BREAST

Question 1

What cells make up the nipple?

Answer 1

keratinised stratified squamous epithelium

Question 2

What makes up the triple assessment breast clinic?

Answer 2

clinical: history and exam
imaging: US if <35 or mammography +/- US if >35
pathology: FNA, core, biopsy

Question 3

Why is a core biopsy more useful than FNA?

Answer 3

A core biopsy provides full histology (as opposed to fine needle aspiration (FNA) which only provides cytology), allowing differentiation between invasive and in-situ carcinoma.

Question 4

Explain the histology scores for core biopsy

Answer 4

B1 = normal
B2 =benign
B3 = uncertain (probably benign)
B4 = suspicious
B5 = benign (a = in-situ, b = invasive)

Question 5

What imaging is done in a woman under 40?

Answer 5

ultrasound due to the density of the breast tissue in identifying anomalies

Question 6

What imaging is done in a woman over 35?

Answer 6

mammography

Question 7

Where do breast carcinomas arise from?

Answer 7

the terminal duct lobular unit

Question 8

What are the two types of breast carcinoma and how can they be differentiated?

Answer 8

ductal (e-cadherin positive)

lobular (e-cadherin negative)

Question 9

Give another presentation of ductal carcinoma in-situ

Answer 9

paget’s disease

Question 10

Risk factors for breast carcinoma

Answer 10

increasing age
early menarche, late menopause,
not breastfeeding
nulliparous or first child after 35
COCP or HRT
high BMI
smoking
alcohol 
genetics

Question 11

What do oestrogen-receptor positive breast carcinomas respond to?

Answer 11

oophrectomy

tamoxifen (pre-menopausal)

aromatase inhibitors (post-menopause)

GnRh antagonists

Question 12

What is HER2?

Answer 12

human epidermal growth factor receptor 2

Question 13

What do HER2-positive breast carcinomas respond to?

Answer 13

herceptin

Question 14

What is the most common benign neoplasm?

Answer 14

fibroadenoma

Question 15

How can cysts be diagnosed and treated?

Answer 15

FNA

Question 16

Which benign breast lump can mimic a carcinoma?

Answer 16

sclerosing adenosis

Question 17

What characterises sclerosing adenosis?

Answer 17

radial scars

complex sclerosing lesions

Question 18

Which benign breast conditions predispose to malignancy?

Answer 18

cyst (small risk)
epithelial hyperplasia (greatly increased)

Question 19

Which condition presents with green nipple discharge?

Answer 19

duct ectasia (blocked duct)

Question 20

Treat mastitis

Answer 20

flucloxacillin

Question 21

Which drugs cause gynaecomastia?

Answer 21

spironolactone 
cimetidine
digoxin
cannabis
finasteride
gonadorelin analogues e.g. Goserelin, buserelin
oestrogens, anabolic steroids

Question 22

Smooth lump with pain on period

Answer 22

fibrocystic change

Question 23

Bloody nipple discharge

Answer 23

intraductal papilloma

Question 24

Commonest cause of spontaneous nipple discharge

Answer 24

intraductal papilloma

Question 25

How does fibroadenoma present?

Answer 25

Mobile, firm breast lumps

no increased risk of malignancy

Question 26

Manage fibroadenoma

Answer 26

diagnose
reassure
excise if >3cm

Question 27

inoperable breast cancer

Answer 27

radiotherapy

Question 28

manage node positive breast cancer

Answer 28

FEC-D chemotherapy

Question 29

A 35 year old woman is worried about a painful lump in her breast. Her mother had breast cancer at the age of 65 years. She is 32 weeks pregnant with no past medical history. She is not taking any medication. She smokes five cigarettes per day.There is a 2 cm lump in her right breast that is tender on palpation. There is also redness of the overlying skin.

Which is the most appropriate management?
A. Bilateral mammogram
B. No further investigations until after delivery
C. Start oral cefalexin
D. Surgical excision of lump
E. Triple assessment

Answer 29

E. triple assessment

–> although it is likely an infection, she needs to exclude malignancy

Question 30

What additional therapy is given if a women has a WLE for breast carcinoma?

Answer 30

whole breast radiotherapy to prevent recurrence