Câncer de mama - Questões Comentadas Residência Médica e Revalida

Introduction

The instructor introduces the topic of breast cancer and explains how the session will be structured.

• The session is about breast cancer.

• 12 questions have been selected for discussion.

• The instructor will discuss each question and provide alternative solutions.

• There will be a break between the first six questions and the second set of six questions.

• Participants can ask questions in the chat, which will be answered during breaks or at the end of the session.

Breast Cancer Staging

The instructor discusses breast cancer staging, including clinical and anatomical staging, TNM system, tumor size, lymph node involvement, metastasis, and treatment options.

• Breast cancer staging is done using clinical and anatomical staging based on TNM system criteria.

• Tumor size is classified as T1 (less than 2 cm), T2 (2 to 5 cm), or T3 (more than 5 cm).

• Lymph node involvement is classified as N0 (no lymph nodes involved), N1 (mobile ipsilateral axillary lymph node involved), N2 (fixed ipsilateral axillary lymph node involved or internal mammary nodes involved), or N3 (ipsilateral infraclavicular or supraclavicular lymph node involved).

• Metastasis is classified as M0 (no distant metastasis) or M1 (distant metastasis present).

• Treatment options depend on tumor stage. For tumors that are locally advanced, neoadjuvant therapy may be used before surgery. For tumors that are not locally advanced, surgery may be performed first followed by adjuvant therapy.

Importance of Bone Scans in Breast Cancer Diagnosis

The instructor explains why bone scans are important in diagnosing breast cancer.

• Bone scans are important in diagnosing breast cancer because bone metastasis is the most common type of metastasis in breast cancer.

• Bone scans can detect bone metastasis before it becomes symptomatic, allowing for earlier treatment and better outcomes.

• However, bone scans are not necessary for initial staging of breast cancer.

Rastreamento de metástases em pacientes com câncer de mama

Nesta seção, o palestrante discute as opções de rastreamento de metástases em pacientes com câncer de mama.

Opções de rastreamento

• A cintilografia óssea é o exame mais importante para verificar a presença de metástases ósseas.

• Em pacientes com estádio maior ou igual a 2B e múltiplos linfonodos envolvidos ou tumores localmente avançados, recomenda-se a realização da tomografia computadorizada por emissão de prótons pósitrons (PET-CT).

• Estudos atuais sugerem que o PET-CT pode substituir todos os outros exames para rastreamento de metástase na paciente com câncer de mama. No entanto, ainda é um exame caro e pouco disponível.

Conduta frente ao nódulo bi-rads 3

Nesta seção, o palestrante discute qual deve ser a conduta frente ao nódulo bi-rads 3.

Classificação bi-rads

• A classificação bi-rads foi criada para deixar os laudos dos exames de imagem da mama mais objetivos.

• Bi-rads 3 indica um achado no exame provavelmente benigno. A chance de câncer é muito pequena (até 2%). A conduta é repetir o exame em seis meses.

• Bi-rads 4 indica um achado suspeito. A chance de câncer é de mais de 2% e menos de 95%. A conduta é fazer uma biópsia.

• Bi-rads 5 indica um achado provavelmente maligno. A chance de câncer é muito alta (mais de 95%). A conduta é fazer a biópsia imediatamente.

Bi-Rads 3 and Factors of Risk for Breast Cancer

In this section, the speaker discusses Bi-Rads 3 and factors of risk for breast cancer.

Bi-Rads 3

• Bi-Rads 3 is a finding that is likely benign.

• The recommended course of action is to repeat the mammogram in six months.

• Other alternatives include surgical biopsy with stereotactic marking, mamotomy, or core biopsy. However, these are not indicated for Bi-Rads 3.

Factors of Risk for Breast Cancer

• Factors of risk for breast cancer can be divided into three categories: personal, environmental and behavioral; reproductive and hormonal history; and genetic and hereditary factors.

• Personal, environmental, and behavioral factors include age over 50 years old, obesity after menopause, sedentary lifestyle, alcohol consumption, frequent exposure to X-rays or previous radiation therapy, previous biopsy with atypia result or dense breasts (85% or more density on mammography).

