Breast cancer

Question 1

How does mutinous carcinoma present?

Answer 1

Lump is of a soft consistency
Macroscopically there is a grey, gelatinous surface when it is cut apart
Better prognosis than non special type

Question 2

What is Paget’s associated with?

Answer 2

DCIS or invasive carcinoma

Question 3

How does DCIS present?

Answer 3

Comedo necrosis is a feature of high nuclear grade ductal carcinoma in situ. It is has a high risk of being associated with foci of invasion.

Question 4

What are the adverse effects of tamoxifen?

Answer 4

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climateric side-effects
venous thromboembolism
endometrial cancer
osteoporosis

Question 5

What are the adverse effects of anastrozole?

Answer 5

osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia

Question 6

How is T presented in the TMN staging?

Answer 6

T1 <2cm
 T2 2-5cm
 T3 5+cm
T4a invades chest wall
T4b invades skin (includes ulceration or oedema)
T4c invades chest wall and skin 
T4d inflammatory breast cancer

Question 7

When should neo-adjuvant chemotherapy (NACT) be considered?

Answer 7

Try to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy

Question 8

What is trastuzumab?

Answer 8

Herceptic

Used in HER2+ breast cancer

Question 9

When is FEC-D chemotherapy used?

Answer 9

Breast cancer that is node positive