LWBK1006-24 LWW-Govindan-Review December 12, 2011 19:15
Chapter 24•Cancer of the Breast 347Answer 24.39. The answer is B.
An underlying malignancy is found in approximately 97% of patients
with Paget’s disease, frequently with high-grade histology. It is not uncom-
mon for an underlying tumor to be several centimeters away from the
nipple. Half of cases are hormone-receptor negative, consistent with the
higher rate of underlying high-grade tumors. (See text: Paget’s Disease. See
also Chaudary Ma, Millis RR, Lane EB, et al. Paget’s disease of the nipple:
A ten year review including clinical, pathological, and immunohistochem-
ical findings. Breast Cancer Res. 1986;8:139–146; Marshall JK, Giffith
KA, Haffty BG, et al. Conservative management of Paget disease of the
breast with radiotherapy; 10- and 15-year results. Cancer. 2003;97:2142–
2149.)Answer 24.40. The answer is B.
Because breast irradiation is contraindicated in the pregnant patient, mas-
tectomy may prove to be a more appropriate management approach even
in patients with tumors amenable to breast conservation, particularly in
women early in pregnancy.Answer 24.41. The answer is C.
Neoadjuvant chemotherapy plays a multifaceted role in the treatment
of locally advanced breast cancer. It may downsize a tumor, making
it more amenable to breast-conserving treatment or helping to achieve
a more acceptable cosmetic result. It may downstage the patient’s dis-
ease by decreasing the number of positive axillary lymph nodes, thereby
improving survival. Giving neoadjuvant chemotherapy allows the oncol-
ogist to gauge the chemosensitivity of the tumor. Regardless of whether
chemotherapy is given in the neoadjuvant or adjuvant setting, postsurgical
radiation is still required, and the outcome is the same. Hormonal ther-
apy improves outcome and should be given after any additional adjuvant
treatment.Answer 24.42. The answer is D.
IBC is a clinical diagnosis. Dermal lymphatic invasion on full-thickness
skin biopsy is often seen but is not required for diagnosis. Most women
will have lymph node involvement. In the absence of distant metastases,
IBC is staged as T4d, stage IIIC disease.Answer 24.43. The answer is A.
Approximately 80% of cases of male breast cancer are estrogen-receptor
positive, presumably because men are effectively postmenopausal. There
does not appear to be a difference in the chances a tumor will be estrogen-
receptor positive depending on the age of a male patient with breast
cancer.Answer 24.44. The answer is C.
As in women, DCIS is primarily a local disease with excellent prognosis,
and axillary node dissection is not necessary.