Breast

Question 1

Genetics of familial breast cancer

Answer 1

BRCA1 on chromosome 17 - 65% risk
BRCA 2 on chromosome 13 - 45% risk
TP53

Question 2

Risk factors for breast cancer

Answer 2

Obesity
Alcohol
Older age
HRT
COCP
Nulliparity
Not breastfeeding.
FHx (twice as much risk if 1st degree relative has BC)
Atypical ductal hyperplasia
Early menarche
Late menopause

Question 3

Types of receptors or molecules BC can involve

Answer 3

Oestrogen or progesterone receptor (good prognosis)
Proliferation marker Ki67
Her-2 epidermal growth factor receptor (poor prognosis)
Triple negative (no oestrogen, progesterone or Her-2)

Question 4

Histopathology of breast cancers

Answer 4

Most are ductal then luminal then other.

Question 5

Pre-invasive BC state

Answer 5

Ductal carcinoma in situ. Extends from wall to lumen of duct. Can cross basement membrane and become invasive. Later cause Paget’s disease.

Question 6

Risk factors for male BC

Answer 6

Klinefelter’s

BRCA2

Question 7

Presentation of BC

Answer 7

Painless BC lump
On screening
Lump in axilla
Nipple inversion/in drawn/retraction
Skin tethering
Nipple discharge
'Peau d'orange'

Question 8

Diagnostic investigations for BC

Answer 8

TRIPLE ASSESSMENT
Clinical assessment
Mammogram +/- USS
Fine needle aspiration (if mass palpable) or cone needle biopsy (if mass not palpable)

Question 9

Other investigations for BC

Answer 9

Lymph nodes involvement e.g. Sentinel lymph node biopsy.

Gene expression profiling via Oncotype DX testing - calculator recurrence and genetics of BC.

Question 10

Staging of BC

Answer 10

TNM
Tumour
Lymph node
Metastases

Question 11

Other index thing used in BC

Answer 11

Nottingham prognostic index for surgical BC

Question 12

Treatment of BC

Answer 12

Surgical = Partial/total mastectomy or breast conservative.
Neo-adjuvant = chemo/radio/endocrine.

Question 13

Adjuvants used in oestrogen receptor +ve BC

Answer 13

If pre-menopausal = Tamoxifen (OR antagonist)

If post-menopausal = Aromatase inhibitor e.g. Anastrozole.

Question 14

Adjuvants used in HER-2 BC

Answer 14

Chemotherapy + trastuzumab

Question 15

Adjuvant used in Triple negative BC

Answer 15

Chemotherapy (FEC regime)

Question 16

BC screening programme

Answer 16

Women aged 50-70 get 3yearly mammogram.

Aims to pick up early stage advanced BC or pre-invasive ductal carcinoma in situ.

Question 17

Indications for mastectomy

Answer 17

Prophylactic
Large tumour relative to breast size
Multi-focal
Sub-areolar tumour
Failed conservative MX
Local recurrence at wide excision

Question 18

Lymph drainage of breasts

Answer 18

Axillary lymph nodes and internal thoracic lymph nodes which drain to apical lymph nodes.

Question 19

Nipple eczema like lesion (red, rough, ulcerated), does not resolve with 2weeks of steroid or anti-fungal cream

Answer 19

Paget’s disease of the nipple.
Underlying malignancy.
Infiltration of tumour to nipple epidermis.

Question 20

Areas which BC commonly metastasis to

Answer 20

Bone, pleura, lung, liver, brain.

Question 21

Smooth, firm, painless, mobile lump in breast

Answer 21

Fibroadenoma

Question 22

Painful, round, mobile lump which feels fluid filled.

Answer 22

Cystic disease of acini lobules.

Question 23

Differential for nipple discharge

Answer 23

Intraductal papilloma

Question 24

Mastitis

Answer 24

Milk stasis triggering inflammatory response. Can be due to infection too e.g. S.aureus.

Question 25

Pain in breastfeeding or just before, poor milk flow, red breast

Answer 25

Engorgement

Question 26

Ligaments in breast

Answer 26

Cooper’s ligaments

Question 27

Inheritance of BRCA gene

Answer 27

Autosmonal dominant.

Question 28

What to investigate before prescribing Trastuzumab

Answer 28

Heart function - Left ventricle ejection fraction. Continue monitoring during treatment too.