Breast cancer

Question 1

What are risk factors of breast cancer?

Answer 1

Older age
Family history

Increased duration of oestrogen exposure:

• early menarche
• late menopause
• HRT or OCP

Obesity
Sedentary lifestyle
Alcohol

Question 2

Clinical features of breast cancer?

Answer 2

Painless lump: fixed, hard, irregular

Nipple changes:

• discharge
• indrawing
• inversion

Skin tethering
Inflamed breast

Metastatic disease:
- bone pain

Question 3

How would you initially investigate a woman with suspected breast cancer?

Answer 3

Triple assessment, gives a score out of 5 on how much you suspect malignancy

1. Clinical (1-5)
2. Imaging (1-5)
3. Biopsy (1-5)

Question 4

As part of the triple assessment, what imaging could you do?

Answer 4

Mammogram
USS
MRI

Question 5

How would you investigate whether there is lymph node involvement?

Describe how it’s done.

Answer 5

Sentinel lymph node biopsy

Injection of radioactive substance near the tumour, which will spread to the sentinel lymph node. A Geiger counter is used to detect radioactivity to find the sentinel node.

Question 6

What is a sentinel lymph node?

Answer 6

The first lymph node to which cancer cells are most likely to spread

Question 7

List some common genes linked with breast cancer?

Answer 7

BRCA1

BRCA2

Question 8

Management of breast cancer (brief summary!)

Answer 8

Surgery

Plus adjuvant therapy if required.

Question 9

Describe surgical management of breast cancer?

Answer 9

Breast surgery, either:

1. Lumpectomy, breast conservation
2. Mastectomy

Axilla surgery, either:

1. Full axillary clearance: if lymph node involvement
2. Limited axillary clearance: if no lymph node involvement

Question 10

In what circumstances would you do a mastectomy?

Answer 10

Relative size of tumour to breast: small breasts, or large tumour

Tumours in more than one location (multifocal)

Patient choice

Question 11

Mastectomy is a safer option than lumpectomy. True or false?

Answer 11

False, there’s no survival advantage to having a mastectomy

Question 12

List the adjuvant therapies used to treat breast cancer?

Answer 12

Drugs that affect oestrogen

Radiotherapy

Chemotherapy

(Herceptin) trastuzumab

Question 13

When would you use drugs that affect oestrogen to treat breast cancer?

What two types are there?

Answer 13

If the tumour was oestrogen receptor positive, use oestrogen blockers

Tamoxifen: pre-menopause

Aromatase inhibitors: post-menopause (eg. anastrozole, letrozole)

Question 14

When is radiotherapy indicated?

Answer 14

Post lumpectomy

Post mastectomy if it was an aggressive tumour

Question 15

When is chemotherapy indicated?

Answer 15

In aggressive disease

Question 16

When is Herceptin indicated?

Answer 16

If the tumour is HER2 positive

Question 17

Oestrogen receptor positive tumour have the worst prognosis. True or false?

Answer 17

False

HER2 receptor +ve tumours do

Question 18

In terms of histopathology, what type of tumours are there?

Which is most common?

Answer 18

Ductal (most common)
Lobular
Tubular
Others

Question 19

How does TNM staging work?

Answer 19

T for tumour:

• size
• invasion of surrounding tissue

N for node:

• involved or not
• which ones

M for metastasis
- has it spread to other part of body

Question 20

When is breast screening offered to women?

Answer 20

47 - 73

Every 3 years

Question 21

When you’re examining a woman with suspected breast cancer, where else should you palpate aside from the breast?

Answer 21

Axilla
Neck

For lymph nodes

Question 22

On the triple assessment, how would you score a lump that is soft and mobile on examination?

Answer 22

P2: benign

Soft and mobile is likely to be benign

Question 23

On the triple assessment, how would you rate these mammogram scans?

• round, regular shaped lesion
• dense, spreading lesion

Answer 23

M2: benign

M5: malignant

Question 24

Calcification is commonly seen in the breast. True or false?

Answer 24

True

Question 25

If a lady presents with symptoms to the breast clinic, what age groups would you do a USS and what age would you do a USS and a mammogram?

Answer 25

Under 40 USS

Over 40 USS and mammogram