Breast cancer

Question 1

What is the MC site of lumps?

Answer 1

upper outer quadrant including tail of spence

Question 2

What node is found in the axillary?

Answer 2

sentinel node (first node that cancer spreads to)

Question 3

What are some suspicious signs of breast cancer?

Answer 3

Dimpling (peau d’orange)
depression
deviation (asymmetrical)
discolouration
discharge
nipple eczema persisting with Tx
mets Sx (bone pain/pleural effusion)

Question 4

What age does the NHS breast screening range from? How often and what test is done?

Answer 4

47-73 years old
3 yearly mammograms

Question 5

what is the % decrease in mortality of Breast ca with this screening?

Answer 5

16-29%

Question 6

Which 2 conditions mean that breast cancer is high risk?

Answer 6

BRCA gene carriers
li fraumeni

Question 7

How often are BRCA gene carriers screened and what ages?

Answer 7

annually
25-60

Question 8

How often are Li Fraumeni syndrome Px screened and what ages?

Answer 8

20-70
annually

Question 9

What type of gene is BRCA?
what are the types?

Answer 9

autosomal dominant
BRCA 1 + 2

Question 10

BRCA 1
what autosome is it on?
associated with?
What can ppl that have BRCA 1 get as prophylaxis and get for free?

Answer 10

C17
Assoc with inherited Breast Ca

Can have prophylactic mastectomy or tamoxifen

Can select embryos that aren’t BRCA +ve

Question 11

BRCA 2
what autosome is it on?
associated with?
Increased risk of?

Answer 11

C13
Associated with male breast cancer
increased risk of ovarian and pancreatic Ca

Question 12

What is the triple assessment?

Answer 12

1. Hx and exam
2. imaging (Mammogram/X RAY, USS, MRI)
3. Cytology (biopsy)

Question 13

Mammogram/X RAY
what would the cancer look like?
CI in who?
what age are mammograms used on and why?

Answer 13

Ca = hyperdense (white)
>40
CI in <40 - cannot pick up Ca in. younger dense breast or female with high HRT

Question 14

USS
What would cancer look like?
Used in what age and why?

Answer 14

Ca = hypodense (dark)
<40 - young dense breast

Question 15

MRI
Pros and cons

Answer 15

pros - good for implants, identifying ruptures, safe and reliable

Cons - expensive + claustrophobic

Question 16

What are the 2 cytology tests done?

Answer 16

fine needle biopsy (FNAC)
core biopsy

Question 17

Pros and cons of fine needle biopsy

Answer 17

Pros:
Less invasive
detects cancer

Cons:
No receptor status
No in situ vs invasive

Question 18

Pros and cons of core biopsy

Answer 18

Pro:
diagnoses Ca
receptor status
in situ vs invasive

Cons:
very invasive and painful

Question 19

what is the lifetime risk of breast cancer in UK?
median age?

Answer 19

1/8
62

Question 20

RF for breast CA?

Answer 20

Nulliparous
Early menarche/late menopause
obesity
smoking
Alcohol (1.3 RR)
HRT (5+ Y)

Question 21

Conditions increasing risk of breast Ca?

Answer 21

BRCA
Li Fraumeni
Peutz Jeghers

Question 22

What is Li Fraumeni?
increases risk of developing?

Answer 22

TP53 mutation
increases risk of developing brain, breast Ca, leukaemia and lymphoma

Question 23

what is protective of breast Ca?

Answer 23

exercise

Question 24

What family Hx can increase Risk of breast Ca?

Answer 24

affected 1^ F<50y bilaterally or <40y unilateral + any 1^ affected M

Question 25

What is the main type of breast cancer (+%)?

Answer 25

Adenocarcinoma
99%

Question 26

What is the 2nd MC type of breast cancer?
% and uni/bi lateral + is it detectable?

Answer 26

Ductal 30%
unilateral and detectable

Question 27

What is the 3nrd MC type of breast cancer?
% and uni/bi lateral + is it detectable?

Answer 27

Lobular
10%
More bilateral and harder to detect on imaging

Question 28

What are other types of breast cancers?

Answer 28

tubular
mutinous
phyllodes
medullary

Question 29

what does in situ and invasive mean?

Answer 29

In situ = not invaded BM
Invasive = beyond BM

Question 30

What does the grading mean in cancer?
how many grades are there and meanings?

Answer 30

How well differentiated cells are
Grade 1 (eg. tubular) = well differentiated
Grade 3 (eg. medullary) = poorly differentiated

Question 31

What sx warrants a referral for breast cancer?

Answer 31

Suspicious exam findings
50s + tethering, unrelenting nipple eczema

Question 32

What referral is done for suspicious breast exam findings?

Answer 32

Urgent 2 week if:
>30 and unexplained breast lump
>50 and unilateral suspicious nipple eczema
or high risk

Question 33

Dx for suspicious breast exam?

Answer 33

Triple assessment
Hx and exam
Imaging
cytology

Question 34

What grading is used for cancer?

Answer 34

TNM

Question 35

What do T1-4 stand for?

Answer 35

T0 = no tumour
T1 = <2CM
T2 = 2-5cm
T3 = >5cm
T4 = Tethering

Question 36

What do N0-3 stand for?

Answer 36

N0 = No LN spread
N1 = Mobile axilla LN
N2 = Fixed axillary LN
N3 = Ipsilateral mammary

Question 37

What does M0-1 stand for?

Answer 37

M0 = No mets
M1 = Mets

Question 38

What is TNM classification for breast cancer?
1-4

Answer 38

1. T1 N0 M0
2. T2/3 N1 M0
3. T4 N>1 M0
4. T4 N>1 M1

Question 39

What is the receptor status and % for each for breast ca?

Answer 39

75% oestrogen +ve (+PgR)
15% HER-2R +ve

Question 40

what is used to monitor response to Tx?

Answer 40

B15-3

Question 41

What is the sortie and parou classification?

Answer 41

genetics Tx based on receptor status

Question 42

what does triple -ve breast ca mean for prognosis?

Answer 42

more aggressive
worse prognosis
younger death

Question 43

What is Ki67?
Score? Meaning?

Answer 43

growth factor (proliferation tumour cell growth marker)
Score >14 = poor prognosis and benefit from chemo