Breast Surgery — MCQs

Question 441: A 30-year-old female presented with unilateral breast cancer associated with axillary lymph node enlargement. What is the further treatment plan following modified radical mastectomy?

• A. Observation and follow up
• B. Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status (Correct Answer)
• C. Adriamycin based chemotherapy only
• D. Tamoxifen only

Explanation: ***Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status*** - The presence of **axillary lymph node enlargement** indicates a higher risk of systemic disease, necessitating **adjuvant systemic therapy** such as chemotherapy. - **Hormone receptor status (estrogen/progesterone receptors)** is crucial for determining the utility of **tamoxifen** as an endocrine therapy, which is often given after chemotherapy to reduce recurrence in hormone receptor-positive tumors. *Observation and follow up* - **Observation alone** is insufficient for a patient with **lymph node-positive breast cancer** as it carries a significant risk of recurrence and metastasis. - **Adjuvant systemic therapy** is required to eradicate micrometastases and improve long-term survival. *Adriamycin based chemotherapy only* - While chemotherapy is essential for **lymph node-positive disease**, omitting **endocrine therapy** (tamoxifen) in hormone receptor-positive cases would be a missed opportunity to further reduce recurrence risk. - **Tamoxifen** specifically targets the estrogen receptor pathway, which is a key driver of growth in a significant proportion of breast cancers. *Tamoxifen only* - **Tamoxifen alone** is not sufficient systemic therapy for **lymph node-positive breast cancer**, as it does not address potential hormone receptor-negative disease or micrometastases that are not responsive to endocrine therapy. - **Chemotherapy** is generally recommended first in node-positive disease to address potential widespread cancer cells.