• Reproductive and hormonal history factors include early menarche before age 12 years old, nulliparity (never having given birth), late first pregnancy after age 30 years old, postmenopausal hormone therapy use for more than five years.

• Genetic and hereditary factors include family history of ovarian cancer or breast cancer before menopause (before age 50), family history of male breast cancer or mutations in BRCA1/BRCA2 genes.

Factors of Risk for Breast Cancer - Impedir 2019

In this section, the speaker discusses a question from Impedir 2019 about identifying the woman with the lowest risk for developing breast cancer based on various risk factors.

Identifying Lowest Risk for Breast Cancer

• Factors of risk for breast cancer can be divided into three categories: personal, environmental and behavioral; reproductive and hormonal history; and genetic and hereditary factors.

• The woman with the lowest risk for developing breast cancer would have the least number of risk factors in all three categories.

Fatores de risco para câncer de mama

Nesta seção, a palestrante discute os principais fatores de risco para o desenvolvimento do câncer de mama e como identificá-los. Ela apresenta uma questão com diferentes alternativas e explica por que algumas estão corretas e outras não.

Identificação dos fatores de risco

• A idade da paciente, história familiar de câncer de mama em homem e mutação genética são alguns dos principais fatores de risco.

• Uma paciente sem nenhum fator de risco tem menos chance de desenvolver câncer de mama.

Análise das alternativas

Alternativa A

• Menarca aos 12 anos não é um fator de risco.

• Primeiro filho aos 17 anos também não é um fator de risco.

• Menopausa aos 42 anos também não é um fator de risco.

Alternativa B

• Menarca aos 14 anos não é um fator de risco.

• Primeiro filho aos 17 anos também não seria um fator de risco.

• Menopausa aos 52 anos também não seria um fator de risco, mas pode indicar menopausa tardia em comparação com outras alternativas.

Alternativa C

• Menarca aos 16 anos não é um fator de risco.

• Primeiro filho aos 32 anos é um fator de risco.

• Todas as pacientes apresentam o mesmo risco, mas isso não é verdade porque algumas têm fatores de risco e outras não têm nenhum.

Classificação Bi-Rads

Nesta seção, a palestrante explica a classificação Bi-Rads e como ela é usada para determinar a conduta em casos de nódulos mamários.

Classificação Bi-Rads

• A classificação Bi-Rads varia de zero (exame inconclusivo) a seis (malignidade comprovada).

• O Bi-Rads 5 indica um achado provavelmente maligno, com chance de câncer muito alta.

Conduta para cada tipo de lesão

• Para nódulos sólidos suspeitos, o tipo de biópsia indicado seria a biópsia por agulha grossa ou core biopsy.

• Para o caso específico do nódulo espiculado descrito na questão, que é um Bi-Rads 5, a conduta indicada seria fazer uma biópsia o quanto antes possível.

Diagnosing and Treating Breast Cancer

In this section, the speaker discusses the importance of identifying the molecular subtype of a breast tumor to determine the appropriate treatment. They also explain which type of biopsy is preferred for visible nodules on ultrasound.

Identifying Molecular Subtype and Biopsy Type

• Identifying the molecular subtype of a breast tumor is essential in determining the appropriate treatment.

• Core biopsy guided by ultrasound is preferred for visible nodules on ultrasound as it is more practical, faster, easier, and more accurate than other methods.

• Stereotactic-guided biopsy is used when a lesion is only visible on mammography.

• Fine needle aspiration biopsy only confirms whether or not cancer cells are present but does not provide enough information to determine treatment.

• Repeating mammography in six months is not an appropriate course of action for BI-RADS 3 lesions.

Treatment Options for HER2 Positive Breast Cancer

In this section, the speaker explains what HER2 positive breast cancer is and discusses different treatment options.

Understanding HER2 Positive Breast Cancer

• HER2 positive breast cancer has an overexpression of HER2 receptors on its cell membrane.

• Trastuzumab (Herceptin) is a drug used to treat HER2 positive breast cancer.

Treatment Options

• Tamoxifen, goserelin, acetate medroxyprogesterone, and raloxifene are not appropriate treatments for receptor hormonal negative tumors like HER2 positive breast cancer.

