Breast cancer

Question 1

Lifetime risk for UK women

Answer 1

1/8

Question 2

Main types of breast cancer (2)

Answer 2

Ductal epithelium

Lobular epithelium

Question 3

Infiltrating carcinoma of the nipple epithelium

Answer 3

Paget’s disease of breast

Question 4

Specific risk factors for breast cancer (e.g. other than age, previous history) (5)

Answer 4

Family Hx (e.g. BRCA)
Ovulating a lot (nulliparity, early menarche and late menopause)
HRT
radiation to chest
alcohol intake

Question 5

Most common presentation of breast cancer

Answer 5

Painless lump

Question 6

Proportion of patients presenting with a breast lump, which is painful

Answer 6

20%

Question 7

Other signs of breast cancer (3)

Answer 7

Nipple change (e.g. inversion)
Nipple discharge
Lymphoedema of the arm

Question 8

Imaging modalities available for investigating a breast lump (3)

Answer 8

Mammography
US
Ultrasound

Question 9

In what situation might mammography be less useful? What might be used instead?

Answer 9

Younger patients with denser breast tissue. US/MRI

Question 10

Biopsy method of choice in breast lump

Answer 10

Core needle biopsy

Question 11

Monoclonal antibody techniques are used to determine what? (3)

Answer 11

ER, PR and HER2 status

Question 12

What is CA 15-3?

Answer 12

A tumour marker which may be useful for prognosis

Question 13

When might bone scan be indicated? (3)

Answer 13

Bone pain
Fractures
Distant/lymph node mets

Question 14

What is stage 0 carcinoma?

Answer 14

Carcinoma in situ

Question 15

Sites of metastases of breast cancer a) local and b) distant

Answer 15

a) chest wall, skin, nipple

b) contralateral breast, lung, liver, bone, brain

Question 16

Surgical options for treatment (2)

Answer 16

Wide local excision

Mastectomy

Question 17

When is mastectomy preferred over WLE? (2)

Answer 17

When tumour is >4cm, or is multifocal

Question 18

Indication for prophylactic bilateral mastectomy

Answer 18

BRCA1/BRCA2 carriers

Question 19

When is radiotherapy offered as treatment? (2)

Answer 19

After conservative surgery (WLE); after mastectomy if axillary nodes +ve

Question 20

Complications of radiotherapy (3)

Answer 20

Radiation pneumonitis
Skin telangiectasis
Osteonecrosis

Question 21

Hormonal therapy for ER+ breast cancers (2)

Answer 21

Tamoxifen (pre-menopausal)
Aromatase inhibitors (post-menopausal)

Question 22

Mechanism of aromatase inhibitors

Answer 22

Inhibit aromatization of androgens to oestrogens in adipose tissue

Question 23

When is tamoxifen less effective?

Answer 23

HER2 amplified cancers

Question 24

in which groups of patient is adjuvant chemotherapy useful?

Answer 24

Younger women

In patients with adverse prognostic indicators e.g. HER2+, ER-,

Question 25

Chemotherapeutic agents used in breast ca. (3)

Answer 25

CMF (cyclophosphamide, methotrexate, 5-FU)
Taxane
Anthracyclines

Question 26

Side effects of anti oestrogens (4)

Answer 26

Reduced libido
Hot flushes
Weight gain
Lethargy

Question 27

Targeted treatment for HER2 amplified cancers

Answer 27

Trastuzumab (herceptin)