breast

Question 1

what is the functional unit of the breast

Answer 1

the lobule (where the milk is produce)

Question 2

are breast cysts associated with cancer

Answer 2

yes

Question 3

if someone has cyclical mastalgia what advise can you give

Answer 3

avoid caffeine, wear supportive bra

Question 4

when do fibroadenomas need to be surgically removed

Answer 4

when they are >3cm

Question 5

what is a papilloma

Answer 5

a wart like growth that grows in the ducts of the breast and causes a blood discharge / can present with a palpable lump

Question 6

Ix for a papilloma

Answer 6

need Triple assessment as can be associated with breast cancer

Question 7

MX of papilloma

Answer 7

complete surgical excision and examine the tissue for cancer

Question 8

what happens in mammary duct ectasia

Answer 8

the milk ducts widen and thicken so fluid becomes backed up leading to inflammation and nipple discharge (white grey green)

Question 9

what is mammary duct ectasia linked to

Answer 9

smoking cessation and menopause

Question 10

MX of mammary duct ectasia

Answer 10

no increase risk of breast cancer so reassure, supportive bra is pain and stop smoking

Question 11

how does fat necrosis present

Answer 11

benign lump, dimpling skin change due to localised degeneration of fat tissue following trauma

Question 12

what age do you do a US vs mammogram

Answer 12

40

Question 13

where are benign conditions most common in the breast

Answer 13

in the upper outer quadrant

Question 14

Rf for breast cancer

Answer 14

FHx, early menarche, late menopause, COCP, smoking, obesity, nulliparous

Question 15

what kind of referral is done for someone under 30 with breast lump

Answer 15

non urgent

Question 16

what is the 2WW for breast cancer

Answer 16

30+ with unexplained lump or 50+ with any nipple change

OR any skin change which may be suggestive of cancer

OR aged 30+ with unexplained axillary nodes

Question 17

what is the breast cancer screening programme

Answer 17

mammogram every 3 years from 50-71w

Question 18

what’s a protective factor of breast cancer

Answer 18

breast feeding

Question 19

what is the most common type of breast cancer

Answer 19

invasive ductal carcinoma

Question 20

what is the presentation in inflammatory breast cancer

Answer 20

presents similar to mastitis as the cancerous cells block the lymph drainage which results in an inflamed appearance of the breast

Question 21

when might someone be offered breast cancer screening earlier

Answer 21

first degree relative develops breast cancer before age 40

Question 22

what does breast cancer grade mean

Answer 22

1 = well differentiated, 2 = moderately differentiated and 3 = poorly differentiated

Question 23

what views are mammograms taken in

Answer 23

mediolateral oblique and craniocaudal

Question 24

when would BRCA screening be done

Answer 24

1) since 2024 - new guidelines specifiy anyone with Jewish ancestry (defined as having at least one Jewish grandparent) is eligible for genetic testing
2) any male relative with breast cancer
3) family history of breast cancer at a younger age
4)

Question 25

when is WLE appropriate

Answer 25

if solitary lesion or small lesion in large breast, <4cm and peripheral. Sentinel lymphnode sample done intraoperatively

Question 26

what is always given after WLE e

Answer 26

radiotherapy

Question 27

what kind of genes are BRCA

Answer 27

TSG BRCA 1 - BREAST, ovarian BRCA2 - OVARIAN, breast, pancreatic and prostate

Question 28

what prognostic calculator can be used for breast cancer

Answer 28

predict

Question 29

what are the options for breast surgery

Answer 29

1) pedicled flap - keep blood supply in tact, this can be done in the same operation 2) free flap - from another area (inferior epigastric) so often done in separate op, with involvement of plastics as blood supply disconnect

Question 30

what should the pt be warned about methylene blue dye

Answer 30

will make tears and urine blue

Question 31

what happens if you can't find the sentinel lymphnode intraoperatively

Answer 31

take 3 nodes and sample them

Question 32

what drug can be used to control galactorrhea

Answer 32

dopamine agonists (cabergoline)

Question 33

causes for galactorrhea

Answer 33

drugs (D2 antagonists) like metoclopramide, prolactinoma, non functioning pituitary tumours, hypothyroidism

Question 34

which breast cancer is normally diagnosed before the menopause

Answer 34

LCIS

Question 35

if in initial presentation someone presents with palpable axillary lymphadenopathy, is it still appropriate to do a sentinel lymphnode biopsy

Answer 35

NO just do an axillary lymph node clearance straight away (only biopsy if no clinical signs of it in the axillary lymph nodes)

Question 36

what chemo is used for women who are node +

Answer 36

FEC-D

Question 37

if someone does not have palpable axillary LN, what must you do prior to surgery

Answer 37

US of the axilla and then sentinel LN biopsy

Question 38

SE of tamoxifen

Answer 38

VTE, menopausal symptoms, endometrial cancer

Question 39

SE of anastrozole

Answer 39

osteoporosis

Question 40

when do you give someone chemoprevention for breast cancer and what is it

Answer 40

chemoprevention is the administration of tamoxifen or anastrozole daily to someone who is identified as being at high risk of breast cancer

Question 41

when do you prescribe flucloxacillin for mastitis

Answer 41

when they have continued breast feeding for 12-24 hrs with no improvement, when there is a nipple issue or when they are systemically unwell

Question 42

what is invasive ductal carcinoma also known as

Answer 42

no special type

Question 43

apart from lobular carcinoma, give some examples of other special types

Answer 43

mucinous, medullary, papillary

Question 44

what is fibroadenosis

Answer 44

fibrocystic breast, may be painful, worse before period