Breast Cancer

Question 1

what is the tripple assessment

Answer 1

1. clinical - history + exam
2. radiological - mammogram/USS
3. cytopathological– FNA/core biopsy

Question 2

breast screening in Scotland

Answer 2

offered 3 YEARLY to women 50-70

Question 3

what % of breast cancers are picked up by screening

Answer 3

50%

Question 4

most common symptom of breast cancer

Answer 4

lump

Question 5

genes associated with breast cancer

Answer 5

BRCA1 BRCA2

Question 6

risk factors for breast cancer

Answer 6

increased age 
previous breast cancer
\+ve family hirsotyr 
early menarche
late menopause 
no pregnancies 
HRT
alcohol consumption 
obesity

Question 7

most common breast cancer

Answer 7

ductal carcinoma

Question 8

presentation of ductal carcinoma

Answer 8

firm, defined lump

Question 9

2nd most common breast cancer

Answer 9

lobular carinoma

Question 10

presentation of lobular carcinoma

Answer 10

softer, ill defined lump

Question 11

what is a ductal carcinoma in situ

Answer 11

malignant changes present in epithelial cells but basement membrane remains intact
- no invasion is seen

Question 12

presentation of ductal carcinoma in situ

Answer 12

majority are non-palpable

- detected by mammogram

Question 13

ductal carcinoma in situ appearance on mammogram

Answer 13

micro calcifications

Question 14

types of ductal carcinoma in situ

Answer 14

high grade: malignant cells with abundant cytoplasm, marked pleomorphism and increased mitoses
low grade: small, regular cells which form micropapillary strucutres
intermediate: in-between these two stages

Question 15

what is pagets disease of the nipple

Answer 15

high grade DCIS that has spread into nipple

Question 16

appearance of pagets disease of the nipple

Answer 16

‘eczema of nipple’ inflammatory changes

itchiness, burning, bleeding

Question 17

what are the 2 forms of lobular in situ neoplasia

Answer 17

atypical lobular hyperplasia

lobular carcinoma in situ

Question 18

what is atypical lobular hyperplasia

Answer 18

<50% of lobule involved

Question 19

what is lobular carcinoma in situ

Answer 19

> 50% lobule involved

Question 20

what does ER positive mean?

Answer 20

grows in response to oestrogen

Question 21

what is HER2

Answer 21

member of human epidermal growth factor receptor family

encodes a transmembrane tyrosine kinase receptor

Question 22

how is HER2 tested for

Answer 22

FISH

Question 23

what drug is given for HER2 +ve tumours

Answer 23

herceptin

Question 24

what drug is given to premenopausal women who are ER +ve

Answer 24

tamoxifen

Question 25

what drug is given to post menopausal women who are ER +Ve

Answer 25

letrozole

Question 26

what type of drug is letrozole

Answer 26

aromatase inhibitor

Question 27

why is letrozole only given to post menopausal women

Answer 27

increases risk of osteoporosis

Question 28

lymph node staging

Answer 28

stage 1: nodes -ve
stage 2: 1-3 nodes +ve
stage 3: >4 nodes involved

Question 29

surgery options for breast cancer

Answer 29

wide local excision
mastectomy
axillary node clearance/ sampling/ sentinel node biopsy

Question 30

what is given after surgery

Answer 30

radiotherapy

Question 31

types of flap in mastectomy

Answer 31

latissimus dorsi pedicled flap
deep inferior epigastric artery perforator free flap (DIEP)
inferior gluteal artery perforator free flap (IGAP)

Question 32

arteries used in flaps

Answer 32

deep inferior epigastric

inferior gluteal