Breast Cancer

Question 1

What are risk factors?

Answer 1

Being female
Increased oestrogen exposure
HRT - combined especially
Obesity
Smoking
Family history
More dense breast tissue
COCP

Question 2

What are BRCA genes

Answer 2

Tumour suppressor genes

Question 3

What chromosome is the BRCA 1 gene found

Answer 3

17

Question 4

What other cancers do mutations of the BRCA 1 gene increase risk of ?

Answer 4

Ovarian
Bowel
Prostate

Question 5

What chromosome is BRCA2 gene found on?

Answer 5

13

Question 6

What other cancers does BRCA 2 predispose you to?

Answer 6

Ovarian cancer

Question 7

What are the two types of carcinoma in situ

Answer 7

Ductal and lobular

Question 8

How is ductal carcinoma in situ usually picked up?

Answer 8

mammogram screening

Question 9

What is DCIS

Answer 9

Pre-cancerous or cancerous epithelial cells of the breast duct
Localised to a single area

Question 10

What is LCIS

Answer 10

Pre-cancerous condition

Question 11

How is LCIS usually picked up

Answer 11

Incidentally on breast biopsy

Question 12

How is LCIS managed

Answer 12

Close monitorign

Question 13

How is DCIS managed

Answer 13

Excision and adjuvant treatment q

Question 14

What is invasive ductal carcinoma NST

Answer 14

NST no specific type
Originate in cells from breast ducts

Question 15

Can invasive ductal carcinoma NST be seen on mammograms?

Answer 15

Yes

Question 16

Where do invasive lobular carcinomas originate

Answer 16

Lobules

Question 17

How does inflammatory breast cancer present

Answer 17

Swollen
Warm
Tender
Pitting skin

Question 18

What is Paget’s disease of the nipple

Answer 18

Breast cancer involving the nipplE
mAY REPRESENT DCIS OR INVASIVE BREAST CANCER

Question 20

How does Paget’s disease of the nipple present

Answer 20

Eczema of the nipple
Erythematous scaly rash

Question 21

Explain the breast cancer screening program

Answer 21

Mammogram every 3 years aged 50 to 70

Question 22

How often is mammogram offered for those at high risk

Answer 22

Annually, age depends

Question 23

What chemoprevention may be offered at women at high risk?

Answer 23

Tamoxifen - premenopausal
Anastrozole if post-menopausal

Question 24

What are clinical features that may suggest breast cancer

Answer 24

Lump - hard, irregular, painless or fixed in place
Lump tethered to the skin or chest wall
Nipple retraction
Skin dimpling - peau d’orange
Oedema
Lymphadenopathy

Question 25

Who should have a 2 week wait referral?

Answer 25

Unexplained breast lump in patients aged 30 or above Unilateral nipple changes 50 or above

Question 26

What is involved in a triple assessment?

Answer 26

Clinical assessment Imaging Biopsy

Question 27

Which scan is more effective in older women?

Answer 27

mammogram

Question 28

If women are diagnosed with breast cancer, what further investigation are they offered?

Answer 28

USS of the axilla and USS guided biopsy of any abnormal nodesW

Question 29

What is a sentinel lymph node biopsy>?

Answer 29

Sentinel node biopsy is performed during breast surgery for cancer. An isotope contrast and a blue dye are injected into the tumour area. The contrast and dye travel through the lymphatics to the first lymph node (the sentinel node). The first node in the drainage of the tumour area shows up blue and on the isotope scanner. A biopsy can be performed on this node, and if cancer cells are found, the lymph nodes can be removed.

Question 30

What are the 3 breast cancer receptors

Answer 30

Oestrogen receptors Progesterone receptors HER2

Question 31

what is triple negative breast cancer

Answer 31

Breast cancer cells that do not express any of the three receptors

Question 32

What are the 4 common locations for breast cancer metastasis

Answer 32

Lungs Liver Bones Brain

Question 33

What staging system is used for breast cancer

Answer 33

TNM

Question 34

What are the treatments for oestrogen receptor positive breast cancer? How long are they given for?

Answer 34

Tamoxifen if premenopausal Aromatase inhibitors for postmenopausal women 5-10 years

Question 35

What is a risk of tamoxifen

Answer 35

Increases risk of endometrial cancer

Question 36

How does tamoxifen work

Answer 36

Blocks oestrogen receptors in breast tissue

Question 37

How do aromatase inhibitors work

Answer 37

Block the creation of oestrogen in fat tissue

Question 38

What targeted treatments can be used for HER2 cancer?

Answer 38

Trastuzumab Pertuzumab Neratinib

Question 39

What are the main options for breast reconstruction

Answer 39

Breast implants Flap reconstruction

Question 40

wHAT ARE the different types of flap reconstruction?

Answer 40

1. Lattissimus dorsi flap 2. Transverse rectus abdominis flap 3. Deep inferior epigastric perforator flap

Question 41

What is the adjuvant hormonal therapy for oestrogen receptor positive cancer in pre menopausal women?

Answer 41

Tamoxifen

Question 42

What is the adjuvant hormonal therapy for oestrogen receptor positive cancer in post menopausal women?

Answer 42

Anastrozole

Question 43

What are side effects of tamoxifen?

Answer 43

Menstrual disturbance VTE Increased risk of endometrial ca

Question 44

What is the main side effect of aromatase inhibitors ?

Answer 44

Osteoporosis

Question 45

What investigation should women who are starting anastrozole have before ?

Answer 45

DEXA scan

Question 46

What adjuvant hormonal therapy is given for those with HER2 receptor positive breast cancer ?

Answer 46

Trastuzumab