7.1 breast cancer

Question 1

what are the diagnostic tests typically used in breast cancer?

Answer 1

mammography
ultrasonography
biopsy

Question 2

what are the complications of breast cancer?

Answer 2

metastases - commonly to bone, brain, lung and liver

spinal cord compression

hypercalcemia

upper extremity lymphedema

cardiac dysfunction secondary to chemotherapy

infertility in premenopausal patients

Question 3

how can breast cancer be classified?

Answer 3

TNM staging

Question 4

what are the clinical presenting features of breast cancer?

Answer 4

physiological swelling and tenderness

nodularity - lumpy/sore

breast pain (not usually associated in malignancy)

palpable breast lump

nipple discharge, including galactorrhoea

breast infection and inflammation, usually associated with lactation

Question 5

what is pubertal breast development know as?

Answer 5

thelarche

Question 6

how do symptoms of nodularity link to menstruation?

Answer 6

symptoms are greatest about one week before menstruation and decrease when it starts

if changes are bilaterally symmetrical, they’re rarely pathological. if asymmetrical, review patient after one of two menstrual cycles, seeing her mid cycle

Question 7

what is the treatment for nodularity?

Answer 7

analgesia

a good, well fitting bra

Question 8

what are most benign breast lumps found and what are their features?

Answer 8

cysts or fibroadenomas

features include 3D, mobile and smooth shape with regular borders and a solid or cystic consistency

Question 9

what age group are cysts found in?

Answer 9

35-50 usually

palpable as discreet lumps and cannot be distinguished from solid tumours from clinical examination alone

Question 10

what are fibroadenomas?

Answer 10

lumps of fiborous and epithelial tissue in women
peak incidence 20-24 years old

benign and commonly found in young women. the most common type of breast lesion.

Question 11

what differential diagnosis could you think of with unilateral nipple discharge in a non-breastfeeding woman?

Answer 11

galactorrhoea
duct estasia
breast cancer
mastitis 
tumour in milk duct

Question 12

what is mammary duct ectasia?

Answer 12

dilation of major ducts, filled with creamy secretions with periductal inflammation

can get nipple discharge, retracted nipple, acute inflammation or recurrent chronic inflammation with abscess formation

Question 13

what is mastitis?

Answer 13

generalised cellulitis of the breast

treat with antibiotics

Question 14

what is a breast abscess?

Answer 14

build up of pus in breast due to infection

present with point tenderness, erythema and fever

generally related to lactation
non lactation abscesses more frequent in smokers

caused by staph or strep

Question 15

what changes should cause you to refer someone to a cancer specialist immediately?

Answer 15

aged >30 and have an unexplained breast lump with or without pain or
- unexplained lump in axilla

aged >50 with any of the following symptoms in one nipple only

• discharge
• retraction of skin (p’eau d’orange)
• other changes of concer

Question 16

what breast conditions cause mammographic abnormalities?

Answer 16

densities
- invasive carcinomas, fibroadenomas, cysts

calcifications
- DCIS, invasive carcinomas, cysts and other benign changes

Question 17

how do we improve survival from breast cancer?

Answer 17

early detection
neoadjuvant chemotherapy 
gene expression profiles
genetic screening
prophylactic masectomies

Question 18

what are some risk factors for breast cancer?

Answer 18

• age
• BRCA 1/BRCA 2 positive
• family history
• menarche at age 13 or younger
• first child over the age of 30
• later onset of menopause
• drinking

Question 19

how does breast cancer screening work in the UK?

Answer 19

women age 50-70 come every 3 years for a mammogram

Question 20

what is ductal carcinoma in situ?

Answer 20

breast cancer in the milk ducts
may not have symptoms but may present with
- breast lump
- nipple discharge

and histologically

• calcification
• central necrosis

Question 21

what are the common histoloigical types of breast cancer?

Answer 21

adenocarcinoma

DCIS
Invasive

can be classified by histological type