Breast Cancer

Question 1

Most common type of breast cancer?

Answer 1

Invasive ductal carcinoma (75%)

Question 2

RF for breast cancer?

Answer 2

Age
Increased oestrogen exposure
BRCA1 (breast and ovarian)
BRCA2 (female and male breast)

Question 3

Clinical presentation?

Answer 3

Breast mass (most common)
Nipple discharge
Skin changes (tethering, P'eau d'orange)
Regional lymphadenopathy
Metastatic symptoms e.g. SCC (rare)

Others: weight loss, fatigue

Question 4

Investigations

Answer 4

1. Mammography
   - screening - every 3 years between 50-70yrs
   - Pre-op B/L
2. Diagnostic = biopsy (usually Fine needle aspiration (FNAC))
3. Isoptopic bone scan and liver imaging with high risk disease

Question 5

Grading

Answer 5

Grade 1 = well differentiated
–>
Grade 3 = poorly differentiated

Question 6

T, N, M

Answer 6

T1 = invasice <2cm
T2 = invasive <5cm
T3 = invasive >5cm

N1 = mobile axillary nodes
N2 = fixed axillary nodes
N3 = internal mammary LN

Question 7

Staging

Answer 7

Stage 0 = Tis, N0, M0

Stage 1 = T1, N0, M0
Stage 2 = T0/T1/T2, N1, N0 or T3, N0, M0
Stage 3 = T or N > stage 2
Stage 4 = any with M1

Question 8

Management (surgery and radiotherapy)

Answer 8

1. Surgery - mastectomy or wide local excision (WLE)
2. Axillary LN assessment in all post-op pts
3. Radiotherapy - adjuvant
   - all WLE pts
   - pts with high recurrence risk
   - palliative for recurrent local disease

Question 9

Systemic management

Answer 9

Chemo/endocrine - things to consider:

• ER +ve = good response and prognosis
• HER2 = poor prognosis, good response
• Menopausal status

Chemo - adjuvant better response in younger patients
- used in palliative

Question 10

Endocrine management

Answer 10

1. Tamoxifen (in ER +ve) - 20mg a day for 5 years
   - SE - hot flushes, Increased VTE, increased endometrial
2. Aromatase inhibitors in post-menopasual women e.g. anastrazole
   - increased efficacy and decreased toxicity than tamoxifen
   - Increased osteoporosis
3. Herceptin in HER2 +ve pts

Question 11

Ovarian ablation

Answer 11

Oophorectomy
Rtx induced menopause
LHRH agonists

–>Significantly reduces recurrence in pre-menopausal women

Question 12

Prognosis (5-year survival)

Answer 12

stage 1 = 84%
2 = 71%
3 = 48%
4 = 18%