Breast Cancer

Question 1

Layer of cells affected in breast cancer

Answer 1

Epithelial

Question 2

Hormone receptors found in breast cancer that can be targeted as part of Tx

Answer 2

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

Question 3

Most common form of breast cancer (hint: it’s pre-cancerous)

Answer 3

Ductal cell carcinoma in Situ

Question 4

Anatomical location of DCCIS

Answer 4

Localised to wall of ducts into lumen

Question 5

Presentation of DCCIS on mammogram

Answer 5

Micro-calcifications

Question 6

The invasion of what layer makes DCCIS invasive ductal carcinoma

Answer 6

Basement membrane

Question 7

Forms 80% of invasive breast cancer cases

Answer 7

Invasive ductal carcinoma

Question 8

This disease is caused by the spread of DCIS releasing mobility factors that allow cancer cells to settle between squamous epithelial cells

Answer 8

Pager disease

Question 9

Presentation of Paget disease

Answer 9

• inflammation
• nipple discharge
• itchy
• eczema

Question 10

Definition of lobular carcinoma in situ

Answer 10

Cluster of tumour cells in lobules

Question 11

Location & distribution of lobar carcinoma on situ

Answer 11

Bilateral & multi-centric

Question 12

Why is lobular cell carcinoma in situ impalpable

Answer 12

Sparse distribution of tumour cells

Question 13

Presentations of lobular cell carcinoma in situ

Answer 13

• small
• bland
• uniform
• single row proliferations

Question 14

Buzzword associated with inflammatory breast cancer

Answer 14

Abscess/mastitis

Question 15

Symptoms of inflammatory breast cancer

Answer 15

Peau d’ orange

Question 16

Does inflammatory breast cancer respond to Abx

Answer 16

No

Question 17

Prognosis of inflammatory breast cancer compared to other cancers

Answer 17

Worse

Question 18

Patient age and gene associated with medullary carcinoma

Answer 18

• young

- BRCA1

Question 19

Explain the appearance of the solid sheets found in medullary carcinoma

Answer 19

Anaplastic cells with larger pleomorphic nuclei (frequent mitosis)

Question 20

Lymphatic infiltration can be found surround what tumour

Answer 20

Medullary carcinoma

Question 21

Prognosis of medullary carcinoma compared to ductal

Answer 21

Better

Question 22

The 2Ls2Bs metastatic spread of breast cancer

Answer 22

• lungs, liver

- bones, brain

Question 23

Describe the following of malignant lumps:

• softness
• pattern
• pain
• location
• axillary spread

Answer 23

• hard
• irregular
• painless
• fixed to deep tissue
• spread via lymph

Question 24

What is peau d’ orange seen in breast cancer

Answer 24

Dimpling of skin

Question 25

Explain the nipple retraction seen in breast cancer

Answer 25

- suspension ligament | - lactiferous duct fibrosis

Question 26

A chromosome 17 mutation that increases the risk of breast, bowel and prostate cancer

Answer 26

BRCA1

Question 27

A chromosome 13 mutation that increase the risk fo breast cancer

Answer 27

BRCA2

Question 28

Other mutations that increase the risk of breast cancer

Answer 28

- TP53 - ERBBB2 - PTEN

Question 29

Female relevant factors that increase the risk of breast cancer (think menopause, menarche, pregnancy)

Answer 29

- early menarche - late menopause - late pregnancy - HRT/OCP

Question 30

The inflammation in breast cancer can damage what structures that lead to fibrosis

Answer 30

- suspension ligament | - lactiferous ducts

Question 31

Regional tissues invaded in breast cancer

Answer 31

- pec muscles - skin - blood/lymph spread

Question 32

Explain the skin dimpling of peau d’ orange

Answer 32

- blocked lymph vessels - +++ lymph - sespensory ligament doesn’t allow stretching —> thick & dimpled skin

Question 33

Target group for 3-y mammogram

Answer 33

50-70

Question 34

Who is invited to annual mammograms

Answer 34

High-risk

Question 35

Direction of mammogram

Answer 35

Caudal-cranial/mediolateral oblique

Question 36

Triple assessment includes

Answer 36

- physical examination - mammogram - biopsy/FNA

Question 37

A >30 qualifies for a 2-w referral if she has …. or

Answer 37

- unexplained breast lump | - unexplained axillary lump

Question 38

A >50 qualifies for a 2-w referral if she has

Answer 38

Unilateral nipple changes

Question 39

Non-adjuvant chemo is given

Answer 39

Before surgery

Question 40

The growth of which hormone receptor positive cancer cells can be promoted via blocking hormonal effect in med Tx

Answer 40

- HER2 - ER - PR

Question 41

Oestrogen receptor antagonist (selective oestrogen receptor modulator) that is used against ER +ve tumours

Answer 41

Tamoxifen

Question 42

Is tamoxifen used in pre or post menopausal

Answer 42

Pre-menopausal

Question 43

Tamoxifen has a preventative role in

Answer 43

Osteoporosis

Question 44

Tamoxifen poses an increased risk of what cancer

Answer 44

Endometrial

Question 45

Aromatase inhibitor that targets ER +ve tumours

Answer 45

Anastrozole/letrazole

Question 46

Mechanism of aromatase

Answer 46

Androgen —> oestrogen in adipose tissue

Question 47

Duration of anastrozole

Answer 47

5-10 yrs

Question 48

Is anastrozole used in pre or post menopausal woman

Answer 48

Post menopausal

Question 49

Monoclonal Ab that targets HER2 +ve tumours

Answer 49

Trastuzmab/herceptin

Question 50

Cardiac complication of trastuzumab/herceptin

Answer 50

HF

Question 51

Drug that has the same mechanism as trastuzmab and is used in combination with it

Answer 51

- pertuzumab | - perjeta

Question 52

Tyrosine kinase inhibitor used in HER2 +ve tumours

Answer 52

Neratinib