Breast

Question 1

What is the prognostic scoring system for a breast tumour?

Answer 1

Nottingham Prognostic Index

Parameters:

• tumour size
• LN involvement
• grade

Score relates to 5y survival rates: <2.5 = 93%, >5.4 = 50%

(AS, Adam)

Question 2

What are risk factors for breast cancer?

Answer 2

• Female
• Oestrogen exposure: early menarch, late menopause,OCP, HRT
• Breast dx: previous Ca, DCIS, FHx
• Genetic: BRCA 1/2

(AS)

Question 3

Identify appropriate investigations of a breast lump

Answer 3

Triple assessment

• Full history
• USS (+ mammogram if >35y, oblique and craniocaudal views)
• Cytology
  
  • FNA - if suspect benign
  • Core needle biopsy - if suspect Ca

(Y3 notes, AS)

Question 4

Idenitfy appropriate investigations when triple assessment has suggested breast cancer

Answer 4

• Bloods: FBC, LFTs, ESR, bone profile
• Imaging (staging): MRI breast (esp if planning breast conserving surgery), CT chest/abdo/pelvis, CXR, USS liver, bone scan

(AS)

Question 5

How do you assess a patient post-mastectomy

Answer 5

• Hx: include RFs, any post-op pain/anaesthesia, current symptoms, tx plan
• O/E:
  
  • Inspect (STRAP): Scar, Tissue (skin, axilla), Radiotherapy evidence, Arm lymphoedema, Pec major (ask pt to press hips)
  • Palpate (BASS): remaining Breast, Axilla, Supraclavicular fossa, Spine
  • Percuss + auscultate lungs for mets
  • Examine abdomen for hepatomegaly

(AS)