Copy of Medical Oncology Module 4

A 45-year-old woman presents with a new breast lump. Which imaging modality is recommended as the initial step in her diagnostic workup according to current guidelines?

A 55 year old lady presents with orthopnea and paroxysmal nocturnal dyspnea. She has a history of breast cancer treated with chemoradiotherapy and surgery 10 years ago. She has no known cardiac risk factors.

On examination, her apex beat is displaced to the 6th intercostal space in the mid axillary line.She has bibasal crackles on auscultation. She receives treatment with frusemide with good effect.

Which chemotherapeutic agent is responsible for her condition?

A 55-year-old woman presents to your clinic with a palpable lump in her left breast that she noticed 2 weeks ago. She denies any nipple discharge or skin changes over the lump. On examination, the lump is firm and located in the upper outer quadrant of the left breast. You perform a core biopsy, and the pathology report describes atypical ductal hyperplasia.

Which of the following is the most appropriate next step in management?

A 42-year-old woman has recently had a mastectomy after being diagnosed with breast carcinoma. Her paternal grandmother had ovarian carcinoma in her early fifties. She has a 32-year-old well sister. Apart from advising her on appropriate adjuvant therapy, the next most important issue you should also discuss with her is:

A 48-year-old woman presents to your clinic with a 3-month history of spontaneous, unilateral bloody discharge from her right nipple. She denies any palpable lump or recent trauma to the breast.

On examination, the nipple appears slightly inverted but can be easily everted with manipulation, and no skin changes are observed. Mammography and ultrasound of the right breast have been performed, showing no definitive mass.

Nipple discharge cytology was performed, and no malignant cells were identified.

Which of the following statements is most accurate regarding this clinical scenario?

According to a study using the Cancer Intervention and Surveillance Modeling Network (CISNET) models to simulate US breast cancer mortality rates from 1975 to 2019, which factor contributed the most to the observed reduction in breast cancer mortality?

A 62-year-old woman is diagnosed with breast cancer. Histopathological examination reveals that the tumor expresses estrogen receptors (ER) but not progesterone receptors (PR).

Based on the hormone receptor status, which of the following characteristics is most likely associated with this patient’s breast cancer subtype?

In a study analyzing gene expression patterns in breast cancer patients using cDNA microarrays, which of the following findings was NOT observed?

A 32-year-old woman presents to your oncology clinic for a follow-up visit after recently undergoing breast-conserving surgery for early-stage breast cancer. She is otherwise healthy, with no significant past medical history or family history of breast or ovarian cancer. She does not smoke, consumes alcohol socially, and leads an active lifestyle. The surgery was uncomplicated, and she has recovered well, with no residual pain or significant side effects.

The final pathology report from her surgery provides the following details about the tumor:

• Size: 2cm
• Hormone status: Estrogen Receptor (ER) negative, Progesterone Receptor (PR) negative
• HER-2 status: Positive
• Histology: Well-differentiated ductal carcinoma
• Nodal status: No lymph node involvement (Node negative)

Given her young age, the tumor’s characteristics, and her current post-operative status, you are considering the best adjuvant treatment options to improve her overall survival.

The goal is to address the aggressive nature of HER-2 positive tumors while considering the patient’s quality of life and potential treatment-related side effects.

What is the best adjuvant treatment to improve her overall survival?

A 48-year-old postmenopausal woman presents to your clinic with a recent diagnosis of breast cancer. She has been participating in annual breast cancer screening programs due to her dense breast tissue, which is known to increase the risk of breast cancer and can make mammograms less effective at detecting tumors.

During her most recent screening, a new 1.5-cm area of microcalcifications was detected in her left breast, without any associated palpable mass. Subsequent biopsy of this area revealed a Grade 2, ER/PR negative, and HER2-negative infiltrating ductal carcinoma.

The patient has a family history of breast cancer, with a maternal aunt diagnosed at the age of 50. Aside from her current diagnosis, she reports being in good health, with no significant past medical history. Her medications include a daily multivitamin and occasional ibuprofen for headaches. She denies any history of hormone replacement therapy.

On physical examination, she appears well, with normal vital signs and no lymphadenopathy. The only abnormal finding is ecchymosis at the site of the recent breast biopsy.

Given her postmenopausal status, tumor characteristics, and family history, you are considering the most appropriate next step in her management, focusing on local control of the disease while minimizing the risk of recurrence and considering the patient’s quality of life.

Which of the following is the most appropriate next step in management?

A 42-year-old premenopausal woman presents to your clinic with a recent diagnosis of early-stage hormone receptor-positive breast cancer. She has no significant past medical history and her family history is notable for breast cancer in her mother at the age of 50.

On examination, there is a palpable 2 cm mass in the upper outer quadrant of the left breast, with no palpable axillary lymph nodes. Mammography and biopsy have confirmed the diagnosis, and the tumor is found to be estrogen and progesterone receptor positive, HER2 negative, with no lymphovascular invasion.

As part of the multidisciplinary team meeting to discuss her management, you are considering adjuvant systemic therapy options to reduce the risk of recurrence.

Given her premenopausal status and tumor characteristics, which of the following medications should generally be avoided in her treatment plan?

A 45-year-old woman with HER2-positive early breast cancer underwent neoadjuvant chemotherapy consisting of a taxane and trastuzumab. Post-treatment surgical assessment revealed residual invasive disease in the axilla. Considering the patient’s prognosis and the potential benefits of further adjuvant therapy, you are contemplating the next step in her treatment plan.

Which adjuvant therapy should be considered to significantly reduce the risk of recurrence of invasive breast cancer or death in this patient?

In a post-menopausal patient, which one of the following is the best initial hormonal therapy for hormone receptor-positive metastatic breast cancer?

With regards to cancer screening, which of the following cancer is routinely recommended in Australia?

A 48-year-old woman with previously untreated, locally recurrent inoperable metastatic triple-negative breast cancer (TNBC) is under consideration for first-line treatment.

Her tumor has a PD-L1 combined positive score (CPS) of 12.

Which treatment option would most likely provide a significant and clinically meaningful improvement in progression-free survival (PFS) for this patient?

A 62-year-old male with metastatic colorectal cancer, confirmed to have microsatellite-instability-high (MSI-H) and mismatch-repair-deficient (dMMR) markers, is evaluating first-line treatment options with his oncologist.

Given his condition, which of the following treatment strategy is more likely to result in better progression free survival?

Which of the following statements is correct regarding the differences between left-sided and right-sided colorectal cancer?

A 55-year-old male patient with unresectable, RAS wild-type, left-sided, metastatic colorectal cancer is under your care.

Which treatment option would most likely improve his overall survival when added to standard first-line chemotherapy?