Breast Cancer

Question 1

What is the incidence of breast cancer in the general population?

Answer 1

affects 1 in 8 women

Question 2

What are the risk factors for breast cancer?

Answer 2

Age: increased incidence
Previous breast cancer
Genetic: BRCA1 and BRCA2 (5%)
Early menarche and late menopause
Late or no pregnancy
HRT
Alcohol (>14 units a week)
Weight
Post radiotherapy treatment for Hogkin's disease

Question 3

How can breast cancer present?

Answer 3

Lump
Mastalgia (persistent unilateral pain)
Nipple discharge (blood-stained)
Nipple changes (Paget’s disease, retraction)
Change in the size or shape of the breast
Lymphoedema (swelling of the arm)
Dimpling of the breast skin (orange peel)

Question 4

Why is the sensitivity of breast imaging reduced in young women under 35?

Answer 4

Presence of increased glandular tissue

Question 5

What are the different types of invasive breast cancer?

Answer 5

80% ductal carcinoma
10% lobular carcinoma
10% others

Question 6

What are the different types of non invasive breast cancer?

Answer 6

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

Question 7

Name some of the possible members of a breast cancer MDT

Answer 7

Breast surgeon
Radiologist
Cytologist
Pathologist
Clinical oncologist
Medical oncologist
Nurse counselor
Psychologist
Reconstructive surgeon
Patient and partner
Palliative care

Question 8

What is the T scale for the primary tumour?

Answer 8

Tx - primary tumour cannot be assessed
T0 - primary tumour not palpable
T1 - clinically palpable tumour, size <2 cm
T2 - tumour size 2-5 cm
T3 - tumour size >5 cm
T4a - tumour invading skin
T4b - tumour invading chest wall
T4c - tumour invading both
T4d - inflammatory breast cancer

Question 9

What is the N scale for the regional lymph nodes?

Answer 9

N0 - no regional lymph nodes palpable
N1 - regional lymph node palpable, mobile
N2 - regional lymph node palpable, fixed

Question 10

What is the M scale for distant metastases?

Answer 10

Mx - distant metastasis cannot be assessed
M0 - no distant metastasis
M1 - distant metastasis

Question 11

What are the complications of axillary treatment?

Answer 11

Lymphoedema (10-17%)
Sensory disturbance (intercostobrachial n.)
Decreased ROM of the shoulder joint
Nerve damage (long thoracic, thoracodorsal, brachial plexus)
Vascular damage
Radiation-induced sarcoma

Question 12

What are the factors associated with increased risk of disease recurrence?

Answer 12

Lymph node involvement
Tumour grade
Tumour size
Steroid receptor status (negativity - ER/PR neg)
HER2 status (positivity - HER2 pos)
Lymphovascular invasion

Question 13

What are some of the possible complications of radiotherapy?

Answer 13

Skin reactions / skin telangiectasis
Radiation pneumonitis
Cutaneous radionecrosis / osteonecrosis
Angiosarcoma

Question 14

How does hormone therapy for breast cancer work?

Answer 14

Blocks stimulation of cell growth by oestrogen, in oestrogen receptor positive cells (ER+)

Question 15

How does Tamoxifen work?

Answer 15

Blocks stimulation of cell growth by oestrogen
Blocks directly on ER receptor
Effective in all age groups
More effective given after chemotherapy

Question 16

How do Aromatase inhibitors work?

Answer 16

Blocks stimulation of cell growth by oestrogen by inhibiting oestrogen receptor synthesis
Should only be used in postmenopausal women

Question 17

What is Trastuzumab (Herceptin) and how does it work?

Answer 17

Monoclonal antibody against HER2 receptor
Given to patients with overexpression of HER2 and chemotherapy
50% decreased risk of recurrence
33% increase in survival at 3 years