A 64-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of type 2 diabetes mellitus for which she takes metformin. Her surgical history is a total knee arthroplasty 7 years ago. Her family history is insignificant. Physical examination is notable for an irregular nodule near the surface of her right breast. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of a portion of a breast?
AArthroplasty
BLumpectomy
CVasectomy
DMastectomy
ELaminectomy
The patient undergoes a mammogram, which shows a 6.5mm sized mass with an irregular border and spiculated margins. A subsequent core needle biopsy of the mass shows infiltrating ductal carcinoma with HER2-positive, estrogen-negative, and progesterone-negative immunohistochemistry staining. Blood counts and liver function tests are normal. Laboratory studies show: Hemoglobin 12.5 g/dL Serum Na+ 140 mEq/L Cl- 103 mEq/L K+ 4.2 mEq/L HCO3- 26 mEq/L Ca2+ 8.9 mg/dL Urea Nitrogen 12 mg/dL Glucose 110 mg/dL Alkaline Phosphatase 25 U/L Alanine aminotransferase (ALT) 15 U/L Aspartate aminotransferase (AST) 13 U/L Which of the following is the most appropriate next step in management?
ABreast-conserving therapy and sentinel lymph node biopsy
BBilateral mastectomy with lymph node dissection
CTrastuzumab therapy
DBone scan
EWhole-body PET/CT
A 42-year-old woman presents to the physician because of an abnormal breast biopsy report following suspicious findings on breast imaging. Other than being concerned about her report, she feels well. She has no history of any serious illnesses and takes no medications. She does not smoke. She consumes wine 1–2 times per week with dinner. There is no significant family history of breast or ovarian cancer. Vital signs are within normal limits. Physical examination shows no abnormal findings. The biopsy shows lobular carcinoma in situ (LCIS) in the left breast. Which of the following is the most appropriate next step in management?
ACareful observation + routine mammography
BLeft mastectomy + axillary dissection + local irradiation
CLumpectomy + routine screening
DLumpectomy + breast irradiation
EBreast irradiation + tamoxifen
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