booby cancer

Question 1

breast cancer risk factors

Answer 1

• Female
• Increased oestrogen exposure – earlier onset of periods + later menopause
• More dense breast tissue – more glandular tissue
• Obesity
• Smoking
• Fam history – first degree relative
• HRT – particularly combined HRT containing bother oestrogen + progesterone
• COCP – gives small increase in risk of breast cancer, but risk returns to normal 10 yrs after stopping pill

Question 2

breast cancer screening

Answer 2

mammogram every 3yrs to women age 50-70yrs
- bilateral MLO + CC
- suspicious finding go to 1 stop clinic

1 stop clinic = triple assessment
- imaging - US, mammography >40yrs
- pathology - core biopsy, large volume vacuum biopsy

-> scoring 1 to 5

Question 3

origins of metastatic breast cancer

Answer 3

2Ls 2Bs

Lung
liver
bones
brain

Question 4

breast cancer imaging

Answer 4

US
- lumps in young (<30)
- helpful distinguishing solid to cystic
mammograms
- more effective for older
- can pick up calcification missed by US

MRI
- screening high risk women
- to further assess size + feature of tumour

Question 5

mastectomy vs wide local excision

Answer 5

mastectomy
- multifocal tumour
- central tuour
- large lesion in small breast
- DCIS >4cm
- patient choice

wide local excision
- solitary lesion
- peripheral tumour
- small lesion in large breast
- DCIS <4cm
- patient choice

Question 6

who is radiotherapy offered to post breast cancer surgery

Answer 6

• wide local incision
• T3/T4 tumours + those with 4 or more positive axillary nodes
• palliative breast radiotherapy

for it to be effective should start within 12week
- if also requires chemo, this is delivered first + RT commences 4 weeks after last doses of chemo

Question 7

hormone treatment in oestrogen receptor positive women

Answer 7

premenopausal = tamoxifen

postmenopausal = aromatase inhibitors (letrozole/anastrozole)

Question 8

biological therapy in HER2 positive cancers

Answer 8

trastuzumab (Herceptin)

*cannot be used in patients with hx of heart disorders

Question 9

indications for neoadjuvant chemotherapy

Answer 9

(neoadjuvant = before primary treatment)

downsizing a tumour (inoperable to operable) + coverting to lumpectomy instead of mastectomy

enrolling patients on clinical trial for “indow of opportunity”
locally advanced breast cancers
large primary tumours

Question 10

indications of adjuvant chemo

Answer 10

(adjuvant = after primary treatment)

risk of relapse
tumour
extent
grade
proliferation
vascular invasion

Question 11

online prognostic tool of breast cancer

Answer 11

PREDICT v2

• oncotype DX test used mostly in tayside

Question 12

triple neg early breast cancer

Answer 12

chemo - neoadjuvant/adjuvant
20% of breast cancers
higher risk to develop brain / CNA or visceral mets

Question 13

inflammatory breast cancer

Answer 13

1-3% of boob cancers
present similarily to breast abscess or mastitis
- swollen, warm, tender breast with pitting skin (peau d’orange)
- does not respond to antibiotics

worse prognosis than other breast cancers

Question 14

in situ carcinomas

Answer 14

ductal (DCIS)
lobular (LCIS)

in situ carcinoma
- confined within basement membrane of acini + ducts
- cytologically malignant but non-invasive carcinoma

Question 15

lobular in situ neoplasia

Answer 15

marker of subsequent risk
true precursor lesion - invasive malignancies arise from it

• atypical lobular hyperplasia
• lobular carcinoma in situ`

Question 16

histology of lobular in situ neoplasia

Answer 16

solid proliferation
intracytoplasmic lumens
ER positive
E-cadherin neg

Question 17

features of lobular carcnoma in situ

Answer 17

frequently multifocal +bilateral
low incidence - decreases more after menopause
not palpable, not visible grossly
may calcify - mammography
usually an incidental finding

Question 18

intraductal proliferations risk of going malignant

Answer 18

• Epithelial hyperplasia of usual type – 2x RR
• Columnar cell hyperplasia +/- atypia
• Atypical ductal hyperplasia – 4x RR
• Ductal carcinoma in situ – 10x RR
• (RR = risk of going malignant)

Question 19

ductal carcinoma in situ

Answer 19

15-20% of breast malignancies
pre/cancerous epithelial cells of breast ducts
localised to a single area
usually nonpalpable, picked up on screening
arises in TDLU
characteristically unicentric -> single duct system

confined within basement membrane of duct
- may involve lobules - cancerisation
- may involve nipple skin - Pagets

Question 20

ductal carcinoma in situ on imaging + definitive diagnosis

Answer 20

malignant calcifications
shape - linear or branching
distribution - cluster or segmental

pleomorphic (varying) size + density

definitive diagnosis = vacuum assited core biopsy

Question 21

microinvasive carcinoma

Answer 21

rare
DCIS (high grade) with invasion of <1mm

Question 22

malignant invasive breast cancer

Answer 22

malignant epithelial cells which have breached the basement membrane
infiltration of normal tissue
risk of metastasis + death

Question 23

assoc tumours with BRAC1 + BRAC2

Answer 23

BRAC1 - breast, ovarian, bowel, prostate

BRAC2 - breast, ovarian, prostate, pancreatic

Question 24

which hormone recepter breast cancer carries the worst prognosis

Answer 24

triple neg
- cancers which do not express HER2, progesterone or oestrogen receptor

(progesterone receptor - supports ER, rarely positive is ER neg)

Question 25

how is histological grade of breast cancers assessed

Answer 25

nottingham grading system

Question 26

prognostic indicators of breast cancers

Answer 26

nottingham prognostic index
adjuvant! online
NHS predict

Question 27

invasive ductal carcinoma - NST

Answer 27

(NST = non-specific type)
originate in cells from breast ducts
80% of breast cancers
seen on mammogram, patient usuallt feels mass

Question 28

invasive ductal carcinoma on imaging

Answer 28

stellate solid mass or pleomorphic microcalcifications
mass may be circular + calcifications may be non-staging

US
- can be helpful in defining a malignant solid mass
- NOT effective in evaluating calcifications

Question 29

invasive lobular carcinomas

Answer 29

10% of invasive breast cancers
not always visible on mammograms

spreads diffusely with typical histological indian file pattern
- usually not apparent on palpation or by imaging until advanced age

Question 29

invasive lobular carcinomas

Answer 29

10% of invasive breast cancers
not always visible on mammograms

spreads diffusely with typical histological indian file pattern
- usually not apparent on palpation or by imaging until advanced age

Question 30

worse vs better prognosis

Answer 30

worse
- basal
- BRACA1 mutation
- HER2 overexpression

better
- luminal A
- ER/PR positivity