QuestionSBA
QuestionChoice
If the patient was pre-menopausal, tamoxifen would be an appropriate anti-oestrogen medication to use, given that the cancer is oestrogen receptor-positive. However, as the patient is post-menopausal, an aromatase inhibitor should be used in preference.
10034828
b
Tamoxifen
QuestionChoice
A sentinel lymph node biopsy is a surgical procedure that often occurs at the time of a wide local excision or mastectomy, depending on the invasiveness of the cancer. In this case, the patient has expressed a wish to not undergo operative intervention, so this is not a suitable choice. Oral anti-oestrogen medications are likely to be offered.
10034831
e
Sentinel lymph node biopsy
QuestionChoice
This could be an option, however, the patient has expressed she is not keen on surgical management. Anti-oestrogen therapy (letrozole/anastrozole) will likely be offered to slow tumour growth, as the tumour is oestrogen receptor-positive.
10034830
d
Wide local excision
QuestionChoice
Trastuzumab (brand name Herceptin) is a HER-2-directed monoclonal antibody, which may be used by itself or with other chemotherapy. As this cancer is HER-2 negative, it is not an appropriate choice.
10034829
c
Trastuzumab
QuestionChoice
This woman has an oestrogen receptor-positive breast carcinoma. Anti-oestrogen therapy is likely to be used in this case. As the patient is post-menopausal, an aromatase inhibitor (like anastrozole or letrozole) would be used instead of a selective oestrogen receptor modulator. This is because the majority of oestrogen production in post-menopausal females is due to the aromatisation of androgens in the fatty tissues, muscles, and skin.
10034827
a
Letrozole
Concept
Chapter
2693
3779
Breast Cancer
Topic
151
Breast Disease
19369
Letrozole, an aromatase inhibitor, is the preferred treatment for post-menopausal women with oestrogen receptor-positive invasive ductal carcinoma.
A 74-year-old woman is referred to the 2-week-wait breast clinic after finding a lump in the upper outer quadrant of her left breast on self-examination.

She is not keen to have any operative interventions.

Triple assessment outcome:

* Clinical examination - P4 (suspicious of malignancy)

* Imaging (mammography) - M5 (malignant)

* Biopsy - B5 (malignant). Invasive ductal carcinoma.

Immunohistochemistry:

* Oestrogen receptor: strongly positive

* Progesterone receptor: mildly positive

* Human epidermal growth factor receptor 2 (HER2): not expressed

Which of the following is most likely to be a part of her management?
a