breast cancer

Question 1

risk factors

Answer 1

female 
inc oestrogen exposure - early menarche, late menopause
more glandular breast tissue
obesity 
smoking 
FHx

Question 2

risk - COCP

Answer 2

small increase risk, but risk returns to normal 10yrs after stopping pill

Question 3

risk - HRT

Answer 3

increases risk, esp combined HRT

Question 4

BRCA1

Answer 4

chr17

70% breast cancer by 80yrs
50% ovarian cancer
risk prostate + bowel cancer

Question 5

BRCA2

Answer 5

chr13

60% breast cancer by 80yrs
20% ovarian cancer

Question 6

ductal carcinoma in situ (DCIS)

Answer 6

pre-ca/cancerous epithelial cells of breast ducts

potential to become invasive breast cancer (30%)

good prognosis if full excised + adjuvant Rx used

Question 7

Lobular carcinoma in situ (LCIS )

Answer 7

pre-ca condition, premenopausal women

asymtomatic + undetectable on mammogram
usually picked up on biopsy

Mx with close monitoring

risk invasive cancer in future

Question 8

Invasive ductal carcinoma (NST)

Answer 8

originate in cells from breast ducts

represents 80% breast cancers

can be seen on mammograms

Question 9

invasive lobular carcinoma (ILC)

Answer 9

10% of breast cancers

originate breast lobules

not always visible on mammogram

Question 10

Inflammatory Breast Cancer

Answer 10

present similar to breast abscess/mastitis

worse prognosis

Question 11

Paget’s Disease of the Nipple

Answer 11

erythematous scaly rash of nipple/areola

indicates breast cancer involving nipple

Question 12

Breast cancer screening

Answer 12

mammogram every 3yrs to women aged 50-70yrs

Question 13

high risk patients

Answer 13

• first-degree relative with breast cancer <40 yrs
• first-degree male relative with breast cancer
• first-degree relative with bilateral breast cancer, first diagnosed <50yrs
• 2 first-degree relatives with breast cancer

Question 14

monitoring of high risk women

Answer 14

annual mammogram

chemoprevention

risk reducing mastectomy/oopherectomy

Question 15

clinical features

Answer 15

lump: hard, irregular, painless, fixed, tethered
nipple retraction
skin dimpling, oedema
lymphadenopathy

Question 16

referring - 2wk wait if

Answer 16

unexplained breast lump ≥30yrs
unilateral nipple changes ≥50yrs

consider if

• lump in axilla ≥30yrs
• skin changes suggestive breast cancer

Question 17

referring - not-urgent referral for

Answer 17

unexplained breast lumps in patients <30yrs

Question 18

triple diagnostic assessment

Answer 18

clinical assessment - Hx and exam
imaging - USS or mammography
biopsy - fine needle aspiration or core biopsy

Question 19

imaging - younger women

Answer 19

USS - as they have more glandular breast tissue

helpful to distinguish solid lumps from cystic

Question 20

imaging - older women

Answer 20

mammorgrams

Question 21

Ix - when to use MRI

Answer 21

screening in women at high risk

to further assess size and features

Question 22

Lymph node assessment

Answer 22

USS axilla
USS guided biopsy

sentinel lymph node biopsy

Question 23

breast cancer receptors

Answer 23

receptors can be tagted by treatments

1/oestrogen receptors
2/progesterone receptors
3/human epidermal growth factor (HER2)

Question 24

triple negative

Answer 24

breast cancer cells do not express any of the 3 receptors

worse prognosis and treatment options are limited

Question 25

when is gene expression profiling done

Answer 25

early breast cancers that are ER+ but HER2 and lymph node negative

Question 26

metastases

Answer 26

lungs liver bones brain