Breast Cancer

Question 1

def of breast cancer in situ

Answer 1

breast cancer confined to the duct or lobule

does not extend beyond the basement membrane

Question 2

what is ductal carcinoma in situ

Answer 2

precursor to invasive carcinoma

Question 3

what are the different types of breast cancer in situ

Answer 3

DCIS

LCIS

Question 4

what does DCIS increase risk of

Answer 4

invasive breast cancer at site of biopsy

Question 5

what does LCIS increase risk of

Answer 5

invasive breast cancer in either breast

Question 6

which was more common DCIS or LCIS

Answer 6

DCIS (85%)

LCIS (15%)

Question 7

epi

Answer 7

elderly

Question 8

what does HRT increase risk of

Answer 8

invasive breast cancer

Question 9

what does HRT not have an affect on

Answer 9

DCIS

Question 10

aetiology of DCIS

Answer 10

proliferation of malignant appearing epithelial cells which have not penetrated the basement membrane

Question 11

where is the origin of most DCIS

Answer 11

terminal duct lobular lesions

Question 12

what is the progression of benign disease to invasive breast cancer

Answer 12

1 typical hyperplasia
2 atypical hyperplasia
3 DCIS
4 invasive breast cancer

Question 13

what receptor is associated with DCIS

Answer 13

oestrogen receptor

Question 14

what marker is used to guide therapy with DCIS

Answer 14

HER2

Question 15

is HER2 more highly expressed in DCIS or invasive breast cancer

Answer 15

DCIS

Question 16

how does oestrogen play a role in breast cancer in situ

Answer 16

higher oestrogen levels (women) stimulate proliferation of breast epithelial cells in lobules and ducts
mutations occur in these epithelial cells

Question 17

what should be given to women who are at high risk of breast cancer

Answer 17

SERM (selective oesotrogen receptor modulator) such as tamoxifen

Question 18

risk factors for breast cancer

Answer 18

FHx of breast or ovarian cancer
klinefelters syndrome
older age at menopause
older age at first pregnancy
nulliparity

Question 19

what is peutz jeghers syndrome

Answer 19

predisposition to stomach, colon, pancreas, thyroid, breast, lung cancers

Question 20

features of breast cancer in situ

Answer 20

RFs and FHx of breast cancer
nipple discharge (indicating papilloma most commonly or less commonly DCIS

Question 21

first line investigation for breast cancer in situ

Answer 21

mammography looking for calcifications

Question 22

def of primary invasive breast cancer

Answer 22

breast malignancy which has spread past the basement membrane into surrounding tissues

Question 23

epi

Answer 23

most common female malignancy

elderly

Question 24

aetiology of invasive breast cancers

Answer 24

1 genetic factors
-BRCA mutation
2 hormonal factors
-increased levels of oestrogen

Question 25

what does BRCA mutation increase risk of

Answer 25

breast and ovarian cancer | breast>ovarian

Question 26

what are different types of epithelial tumours

Answer 26

invasive ductal carcinoma invasive lobular carcinoma tubular carcinoma medullary carcinoma

Question 27

what is a tumour of the nipple

Answer 27

pagets disease of the nipple

Question 28

what is the primary prevention for breast cancer

Answer 28

SERM such as tamoxifen

Question 29

how often does breast screening occur in the UK

Answer 29

every 3 yrs between 50 and 70yr

Question 30

what are risk factors for invasive breast cancer

Answer 30

``` elderly females PMHx/FHx of breast cancer or ovarian endogenous oestrogen exposure (younger age of menarche and older age of menopause) exogenous oestrogen exposure (OCP) radiation exposure ```

Question 31

features of invasive breast cancer

Answer 31

RFs, PMHx/FHx of breast cancer or ovarian cancer painless breast mass with nipple retraction or asymmetry nipple discharge which can be serous, milky or bloody axillary lymphadenopathy

Question 32

first line invesitigation for invasive breast cancer

Answer 32

mammogram - irregular spiculated mass - clusterered calcifications

Question 33

what is peau d'orange associated with

Answer 33

invasive breast cancer

Question 34

def of metastatic breast cancer

Answer 34

breast malignancy which has spread outside the breast and associated lymph nodes (axillary, infra + supraclavicular)

Question 35

how long do patients with MBC commonly survive

Answer 35

2 to 3 yrs

Question 36

aetiology of metastatic breast cancer

Answer 36

1 genetics 2 hormones -oestrogen and progesterone

Question 37

how is metastatic breast cancer classified

Answer 37

patients with bone and soft tissue only - survival is longer | patients with other organ involvement - shorter survival

Question 38

risk factors for metastatic breast cancer

Answer 38

``` elderly females PMHx or FH of breast or ovarian cancer BRCA tumour is >5cm high number of positive nodes ```

Question 39

features of metastatic breast cancer

Answer 39

breast mass bone pain (bone metastases pleural effusion + SOB (lung metastases) neurological features such as weakness or seizures (brain metastases) loss of appetite and weight loss

Question 40

investigations

Answer 40

1 mammography 2 bloods -FBC, if abnormal may indicate bone or liver metastases -LFTs, if abnormal may indicate bone or huge liver metastases -calcium, if elevated may indicate bone metastases 3 imaging -CXR for lung metastases -CT for liver or lung metastases -bone scan for bone metastases