Breast

Question 1

<p>Define breast cancer in situ.</p>

Answer 1

<p>Breast cancer in situ is cancer that is confined to the duct or lobule in which it originated and does not extend beyond the basement membrane.</p>

Question 2

<p>Explain the aetiology/risk factors of breast cancer in situ.</p>

Answer 2

<p>Family history of breast cancer<br></br>Benign breast disease on prior biopsy<br></br>Hereditary breast ovarian cancer syndrome<br></br>Li-Fraumeni syndrome: Mutation of P53 gene<br></br>Cowden's syndrome: Mutation of PTEN<br></br>Klinefelter's syndrome: 47, XXY</p>

Question 3

<p>Summarise the epidemiology of breast cancer in situ.</p>

Answer 3

<p>In the US, it has been estimated that in 2018 there will be 63,960 new cases of breast carcinoma in situ. DCIS comprises 85% and LCIS 15% of in situ carcinomas of the breast.</p>

Question 4

<p>Recognise the presenting symptoms of breast cancer in situ. Recognise the signs of breast cancer in situ on physical examination.</p>

Answer 4

<p>Nipple discharge<br></br>Breast lump<br></br>Eczema-like rash on breast<br></br>Ulceration</p>

Question 5

<p>Identify appropriate investigations for breast cancer in situ and interpret the results.</p>

Answer 5

<p>Mammogram<br></br>FNA</p>

Question 6

<p>Define duct ectasia.</p>

Answer 6

<p>Duct ectasia is a condition in which occurs when a milk duct beneath the nipple widens, the duct walls thicken and the duct fills with fluid. This is the most common cause of greenish discharge.</p>

Question 7

<p>Explain the aetiology/risk factors of duct ectasia.</p>

Answer 7

<p>Aging, mostly women approaching menopause but some women develop this after menopause.<br></br>Inverted nipple<br></br>Smoking</p>

Question 8

<p>Summarise the epidemiology of duct ectasia.</p>

Answer 8

<p>Women approaching menopause generally get duct ectasia because as they age, the milk ducts under the areola get shorter and wider. It can very rarely occur in men.</p>

Question 9

<p>Recognise the presenting symptoms of duct ectasia. Recognise the signs of duct ectasia on physical examination.</p>

Answer 9

<p>Dirty white, greenish or black nipple discharge from one or both nipples<br></br>Tenderness in the nipple or surrounding breast tissue<br></br>Erythema<br></br>A breast lump or thickening near the clogged duct<br></br>Inverted nipple</p>

Question 10

<p>Identify appropriate investigations for duct ectasia and interpret the results.</p>

Answer 10

<p>Breast exam<br></br>Mammogram<br></br>USS<br></br>Sample of discharge for culture/cystoscopy<br></br>FNA</p>

Question 11

<p>Define fibrocystic breasts.</p>

Answer 11

<p>Fibrocystic change of the breast is a non-specific term, commonly understood as a continuum of physiological changes that expand to the pathological spectrum. It is a condition characterised by 'lumpy' breasts, associated with pain and tenderness that fluctuate with the menstrual cycle.</p>

Question 12

<p>Explain the aetiology/risk factors of fibrocystic breasts.</p>

Answer 12

<p>Late-onset menopause<br></br>Later age at first childbirth<br></br>Nulliparity<br></br>Obesity<br></br>Oestrogen replacement therapy</p>

Question 13

<p>Summarise the epidemiology of fibrocystic breasts.</p>

Answer 13

<p>It is difficult to determine the exact incidence of this condition, given that there is no clear definition or diagnostic criteria and that it is often a diagnosis of exclusion. The estimated incidence rate of fibrocystic changes increases with age, peaking at 40-44 years old before incidence decreases.</p>

Question 14

<p>Recognise the presenting symptoms of fibrocystic breasts on physical examination. Recognise the signs of fibrocystic breasts on physical examination.</p>

Answer 14

<p>Mastalgia<br></br>Diffuse symmetrical lumpiness through both breasts<br></br>Age 30 to 50 years<br></br>Nipple discharge<br></br>Palpable breast mass</p>

Question 15

<p>Identify appropriate investigations for fibrocystic breasts and interpret the results.</p>

Answer 15

<p>Mammography<br></br>Breast ultrasound<br></br>Cyst aspiration<br></br>Breast biopsy</p>

Question 16

<p>Define intraductal papilloma.</p>

Answer 16

<p>Intraductal papillomas of the breast are benign lesions.</p>

Question 17

<p>What are the two types of intraductal papilloma?</p>

Answer 17

<p>Central</p>

<p>Peripheral</p>

Question 18

<p>What is the central type of intraductal papilloma?</p>

Answer 18

<p>The central type develops near the nipple. They are usually solitary and often arise in the period nearing menopause.</p>

Question 19

<p>What is the peripheral type of intraductal papilloma?</p>

Answer 19

<p>On the other hand, the peripheral type are often multiple papillomas arising at the peripheral breasts, and are usually found in younger women. The peripheral type is associated with a higher risk of malignancy.</p>

Question 20

<p>Explain the aetiology/risk factors of intraductal papilloma.</p>

Answer 20

<p>PMHx of breast cancer or a high-risk breast lesion.<br></br>Genetic factors, such as a mutation of the BRCA1 or BRCA2 gene.<br></br>Childhood radiation exposure to the chest.</p>

Question 21

<p>Summarise the epidemiology of intraductal papilloma.</p>

Answer 21

<p>There is an incidence of 2-3%. It is the most common cause of bloody nipple discharge in women aged 20-40 years old.</p>

Question 22

<p>Recognise the presenting symptoms of intraductal papilloma. Recognise the signs of intraductal papilloma on physical examination.</p>

Answer 22

<p>Bloody nipple discharge<br></br>Breast enlargement<br></br>Lumps<br></br>Pain or discomfort</p>

Question 23

<p>Identify appropriate investigations for intraductal papilloma and interpret the results.</p>

Answer 23

<p>Galactogram<br></br>FNA<br></br>Mammogram/Breast USS</p>

Question 24

<p>Define metastatic breast cancer.</p>

Answer 24

<p>Breast cancer is considered metastatic breast cancer (MBC) if the disease has spread beyond the breast and ipsilateral lymph nodes (axillary, internal mammary, infra- and supraclavicular).</p>

Question 25

<p>Explain the aetiology/risk factors of metastatic breast cancer.</p>

Answer 25

<p>Female sex<br></br>Age >50 years<br></br>Family history of breast and/or ovarian cancer<br></br>BRCA1 and BRCA2</p>

Question 26

<p>Summarise the epidemiology of metastatic breast cancer.</p>

Answer 26

<p>The breast is the most common site of cancer in women worldwide, accounting for approximately 24% of female cancers, with highest rates in North America, Western and Northern Europe, and Australia. MBC diagnosed at initial presentation or following treatment for loco-regionally-confined breast cancer, occurs in approximately 40% of breast cancer patients.</p>

Question 27

<p>Recognise the presenting symptoms of metastatic breast cancer. Recognise the signs of metastatic breast cancer on physical examination.</p>

Answer 27

<p>Bone pain<br></br>Pleural effusion<br></br>Palpable mass after treatment of the primary tumour<br></br>Shortness of breath<br></br>Anorexia<br></br>Weight loss</p>

Question 28

<p>Identify appropriate investigations for metastatic breast cancer and interpret the results.</p>

Answer 28

<p>FBC<br></br>LFTs<br></br>Calcium<br></br>CXR<br></br>CT (of chest and abdomen)<br></br>Bone scan</p>