Her2 Superexpression and Trastuzumab

In this section, the speaker discusses how the superexpression of Her2 leads to an increased proliferation of tumor cells and how trastuzumab is used to treat patients with breast cancer who have Her2 superexpression.

Her2 Superexpression and Trastuzumab

• Her2 superexpression leads to increased proliferation of tumor cells.

• Trastuzumab is used to treat patients with breast cancer who have Her2 superexpression.

Course and Question Bank Overview

In this section, the speaker provides an overview of their course and question bank.

Course and Question Bank Overview

• The course includes over 600 hours of video lectures, access to a forum for questions, personalized study plans, and access to a list of questions based on engineering reverse.

• The question bank has over 172k questions with more than 80k commented alternative by alternative. It also has more than 54k questions that are commented in video format.

• The system allows users to choose from over 20 filters when selecting questions. Users can create custom lists or timed simulations for practice.

• Users can opt for access between six months up to three years depending on their needs.

Exam Question Discussion

In this section, the speaker discusses exam questions related to health screening tests.

Health Screening Tests

• A patient who is asymptomatic without any family history or personal risk factors should undergo health screening tests such as glucose testing and ECG.

• The speaker discusses a case of a 70-year-old woman who is asymptomatic and without any family history or personal risk factors.

Rastreamento de Câncer

This section discusses the recommended cancer screening guidelines for various types of cancer.

Recommended Cancer Screenings

• Colonoscopy is recommended for colorectal cancer screening from ages 50 to 75.

• Mammography is recommended every two years from ages 50 to 74 for breast cancer screening.

• Densitometry is recommended for osteoporosis screening in women over 65 or those with risk factors.

• Pap smear is recommended every three years from ages 21 to 29 and every three to five years with HPV testing from ages 30 to 65 for cervical cancer screening.

Incidence of Cancer in Brazil

This section discusses a question related to the incidence of cancer in Brazil.

Incidence of Cancer in Brazil

• The statement that "about ninety percent of breast cancer cases occur in women without a family history" is incorrect and confusing. This question was later annulled due to its poor wording.

• Prostate cancer is the most common type among men, while breast, cervical, and uterine cancers are more frequent among women depending on their region.

Medical Consultation

This section describes a medical consultation scenario.

Medical Consultation Scenario

• A woman named Claudia visits her family doctor at age 43. She has no comorbidities, takes no medication, and has no family history of disease. She drinks alcohol once a week and exercises three times a week.

Recomendações de rastreamento do Ministério da Saúde e iOS Task Force

Nesta seção, o palestrante discute as recomendações de rastreamento para diferentes tipos de câncer, incluindo câncer colorretal, câncer de tireoide, câncer de mama e câncer cervical. Ele também identifica a alternativa incorreta em uma questão relacionada a essas recomendações.

Recomendações de rastreamento para diferentes tipos de câncer

• O rastreamento do Câncer colorretal é recomendado com colonoscopia dos 50 ou 75 anos de idade.

• O rastreamento do Câncer de tireoide não é recomendado nos adultos assintomáticos.

• O rastreamento do Câncer de mama deve ser feito a cada dois anos com a mamografia das mulheres dos 50 aos 74 anos.

• A densitometria óssea é recomendada para mulheres a partir dos 65 anos ou às mulheres com menos de 65 anos se tiver fator de risco para osteoporose.

• O rastreamento do câncer cervical deve ser feito com o papanicolau a cada três anos nas mulheres dos 21 aos 29 anos e entre os 30 e 65 anos pode ser feito o papanicolau a cada três anos e captura híbrida a cada cinco anos.

Identificação da alternativa incorreta

• A alternativa incorreta é que a ultrassonografia transvaginal está indicada como forma do rastreamento do Câncer de ovário com os em dosagem de ca-125. Nem o Ministério da Saúde e nem a ex-presidente Taís que força recomenda o rastreamento de câncer de ovário.

Detecção precoce de câncer de mama

Nesta seção, o palestrante discute um artigo publicado no New England Journal of Medicine sobre detecção precoce de câncer de mama por meio da mamografia.

