Breast

Question 1

What is the first line management of an isolated breast cancer <4cm wide?

Answer 1

WLE

Question 2

What is the involvement of the LNs in pre op assessment and procedure optimisation?

Answer 2

Women with no palpable axillary LNopathy should have pre-op USS before primary surgery. If positive, they should have a sentinel node biopsy to assess nodal burden

Patients presenting with palpable LNopathy should receive axillary node clearance at primary surgery

Question 3

What factors can help determine whether mastectomy or WLE is the best option?

Answer 3

Multifocal mastectomy, solitary WLE

Central mastectomy, peripheral WLE

Large lesion in small breast mastectomy, small lesion in large breast WLE

DCIS >4cm mastectomy, DCIS <4cm WLE

Question 4

What should be offered to women post WLE?

Answer 4

Breast reconstruction AND

Whole breast radiotherapy as this reduces risk of recurrence by 2/3rds

Question 5

What patient population are aromatase inhibitors particularly used in?

Answer 5

Post menopausal women with ER+ve Ca

Question 6

What is the most commonly used biological therapy, and what is a contraindication to its use?

Answer 6

Trastuzumab (Herceptin) - used in HER2 positive tumours

Cannot be used if history of heart disorders

Question 7

What chemotherapy regimen is commonly used for breast cancer?

Answer 7

FEC

Fluorouracil
Epirubicin
Cyclophosphamide

Question 8

What are the features of duct ectasia?

Answer 8

A thick greenish/cheesy nipple discharge with a peri-areolar lump, commonly presenting around the time of the menopause with ‘slit like’ nipple retraction

Question 9

What is the discharge like in a ductal papilloma?

Answer 9

Bloodstained

Question 10

What should occur after breast conserving surgery?

Answer 10

Radiotherapy as standard

Question 11

What endocrine therapy is most commonly used in elderly patients even if they are ER+ and why?

Answer 11

Aromatase inhibitors such as Letrozole, as this is how oestrogen is made in post menopausal patients

Question 12

What should be prescribed for patients with grade 3 tumour and axillary nodal involvement?

Answer 12

Cycotoxic chemo +- Herceptin (trastuzumab)

Question 13

Pagets disease of the nipple is most commonly associated with which underlying breast pathology?

Answer 13

Invasive ductal carcinoma

Question 14

What is the difference between Paget’s disease and eczema?

Answer 14

Pagets starts at the nipple and spreads to the areola, whereas eczema progresses opposite to this

Question 15

A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.

Answer 15

Fibroadenoma - non tender, discrete and highly mobile

Question 16

A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.

Answer 16

Fibroadenosis/fibrocystic breast disease/benign mammary dysplasia

Question 17

What is the inheritance of BRCA1/2?

Answer 17

AD

Question 18

What breast lesion would show the halo sign on mammography?

Answer 18

Breast cyst

Question 19

What would a ‘snowstorm sign’ on mammography indicate?

Answer 19

Ruptured breast implant which may track to the axillae

Question 20

Which patients should be referred using TWW for ?breast cancer?

Answer 20

ANY women >30 with an unexplained breast lump
OR
Age>50 with any of the following unilateral signs:
discharge
retraction
other changes of concern

Question 21

Periductal mastitis is common in which patient population?

Answer 21

Smokers

Question 22

What is the use of neo-adjuvant chemotherapy?

Answer 22

It downsizes the tumour before surgery allowing for breast conservation surgery as opposed to mastectomy

Question 23

How do you T stage a breast cancer?

Answer 23

T1 <2cm
T2 2-5cm
T3 5+cm
T4a invades chest wall
T4b invades skin
T4c invades chest wall and skin
T4d inflammatory breast cancer

Question 24

Cause of lump in an obese patient with skin tethering?

Answer 24

Fat necrosis

Question 25

When might you excise a fibroadenoma?

Answer 25

If >3cm and causing moderate discomfort

Question 26

Can family members be chaperones?

Answer 26

No

Question 27

What type of breast cancer have a grey gelatinous surface?

Answer 27

Mucinous carcinoma

Question 28

When would you see comedo necrosis on core biopsy?

Answer 28

High grade DCIS

Question 29

What can be done with nodal involvement should the patient not consent for surgery?

Answer 29

Axillary radiotherapy