Breast cancer

Question 1

what are the risk factors for breast cancer?

Answer 1

• increasing age
• obesity
• increased periods of oestrogen exposure
• ionising radiation
• FH
• BRCA 1 assocated with breast and ovarian, BRCA 2 breast but NOT ovarian

Question 2

What are the different subtypes of breast cancer?

Answer 2

• invasive ductal carcinoma (70-80%)
• lobular carcinoma (10%)
• less common include medullary, colloid comedo and papillary

Question 3

what are the clinical features?

Answer 3

• nipple discharge
• painless lump
• erythema
• tethering
• regional lymphadenopathy
• peau d’orange
• symptoms of metastatic disease

Question 4

What investigations should a woman have?

Answer 4

- Imaging: 
> bilateral mammography
> ultrasound
> regional lymph nodes 
- FNAC/ core needle biopsy 
- breast examination

Question 5

why might ultrasound be more useful in younger patients than mammogram?

Answer 5

• tissue more dense, therefore easier to see on ultrasound

Question 6

Describe the TNM staging in breast cancer?

Answer 6

Tumour: 
> Tis 
> T1- < 2cm 
> T2 2-5cm
> T3 >5cm 
> T4 skin involvement 

Nodes:
> N1- mobile axillary nodes
> N2- fixed axillary nodes
> N3- internal mammary nodes

M:
> distant mets/ none

Question 7

What would nodal involvement mean for staging?

Answer 7

• At least stage 2

- Metastases means stage 4

Question 8

what sort of staging investigations would you do?

Answer 8

• ER and PR status
• HER 2 receptor status
• LFT/ CXR
• Bone scan

Question 9

What is the surgical protocol?

Answer 9

• Mastectomy less favoured for aesthetic reasons
• wide local excision
• sentinel lymph node biopsy

Question 10

is anything done after surgery?

Answer 10

• adjuvant radiotherapy post-mastectomy radiotherapy is recommended in patients with 4 or more positive axillary nodes
• chemotherapy./ hormone therapy

Question 11

what is the risks with giving tamoxifen?

Answer 11

• pro-oestrogenic effect on uterus so increased risk of breast ca
• pro-thrombotic
• risk of endometrial ca

Question 12

what is the dose of tamoxifen? who takes tamoxifen?

Answer 12

• 20mg/ day

- ER receptor positive younger women

Question 13

Who is most likely to respond to endocrine therapy? What kind of endocrine therapy is there?

Answer 13

• ER positive tumours (50-60%)
• Anti-oestrogens
• aromatase inhibitors
• LHRH agonists
• ovarian ablation