Breast

Question 1

What is the blood supply of the breast?

Answer 1

Branch of the internal mammary artery and lateral thoracic branches of the axillary artery

Question 2

In which age group in particular do breast cysts most commonly occur?

Answer 2

Most occur in peri-menopausal age group

Question 3

How are breast cysts diagnosed and managed?

Answer 3

Cyst aspiration US - guided - surgical excision only indicated if non-traumatic aspiration is blood-stained (risk of intracystic cancer or +++ recurrence)

Question 4

In which age group do fibroadenomas most commonly occur?

Answer 4

Below 30

Question 5

How are fibroadenomas managed?

Answer 5

Can be left alone unless patient wants it removed. Removal indicated if investigations shows suspicious features

Question 6

What may microcalcification on mammography suggest?

Answer 6

DCIS - proliferation of malignant breast epithelium that is confined to the duct lystem

Question 7

Which type of carcinoma has the classical histological features of single files of malignant cells (Indian files)?

Answer 7

Invasive lobular carcinoma

Question 8

Which of the following is pre-malignant? DCIS vs LCIS

Answer 8

Ductal carcinoma in situ is pre-malignant, LCIS is not

Question 9

What is the biggest risk factor for developing breast cancer?

Answer 9

Age

Question 10

What are the Australian breast screening guidelines?

Answer 10

Free screening mammography for those aged 40 - 74.

Only those between 50-69 are actually invited to attend, as this is where screening mammography has been proven to be most effective

Two-yearly intervals

Question 11

What is multicentric vs multifocal disease?

Answer 11

Multicentric - 2 or more foci of cancer within different quadrants of same breast

Multifocal - 2 or more foci of cancer within same breast quadrant

Question 12

What are the complications of mastectomy +/- axillary dissection? (4)

Answer 12

Bleeding, infection

Seroma - pocket of fluid developing

With axillary dissection in particular: pain and numbness of upper medial aspect of arm and chest wall below axilla, arm lymphoedema

Question 13

When is tamoxifen used in treating breast cancer?

Answer 13

Tamoxifen is a selective oestrogen receptor modulator

Most effective in women with oestrogen receptor-positive breast cancer - can be adjuvant in early disease

Question 14

When is herceptin used in treating breast cancer?

Answer 14

If cancer is Her2- receptor positive

Question 15

What does the triple test in assessing breast disease refer to?

Answer 15

1. Physical examination
2. Imaging - mammography
3. Needle biopsy

Question 16

What is mammary duct ectasia also known as?

Answer 16

‘Spilt milk’ mastitis/plasma cell mastitis

Question 17

In which patient population is ovarian oblation considered (in breast cancer) and how is this achieved

Answer 17

In pre-menopausal women who are positive for oestrogen receptors, achieved by surgical oophorectomy, ovarian irradiation by using LHRH analogues e.g. goserelin

Question 18

How can metastatic breast disease treated? (4)

Answer 18

Endocrine therapy: Tamoxifen, oophorectomy, progestogesns, non-steroidal aromatase inhibitors

Chemo

Radio

Limited role of surgery (Except oophorectomy as above)

Question 19

What are phyllodes tumours also known as?

Answer 19

serocystic disease of brodie

Question 20

What are phyllodes tumours?

Answer 20

Fibroepithelial tumours that clinically resemble fibroadenoma, all are are considered to have malignant potential (so rx: wide local excision with clear margins or , total mastectomy if aggressive)