Breast cancer

Question 1

presentation of breast cancer

Answer 1

painless lump - irregular, hard, fixed
nipple discharge
nipple in-drawing
skin tethering

inflammatory carcinomas are rapidly growing, painful and red

Question 2

risks for getting breast cancer

Answer 2

had it before
family history
BRCA 1/2 gene
tp53 gene
no kids/breastfeeding
early menarche/late menopause
obesity
alcohol
HRT

Question 3

are more breast cancers ductal or lobular?

Answer 3

70% ductal (epithelial lining of ducts)

10% lobular (epithelial lining of terminal ducts - lobules)

Question 4

assessment of breast lump

Answer 4

triple assessment
clinical assessment
mammography
biopsy

each scores out of 5 and they should match
(MRI can be useful)

Question 5

surgical treatment of breast cancer

Answer 5

breast conservation if lump 1/4 breast volume
pre operative chemo can shrink the tumour to meet this criteria

mastectomy - if large, multiple etc
with/out immediate/delayed reconstruction

axilla surgery may be required

Question 6

will full axillary clearance how many will get lymphoedema

Answer 6

10%

Question 7

if ER positive what adjunct can be used

Answer 7

tamoxifen if premenopausal (inhibits oestrogen receptor)

anastrozole if post menopausal - aromatase inhibitor (stops conversion of androgens to oestrogen - so osteoporosis risk)

Question 8

if HER 2 positive what adjunct can be used

Answer 8

trastuzumab (Herceptin)

Question 9

extras for treatment

Answer 9

radiotherapy (wide local excision)/chemotherapy
bisphosphonates
denosumab - for osteoporosis in older women