Breast Cancer

Question 1

What are the 3 genes most associated with familial cases of breast cancer?

Answer 1

BRCA1, BRCA2 and TP53 gene mutations

Question 2

What are the cancers associated with mutations to BRCA2 gene?

Answer 2

Breast cancer, Ovarian cancer, pancreatic, bowel, and endometrial cancer

Question 3

What is the condition caused by TP53 gene mutation? What cancers are seen in this condition?

Answer 3

Li-Fraumeni syndrome.

Breast cancer, Lung cancer, colon cancer, leukemia, adrenocortical, glioma, sarcoma.

Question 4

What are the characteristics of BRCA-associated breast cancer?

Answer 4

Younger age of onset

Frequently bilateral breast affected

Worse hislogical features: more aneuploidy, higher proliferation indices, higher grade, higher proportion with negative hormone receptor.

Question 5

Where does breast cancer often metastasise to?

Answer 5

Bone (70%), Lung (60%), Liver (55%)

Question 6

Nipple retraction is more likely in which carcinoma type: Ductal carcinoma or Lobular carcinoma?

Answer 6

Ductal carcinoma

Question 7

Which cancer is the most likely cancer to metastasise to the bone?

Answer 7

Breast cancer, followed by lung and prostate cancer

Question 8

The progression of metastasis through the lymph node in breast cancer is orderly/non-orderly.

Answer 8

Orderly

Question 9

Which imaging is for staging purposes in breast cancer?

What further imaging is done for suspicious findings?

Answer 9

CXR, US, bone scan.

CT, MRI or PET are further done for “suspicious findings”

Question 10

Are tumour markers used for staging in breast cancer?

Answer 10

NO.

Question 11

CT and MRI is used for what in breast cancer?

Answer 11

If there is clinical suspicion of metastasis.

Question 12

What are the indications for radiotherapy in those who have undergone mastectomy?

Answer 12

All tumours >5cm
Tumours deep in the breast, where surgical clearance is 3mm or less.
All patients with 4 or more lymph node metastases.

Question 13

Treatment for early breast cancer

Answer 13

Wide local excision and axillary node surgery, followed by breast radiotherapy (adjuvant)

Question 14

What is the management of metastatic disease?

Answer 14

Metastatic disease management includes radiotherapy to palliate painful bone metastases, and second-line endocrine therapy with aromatase inhibitors, which inhibits peripheral oestrogen production in adrenal and adipose tissue

Question 15

Give examples of adjuvant hormonal therapy. Who are they suitable for?

Answer 15

Tamoxifen and aromatase inhibitors for ER+ patients

Question 16

Who should be offered adjuvant chemotherapy?

Answer 16

Patients at higher risk of recurrence:

• tumours >1cm
• tumours that is ER(-)
• presence of involved axillary lymph nodes

Normally, adjuvant radiotherapy is given

Question 17

What is the difference between core biopsy and FNA?

Answer 17

Core biopsy provides histology, whereas FNA only provides cytology.
Histological sample can detect breast cancer more accurately.