Question

A 75-year-old hypertensive woman has a 2 x 2 cm infiltrating duct cell carcinoma in the subareolar region of the breast. There are no palpable lymph nodes or distant metastases; however, she was treated for pulmonary tuberculosis 20 years ago. The best line of management for her would be:

• A. Modified radical mastectomy followed by radiotherapy
• B. Modified radical mastectomy followed by 6 cycles of chemotherapy
• C. Breast conservation surgery followed by radiotherapy
• D. Modified radical mastectomy followed by hormone therapy

Hint:

Think about which treatments are safe given her old TB and her age.

Answer 1

The Correct Option is D

This question is solved by ruling out any option that clashes with either her old tuberculosis or her age.

1. MRM followed by radiotherapy: radiotherapy risks reactivating old pulmonary TB and aggravating existing lung damage — a poor choice here.
2. MRM followed by chemotherapy: 6 cycles of chemotherapy is excessive and poorly tolerated at age 75 for a small, node-negative tumor.
3. Breast conservation followed by radiotherapy: a subareolar tumor is a poor candidate for conservation, and radiotherapy again clashes with her TB history.
4. MRM followed by hormone therapy: mastectomy removes the disease without needing chest irradiation, and hormone therapy suits an elderly patient with a likely receptor-positive tumor — the safest and most appropriate option.

Correct answer: Modified radical mastectomy followed by hormone therapy.