Breast Cancer

Question 1

State when a person is referred for breast cancer screening.

Answer 1

1st degree relative with breast cancer less than 40 years old, male breast cancer or bilateral breast cancer. 1st and 2nd degree relative with breast and ovarian cancer.

Question 2

If a known BRCA 1/2 mutation is present, what is the women offered?

Answer 2

Annual MRI 3-49 years. Annual mammography 50-69 years old.

Question 3

State 3 parts of the breast.

Answer 3

Glandular tissue. Stroma. Lymphatic vessels.

Question 4

State 2 types of cells found in the glandular tissue of the breasts.

Answer 4

Alveolar cells (secrete milk). Myoepithelial cells (squeeze and push milk out of lumen).

Question 5

State a hormone responsible for the alveolar cells to divide and increase in number.

Answer 5

Oestrogen. Progesterone.

Question 6

What happens to the alveolar cells after menstruation?

Answer 6

Alveolar cells undergo division and apoptosis.

Question 7

State 2 of the 4 molecular stub-types used in identifying breast cancer.

Answer 7

Oestrogen receptor (ER). Progesterone receptor (PR). Human epidermal growth factor receptor 2 expression (HER2). Protein Ki67 levels.

Question 8

State 3 molecular sub-types.

Answer 8

Luminal A. Luminal B. Triple-negative. HER2 enriched. Normal-like.

Question 9

State the function of alveolar cells.

Answer 9

Make milk.

Question 10

State the function of myoepithelial cells.

Answer 10

Squeeze and push milk out of the lumen.

Question 11

State the function of the basement membrane.

Answer 11

It exists to prevent air bubbles from forming in the blood, and from blood entering the alveoli.

Question 12

State the 2 types of breast cancer.

Answer 12

Ductal carcinoma in-situ (tumours cells grow from the wall of the ducts into the lumen). Invasive ductal carcinoma (tumour crosses the basement membrane and migrate along the lactiferous ducts). Lobular carcinoma in-situ (clusters of tumour cells grow within lobules (don’t invade the ducts).

Question 13

State 2 genetic causes of breast cancer.

Answer 13

BRCA1 and BRCA2 - autosomal dominant mutations. TP53 gene mutation - slow cell division and make cells divide uncontrollably. ERBB2 gene - increase human epidermal growth factor receptor 2 (HER-2) - activates growth cells.

Question 14

State 2 environmental risk factors for breast cancer.

Answer 14

Increase in the number of menstrual cycles (alveoli divided and then die) - early stage menarche. Late age menopause. Medications containing oestrogen. Ionising radiation. Smoking. Increase in alcohol consumption. Obesity.

Question 15

State 2 complications of breast cancer.

Answer 15

Tumour inflammation - suspensory ligaments/lactiferous ducts metastasis. Tumour can enter lymph vessels - lymph builds up in interstitial space - swelling, thickened and dimpled skin. Metastasis - tumour spread to the bone and brain via the blood.

Question 16

State a factor which reduces the risk of breast cancer.

Answer 16

Early pregnancy. Longer time breastfeeding.

Question 17

State a treatment complication.

Answer 17

Lymph node resection - lymphedema (swelling generally in your arms/legs). Cytotoxic chemotherapy - infertility. Chemotherapy/radiation therapy - cardiac disorders/myeloid neoplasms (abnormal growth in bone marrow/spinal cord).

Question 18

State 3 symptoms of breast cancer.

Answer 18

Hard, painless lump/swelling. Nipple retraction. Nipple discharge - normally bloody. Eczema - like rash (Paget’s disease of breast). Skin dimpling - orange peel skin. Palpable lymph nodes - swelling under armpit (spread to axillary lymph nodes). Breast immobile and fixed (infiltration if cancer cells spread into pectoral muscles). Fibrosis of lactiferous ducts and suspensory ligaments. Lympoedema (swelling in your arms/legs).

Question 19

State 2 things used to diagnose breast cancer.

Answer 19

Physical exam.
Mammography. 
Ultrasound.
Cytology.
Core biopsy.

Question 20

What does the TNM system mean?

Answer 20

T - size of the tumour
N - degree in which cancer has spread to lymph nodes
M - degree in which cancer has spread to other sites

Question 21

State 3 treatments for breast cancer.

Answer 21

Surgery - partial mastectomy, total mastectomy, oophorectomy (removal of one or more ovaries). Wide excision (skin lesion and surround area of cells removed).
Radiotherapy.
Chemotherapy - tamoxifen, raloxifene.
Hormonal therapy - when tumours have hormone receptors e.g. oestrogen, HER2.