Breast Cancer

Question 1

define breast cancer

Answer 1

carcinoma of the breast tissue - commonly occurring in women

Question 2

risk factor of breast cancer

Answer 2

increased hormone exposure 
BRCA1/2 mutations 
advanced age 
obesity 
alcohol + tobacco use 
PMH of breast cancer
previous radiotherapy treatment

Question 3

what is involved in breast cancer screening?

Answer 3

3 yearly mammogram (XR) for all women registered with a GP aged 50-70yrs

Question 4

indications for urgent cancer referral pathway (2wks)

Answer 4

> 30 with unexplained breast mass
50 with nipple discharge, retraction or concerning symptoms
skin changes suggesting cancer
30 with unexplained axillary mass

Question 5

features of ductal carcinomas in breast cancer

Answer 5

abnormal proliferation of ductal cells
loss of acinar structure and enlargement of nuclei
no breaching of basement membrane = in situ (DCIS)

Question 6

features of lobular carcinomas

Answer 6

abnormal proliferation of lobular cells into singular rows
appear small, bland and uniform
often non-palpable
no breaching of basement membrane = in situ (LCIS)

Question 7

features of medullary carcinomas

Answer 7

composed of solid sheets of anaplastic cells with large pleomorphic nuclei
prominent nucleoli and mitoses
significant lymphocytic infiltration surrounding tumour
associated with BRAC1

Question 8

features of BRCA1

Answer 8

found on Ch17
autosomal dominant
gives rise to high grade triple negative cancers

Question 9

features of BRCA2

Answer 9

found on Ch13
autosomal dominant
gives rise to oestrogen and progesterone receptor +ve tumours

Question 10

hormonal receptor activity tested for in breast cancer

Answer 10

oestrogen (ER)
progesterone (PR)
human epidermal growth factor type 2 (HER2)

Question 11

management of ER +ve tumours

Answer 11

if premenopause: tamoxifen - an ER receptor antagonist

if postmenopause: anastrozole - an aromatase inhibitor

Question 12

management of HER2 +ve tumours

Answer 12

trastuzumab (herceptin) - a monoclonal antibody

Question 13

investigations of suspected breast cancer

Answer 13

clinical examination
mammogram
fine needle aspirate or core needle biopsy

Question 14

surgical management of breast cancer if small, solitary lesions

Answer 14

wide local excision (WLE)
sentinal node biopsy + clearance if +ve
adjuvant radiotherapy

Question 15

surgical management of breast cancer if larger, non-solitary lesions

Answer 15

masectomy - can follow with reconstruction 
adjuvant radiotherapy (if T3-4 or +ve nodes)

Question 16

is there a preferred imaging modality in patients <40yrs

Answer 16

yes, patients <40yrs should have a US rather than mammogram due to increased density of breast tissue

Question 17

side effects of tamoxifen

Answer 17

hot flushes
nausea 
vaginal bleed and discharge 
weight gain 
⬆️ DVT/PE + endometrial cancer risk

Question 18

side effects of trustuzamab ‘herceptin’

Answer 18

cardiac dysfunction - including HF

teratogenicity