12 - Breast Carcinoma

Question 1

how many women are affected by breast carcinoma?

Answer 1

1/8 females

accounts for 22% of female cancers

Question 2

how many men are affected by breast carcinoma?

Answer 2

1/870 males

Question 3

how does breast carcinoma appear in mammogram?

Answer 3

soft tissue opacity

microcalcification

Question 4

how does breast carcinoma appear macroscopically?

Answer 4

hard lump

fixed mass

tethering to skin

peau d’orange dimpling of skin

Question 5

RFs for breast carcinoma?

Answer 5

gender

age

menstrual history

age at first pregnancy

radiation

family history

personal history

hormonal treatment

genetics

obesity

lack of exercise

alcohol

Question 6

what % of breast cancers can be put down to inherited factors?

Answer 6

5-10%

Question 7

BRCA1 gene - % contribution to hereditary breast cancer?

Answer 7

20-40%

Question 8

BRCA2 gene - % contribution to hereditary breast cancer?

Answer 8

10-30%

Question 9

TP53 gene - % contribution to hereditary breast cancer?

Answer 9

<1%

Question 10

PTEN gene - % contribution to hereditary breast cancer?

Answer 10

<1%

Question 11

other genes - % contribution to hereditary breast cancer?

Answer 11

30-70%

Question 12

histological classification - 2 types of 2 non-invasive carcinomas?

Answer 12

DCIS - ductal carcinoma in situ

LCIS - lobular carcinoma in situ

Question 13

histological classification - 3 types of 2 invasive carcinomas?

Answer 13

invasive ductal carcinoma (NST)

Invasive lobular carcinoma and its variants

special types

Question 14

how is in situ carcinoma detected?

Answer 14

it’s preinvasive so it does not form palpable tumour -

therefore,

can only be detected using X-ray in DCIS-screening

Question 15

name 4 special types of breast carcinomas?

Answer 15

tubular carcinoma

mucinous carcinoma

carcinoma with medullary features

metaplastic carcinoma

Question 16

name 5 diagnostic procedures for breast carcinomas?

Answer 16

clinical examination

radiology

FNA cytology

needle core biopsy

wide local excision with adequate margins

Question 17

screening for breast cancer - how much does it reduce mortality?

Answer 17

30%

Question 18

screening for breast cancer - women at what age?

Answer 18

50-70 years

Question 19

screening for breast cancer - how often are mammograms carried?

Answer 19

every 3 years

Question 20

mircocalcifications - are they harmful?

Answer 20

usually harmless - small % may be pre-cancerous/ cancerous tissue

Question 21

what are the 2 big indicators of breast cancer on mammography?

Answer 21

masses

microcalcifications

Question 22

describe 2 routes of LOCAL metastases?

Answer 22

skin

pectoral muscles

Question 23

describe 2 routes of LYMPHATIC metastases?

Answer 23

axillary nodes

internal mammary nodes

Question 24

describe 4 routes of BLOOD metastases?

Answer 24

bone

lungs

liver

brain

Question 25

what is NPI?

Answer 25

Nottingham Prognostic Index -

based on tumour size, grade and nodal status

Question 26

what is ER and PR?

Answer 26

ER - oestrogen receptors

PR - progesterone receptors

Question 27

what are ER and PR used to indicate?

Answer 27

the response to hormonal therapies

Question 28

how does HER-2 relate to trastuzumab?

Answer 28

~20-30% positive - predicts response to trastuzumab

Question 29

how to determine management of breast cancer?

Answer 29

staging of BC

Question 30

treatment - surgery procedures?

Answer 30

mastectomy

breast conserving surgery - WLE

Question 31

other non-surgical treatments?

Answer 31

radiotherapy

antihormonal therapy

chemotherapy

Question 32

which drug is used in antihormonal therapy?

Answer 32

Tamoxifen