Breast Cancer

Question 1

what is the tripple assessment

Answer 1

1. clinical - history + exam
2. radiological - mammogram/USS
3. cytopathological– FNA/core biopsy

Question 2

breast screening in Scotland

Answer 2

offered 3 YEARLY to women 50-70

Question 3

what % of breast cancers are picked up by screening

Answer 3

50%

Question 4

most common symptom of breast cancer

Answer 4

lump

Question 5

genes associated with breast cancer

Answer 5

BRCA1 (chromosome 17)

BRCA2 (chromosome 13)

Question 6

risk factors for breast cancer

Answer 6

increased age 
previous breast cancer
\+ve family history
early menarche
late menopause 
no pregnancies 
HRT
alcohol consumption 
obesity

Question 7

most common breast cancer

Answer 7

ductal carcinoma

Question 8

presentation of ductal carcinoma

Answer 8

firm, defined lump

Question 9

2nd most common breast cancer

Answer 9

lobular carcinoma

Question 10

presentation of lobular carcinoma

Answer 10

softer, ill defined lump

Question 11

what is a ductal carcinoma in situ

Answer 11

malignant changes present in epithelial cells but basement membrane remains intact
- no invasion is seen

Question 12

presentation of ductal carcinoma in situ

Answer 12

majority are non-palpable

- detected by mammogram

Question 13

ductal carcinoma in situ appearance on mammogram

Answer 13

micro calcifications

Question 14

types of ductal carcinoma in situ

Answer 14

high grade: malignant cells with abundant cytoplasm, marked pleomorphism and increased mitoses
low grade: small, regular cells which form micropapillary strucutres
intermediate: in-between these two stages

Question 15

what is pagets disease of the nipple

Answer 15

high grade DCIS that has spread into nipple

Question 16

appearance of pagets disease of the nipple

Answer 16

‘eczema of nipple’ inflammatory changes

itchiness, burning, bleeding

Question 17

what are the 2 forms of lobular in situ neoplasia

Answer 17

atypical lobular hyperplasia

lobular carcinoma in situ

Question 18

what is atypical lobular hyperplasia

Answer 18

<50% of lobule involved

Question 19

what is lobular carcinoma in situ

Answer 19

> 50% lobule involved

Question 20

what does ER positive mean?

Answer 20

grows in response to oestrogen

Question 21

what is HER2

Answer 21

member of human epidermal growth factor receptor family

encodes a transmembrane tyrosine kinase receptor

Question 22

how is HER2 tested for

Answer 22

FISH

Question 23

what drug is given for HER2 +ve tumours

Answer 23

herceptin

Question 24

what drug is given to premenopausal women who are ER +ve

Answer 24

tamoxifen

Question 25

what drug is given to post menopausal women who are ER +Ve

Answer 25

letrozole/anastrazole

Question 26

what type of drug is letrozole

Answer 26

aromatase inhibitor

Question 27

why is letrozole only given to post menopausal women

Answer 27

increases risk of osteoporosis

Question 28

lymph node staging

Answer 28

stage 1: nodes -ve stage 2: 1-3 nodes +ve stage 3: >4 nodes involved

Question 29

surgery options for breast cancer

Answer 29

wide local excision mastectomy axillary node clearance/ sampling/ sentinel node biopsy

Question 30

what is given after surgery

Answer 30

radiotherapy

Question 31

types of flap in mastectomy

Answer 31

latissimus dorsi pedicled flap deep inferior epigastric artery perforator free flap (DIEP) inferior gluteal artery perforator free flap (IGAP)

Question 32

arteries used in flaps

Answer 32

deep inferior epigastric | inferior gluteal

Question 33

what other cancers are BRCA genes linked to

Answer 33

ovarian prostate bowel

Question 34

where does breast cancer metastasise

Answer 34

lung liver bones brain

Question 35

management of DCIS

Answer 35

excision + adjuvant therapy (radiotherapy/tamoxifen)

Question 36

treatment of lobular carcinoma in situ

Answer 36

close monitoring | - 6 monthly exams, yearly mammogram

Question 37

who typically gets lobular carcinoma in situ

Answer 37

pre-menopausal women

Question 38

presentation of inflammatory breast cancer

Answer 38

worsening erythema + oedema of the breast in the absence of signs of infection e.g. fever, discharge, raised WBC, raised CRP

Question 39

when is a mastectomy performed

Answer 39

if tumour too large for wide local excision (>4cm) | patient choice

Question 40

what should women with no palpable axillary lymph nodes receive before surgery

Answer 40

axillary USS | - If positive should receive sentinel node biopsy

Question 41

tumour with grey gelatinous surface

Answer 41

mucinous carcinoma

Question 42

side effects of tamoxifen

Answer 42

DVT Endometrial cancer vaginal bleeding

Question 43

side effects of letrozole

Answer 43

osteoporosis

Question 44

what is Herceptin also known as

Answer 44

Trastuzumab

Question 45

contraindication to giving a patient Herceptin

Answer 45

heart disorders

Question 46

what patients should be referred to suspected cancer pathway

Answer 46

- over 30 + unexplained lump | - over 50 + unilateral discharge / retraction / other suspicious changes