What is major advantage of MRM : Radiation therapy is not necessary
What is Extended radical mastectomy : Classical radical mastectomy + Enbloc removal of Internal
mammary LN
What are breast conservation procedures : Tyectomy(Lumpectomy), Wide excision, Segmantal
mastectomy, Quadrantectomy
What is Adjuvant radiotherapy : When admistered after mastectomy
What is Primary radiothrapy : Whe admistered after breast conservative surgery
Criteria of inoperability of breast ca given by : Haagenson
Mc form of adjuvant Rx : Combination chemotherapy
Mc drugs used in combination chemotherapy : CMF regimen Cyclophosphamide, MTX, 5-FU
Mc drug used in hormonal Rx : Tamoxifen
For premenopausal women, whether nodes involved/not, ER positive/Negative, Adjuvant Rx of choice is
: Combination chemo
For Post menopausal women with ER negative, irrespective of nodes, Adjuvant Rx is : Combination
chemo
For post menopausal women With nodes & ER positive, Adj Rx of choice is : Tamoxifen with/without
chemo
For Post menopause with ER positive, Nodesnegative, Adj Rx of choice is : Tamoxifen
Time period upto which tamoxifen given in Rx of breast ca : 5yrs in premenopausal, 2yrs in post
menopausal
Palliative Rx indicated in which stage : Stage 4
Types of palliative Rx : Radiotherapy, Endocrine Rx, Chemo
What is Aminoguthemide : Aromatase inhibitor
Most useful single chemotherauptic agent used todate is : Doxorubicin (Adriamycin)
Most popular chemo combinations : CMF, CMF +prednisolone, CAF
Cardiomyopathy due to Doxorubicin occurs if cumulative dose exceeds : 450mg/m2
Single most reliable indicator for Prognosis of breast ca : Stage
Median survival for those who resist all types of Rx : 2.5-3yrs
Time taken for single cell to 1cm growth of breast ca : 10yrs

= Factors ass with poor prognosis
Greater size
Aneuploidy
Negative receptors
High histo grade
Tumor labelling index <3%
S phase fraction >5%
Lymphatic/Vascular invasion
More microvessels in tumor
Over expression of Cathepsin, basic Fibroblast GF, erb B2, HER-2/neuoncogene, Type 4 collagen, Allelic
deletion on Ch 11/13, Amplification of C-myc & int-2
Mc tumor marker to evaluate Mets & Recurence in breast ca : CA 15-3, CEA
Most accurate measurement of tumor growth is : S phase analysis using flow cytometry
Breast ca recurrences indicate : Blood borne mets
Mc site of local recurence : Skin of chest wall
Chest wall recurrences occur within : 2yrs of mastectomy
Rx of choice for local recurrence after mastectomy for single isolated nodule : Local excision or RadioRx
Rx of choice for multiple nodules/evidence of regional node involvement : Radiation of entire chest wall
Rx of choice for post menopausal with local recurrence : Systemic chemo / Hormonal Rx
Mc location for implantation of Breast prosthesis : Submuscular (b/w pectoralis major & Minor)
Mc used implants : Silicon gel implants, Saline filled implants, Autologous tissue transplant
Most popular autologous tissue implants used currently : TRAM-flap (Trans rectus abdominus) >>
Latismus dorsi
Current implant of choice for breast reconstruction : Saline filled implants