Breast Cancer

Question 1

breast cancer

Answer 1

commonest cancer in females

Question 2

causes

Answer 2

early period
late menopause
alcohol 
use of combined pill
previous cancer
family history 
late age

Question 3

what genes are common with breast cancer

Answer 3

BRCA1 BRCA2

Question 4

signs

Answer 4

irregular hard lump
skin change
nipple discharge
sensitive breasts
lymphadenopathy

Question 5

types of cancer

Answer 5

invasive ductal
invasive lobular
ductal carcinoma
lobular carcinoma

Question 6

investigations

Answer 6

clinical examination
imaging
core needle biopsy

Question 7

what imaging is used

Answer 7

<35 yrs - USS

>35 yrs - mammogram

Question 8

what hormones are involved in the tumours

Answer 8

oestrogen
progesterone
HER2

Question 9

what is used to stage the cancer

Answer 9

TNM

Question 10

surgical management

Answer 10

small lumps:
wide local excision + adjuvant RT

large lumps:
mastectomy

chemo if not fit for surgery

+ breast reconstruction

Question 11

medical mangement

Answer 11

HER2:
pre-menopause - tamoxifone
post-menopause - anastrozole

oestrogen:
trastuzumab

Question 12

what is the screening programme

Answer 12

50-70yrs every three years

Question 13

when can a patient be referred

Answer 13

urgent:
over 30 and unexplained lump
over 50 with nipple discharge, breast cancer skin changes

non-urgent:
under 30 with unexplained lump

first/second degree relative with history of breast cancer before 40yrs
family male history of breast cancer
bilateral breast cancer, first one diagnosed before 50yrs
2 first degree relatives or one first degree, one second degree relatives
first/second degree relative with ovarian and breast cancer

Question 14

what is Paget’s disease of nipple

Answer 14

eczema changes

underlying breast malignancy