Breast cancer

Question 1

what does the screening programme consist of and who is it for

Answer 1

biplanar digital mammography every 3 years in women aged 50-70

Question 2

where do the majority of breast cancers arise from

Answer 2

the epithelial cells of the milk ducts

most common pattern of infiltration: infiltrating ductal carcinoma

Question 3

non invasive breast cancer

Answer 3

ductal cancer in situ

lobular cancer in situ

Question 4

invasive cancer

Answer 4

infiltrating ductal cancer
infiltrating lobular cancer
mucinous cancer
papillary cancer
tubular cancer

Question 5

what do 10% of women with breast cancer have detectable mutations in

Answer 5

BRCA 1 and 2, and TP53

Question 6

symptoms and signs breast cancer

Answer 6

painless increasing mass
nipple discharge
skin tethering
inflam cancers: oedema and erythema

Question 7

investigation breast cancer

Answer 7

triple assessment:
palpation
radiology (mammography, US & MRI scan)
fine needle aspiration cytology

Question 8

prognositic factors breast cancer

Answer 8

size of primary tumours
the histological subtype (most are infiltrating ductal carcinomas)
histological grade/ differentiation
oestrogen & progesterone receptor (ER, PR) status
Age
menopausal status
expression of HER2 like ER & PR is predictor of rx response

Question 9

poor prognostic factors for breast cancer

Answer 9

young age
premenopausal 
large tumour size
high tumour grade
oestrogen & progesterone receptor negative
positive nodes

Question 10

local rx breast cancer

Answer 10

wide local excision
segmental mastectomy and breast conservation
axilla surgery if spread to nodes
radiotherapy to breast to reduce local recurrence

Question 11

how many people have progesterone and oestrogen receptors

what rx do they have after surgery

Answer 11

1/3

tamoxifen

Question 12

rx for pts w HER2 overexpression

Answer 12

IV trastuzumab further to chemo

Question 13

bisphosphonate rx in breast cancer

Answer 13

bone metastases are a common problem in the management of breast cancer
bisphosphonates reduce the incidence of osteolytic deposits

Question 14

fibroadenomas

Answer 14

benign tumours characterised by a mixture of stromal and epithelial tissue
unlike typical lumps from breast cancer, fibroadenomas are easy to move with clearly defined edges

Question 15

signs and symptoms fibroadenomas

Answer 15

painless
firm
solitary
mobile
slowly growing lump in the breast of a woman of child-bearing years
partially hormone related and regress after menopause

Question 16

where do fibroadenomas arise?

Answer 16

terminal duct lobular unit of the breast

Question 17

diagnosis and treatment

Answer 17

diagnosis through clinical examination, US or mammography and needle biopsy
most are left in situ & monitored by dr
some surgically removed or cryoablation

Question 18

fibrocystic breast changes

Answer 18

30-60% women affected
characterised by non cancerous breast lumps which can sometimes be uncomfortable - often related to hormonal influence from the menstrual cycle

Question 19

signs and symptoms fibrocystic breast changes

Answer 19

fibrous tissue and a lumpy cobblestone texture in the breasts
smooth and have defined edges
free moving in relation to adjacent structures
no rx

Question 20

intraductal papilloma

Answer 20

benign lesions with incidence of 2-3%
central - near nipple and solitary, menopausal W
peripheral - multiple, younger W - higher risk of malignancy

Question 21

what does intraductal papilloma cause

Answer 21

bloody nipple discharge

dont show up on mammography as too small