Breast

Question 1

What is Padget’s Disease of the breast? Also summarise investigations and treatment.

Answer 1

Paget’s disease is an eczematoid change of the nipple associated with an underlying breast malignancy and it is present in 1-2% of patients with breast cancer. In half of these patients, it is associated with an underlying mass lesion and 90% of such patients will have an invasive carcinoma. 30% of patients without a mass lesion will still be found to have an underlying carcinoma. The remainder will have carcinoma in situ.

Paget’s disease differs from eczema of the nipple in that it involves the nipple primarily and only latterly spreads to the areolar (the opposite occurs in eczema).

Diagnosis is made by punch biopsy, mammography and ultrasound of the breast.

Treatment will depend on the underlying lesion.

Question 2

What is a common chemotherapy regimen used in breast cancer that is ER -ve and HER2 -ve?

Answer 2

FEC-D (Fluorouracil, epirubicin, cyclophosphamide + docetaxel)

Question 3

Briefly describe the difference between fibroadenoma and fibrocystic disease.

Answer 3

Fibroadenomas:

• Common in women <30
• Discrete, non-tender, highly mobile lumps (“breast mouse”)

Fibrocystic disease:

• Most common in middle aged women
• Lumpy breast
• May be mildly tender
• Symptoms tend to worsen just before menstruation

Question 4

Outline the brest cancer screening programme in the UK

Answer 4

• Women 47-73
• Mammogram every 3 years
• Looks for small calcifications, suggestive of DCIS (i.e. pre-invasive breast lesions

Women who have an increased BC risk due to FHx may be offered screening from a younger age. This includes:

• One 1st degree female relative diagnosed with BC <40
• One 1st degree male relative diagnosed with BC at any age
• One 1st degree relative with bilateral BC, first lesion diagnosed <50
• Two 1st degree relatives, or one 1st, one 2nd degree, diagnosed with BC at any age
• 2 relatives with BC + 1 ovarian cancer (one of these should be 1st degree)
• 3 relatives diagnosed with BC

Question 5

In what % of BCs is BRCA1/2 implicated?

Answer 5

5-10%

Question 6

What is the mode of inheritance of BRCA1/2 mutations?

Answer 6

1 copy of the gene, i.e. heterozygosity, is usually enough.

Question 7

Describe the “T” of the TNM staging of breast cancer.

Answer 7

T1: <2cm

T2: 2-5cm

T3: 5+cm

T4a: invades chest wall and skin

T4b: inflammatory skin cancer

Question 8

What is the size cut-off for fibroadenomas?

Answer 8

If the fibroadenoma is >3cm, surgical excision is offered.

Question 9

What tumour marker is used for breast cancer?

Answer 9

C 15-3

Question 10

What ist he frist symptom of spinal cord compression?

Answer 10

Back pain is the earliest and commonest sign. This may be worse on lying down and coughing.