breast cancer

Question 1

common or uncommon

Answer 1

1/8 for women and 1./100 for men. More commonly benign than malignant

Question 2

RFs?

Answer 2

• increased age
• early menopause
• late menarche
• obese
• smoker
• FHx BRCA1 2
• not breast feeding
• long oestrogen exposure from long periods

Question 3

PC

Answer 3

firm painless breast lump +/- 
discharge 
orange peel/pitting 
bleeding 
ulcers 
redness 
(breast pain cyclical or non cyclical?)

Question 4

screening?

Answer 4

every 3 yrs 50-70 mammogram

MRI if very high risk

Question 5

pathology? type of cancer

Answer 5

adenocarcinoma common - lobular or ductal

Question 6

triple assessment?

Answer 6

Hx and Ex (E1-E5)
fine needle aspiration - cytology (C1-C5)
Radiology (R1-R5)
graded from benign to making

Question 7

if suspicious - SLN?

Answer 7

sentinel lymph node biopsy - typical spread peri clav and axillary - radio active + blue dye - able to excise in surgery

Question 8

typical spread?

Answer 8

lungs, liver, bones

Question 9

staging? assess spread?

Answer 9

CXR, bone scan, FBC, U+Es, LFTs

microscopic spread is common

Question 10

poor prog factors

Answer 10

young
large primary
tumour is oestrogen or progesterone receptor negative
(+) SLN

Question 11

tx?

Answer 11

early stage - surgery with axillary node clearance with breast conservation or mastectomy (tumour <4cm)

axillary clearance if SLN (+)

Question 12

complications of axillary clearance

Answer 12

oedema, neuro - long thoracic nerve

Question 13

micromets tx?

Answer 13

hormones: oestrogen + progesterone receptor (+)
- aim to decrease oestrogen activity
- pre menopausal: tamoxifen
- post menopausal: aromatase inhibitors

Question 14

anti-Her2 therapy?

Answer 14

trastuzumab - monoclonal Ab against her-2 receptor