Breast cancer

Question 1

Which is the most common cancer in women?

Answer 1

Breast cancer

Question 2

What are the red flag symptoms for breast cancer? (4)

Answer 2

1. Over 30 with;
   - unexplained breast lumo
   - axillary lymphadenopathy
2. Over 50 with nipple changes of retraction, discharge or other change of concern
3. Skin changes suggestive of cancer

Question 3

What is the initial examination done?

Answer 3

Breast examination

Question 4

Name 5 potential signs in a breast examination that would alert you to malignancy?

Answer 4

1. Hard lump
2. Skin tethering / peau d’orange
3. Nipple discharge or distortion
4. Unilateral eczematous skin changes (does not respond to tx)
5. Axillary lymphaneopathy

Question 5

List 5 risk factors for breast cancer?

Answer 5

1. FHx in 1st degree relative (BRCA 1 and 2 genes carry a very high risk but <5% of cases)
2. Age
3. HRT - risk increases after >5 years
4. Radiation to the chest ie. for lung cancer
5. Early menarche / late menopause or Nulliparous / not having breast fed

Question 6

What are the 2 criteria for which you would consider referral?

Answer 6

1. Age > 30 years with unexplained breast lump with or without pain
2. Age > 50 in any one nipple only
   - discharge, retraction or other nipple related changes ie. Pagets

Question 7

What is done by the specialist in the breast clinic?

Answer 7

1. Triple assessment
   - Clinical exmaination
   - USS / Mammogram ( less accurate in younger women)
   - FNA / Tissue diagnosis