Artigo sobre detecção precoce de câncer de mama

• O artigo descreve que houve um aumento na detecção de tumores menores e uma diminuição na detecção de tumores maiores após a implantação do programa de rastreamento com mamografia.

• No entanto, essa tendência foi mais resultado do aumento substancial na detecção dos tumores menores, onde as mulheres foram diagnosticadas com superdiagnóstico ou excesso diagnóstico.

Programa de Rastreamento e a Mamografia

This section discusses the effectiveness of mammography in detecting breast cancer and the potential risks associated with overdiagnosis.

Effectiveness of Mammography

• The Programa de Rastreamento was able to detect tumors earlier, increasing the proportion of small tumors detected from 36% to 68%.

• Mammography was able to discriminate between tumors that would have led to clinical symptoms and those that never would have. However, it also has the potential to lead to overdiagnosis by detecting lesions that would not have become clinically significant.

• The first assertion is true while the second is false. Therefore, the correct answer is option C.

Risks of Overdiagnosis

• Overdiagnosis is a risk associated with breast cancer screening as it can lead to unnecessary treatment for lesions that would not have caused harm.

• Bi-Rads classification system helps in identifying benign or malignant findings on mammograms. It ranges from 0 (inconclusive result), 1 (normal finding), 2 (benign finding), 3 (probably benign finding), 4 (suspicious abnormality), 5 (highly suggestive of malignancy), and 6 (known biopsy-proven malignancy).

Revalida Questão sobre o INCA

This section discusses a question from Revalida about INCA's recommendations for breast cancer screening.

INCA Recommendations for Breast Cancer Screening

• INCA recommends organized breast cancer screening by mammography for women aged 50-69 years every two years.

• This recommendation is different from the recommendations of other organizations such as Febrasgo, which recommend screening with mammography from ages 40 to 74.

Bi-Rads Classification System

This section provides a detailed description of the Bi-Rads classification system used to identify benign or malignant findings on mammograms.

Bi-Rads Classification System

• The Bi-Rads classification system ranges from 0 (inconclusive result), 1 (normal finding), 2 (benign finding), 3 (probably benign finding), 4 (suspicious abnormality), 5 (highly suggestive of malignancy), and 6 (known biopsy-proven malignancy).

• The recommended course of action varies depending on the classification. For example, a patient with a Bi-Rads score of 2 would require routine follow-up, while a patient with a score of 5 would require immediate biopsy.

Banco de Questões

In this section, the speaker talks about the benefits of their question bank.

Features of the Question Bank

• The bank has over 172,000 registered questions.

• Over 80,000 questions have been commented on alternative by alternative.

• Over 54,000 questions have been commented on in video format.

• Users can use more than 20 filters to choose a question to prepare for their exam.

• Questions can be chosen based on residency or revalidation exams, year of the exam, examining board and topic/subtopic.

Personalized Lists and Timed Simulations

In this section, the speaker discusses how users can create personalized lists and timed simulations using the question bank.

Features of Personalized Lists and Timed Simulations

• Users can create personalized lists of questions.

• Users can participate in timed simulations to prepare for their exams.

• Results from timed simulations can be compared with other users' results to determine preparedness for an exam.

Additional Benefits of Acquiring the Question Bank

In this section, the speaker talks about additional benefits that come with acquiring the question bank.

Additional Benefits

• Access to lists of questions based on engineering reverse methodology.

• Ability to download full exams.

• Participation in ranked simulated exams with prizes.

• Accessible via iPhone or Android devices.

Course Extensivo

In this section, the speaker introduces their course extensivo which is designed to help students prepare for exams.

Features of Course Extensivo

• Over 600 hours of video lessons available.

• Downloadable material with unlimited downloads.

• Access to a forum for asking questions.

• Access to a schedule, VIP rooms and monitoring.

• Personalized question lists for each topic.

• Options for 6 or 36 months of access.

Bonus Material

In this section, the speaker talks about bonus material that comes with acquiring the course extensivo.

Bonus Material

• Access to the question bank.

• Podcasts of all lessons.

• Course intensivão de 2022.

Conclusion

In this section, the speaker concludes their presentation and thanks viewers for attending.

Conclusion

The speaker thanks viewers for attending and encourages them to contact him if they have any questions.