Breast Cancer

Question 1

Definition of breast cancer?

Answer 1

Malignancy of breast tissue?

Question 2

Most common type and epidemiology of breast cancer?

Answer 2

Invasive ductal carcinoma

• most common cancer in the UK
• affects men as well, but obviously women more

Question 3

What is staging of cancer?

Answer 3

analysis of Spread

Question 4

What mnemonic used to describe staging?

Answer 4

TNM

• tumour
• nodes
• metastases

Question 5

What is grading of cancer?

Answer 5

analysis of Differentiation

Question 6

What grading system is used in breast cancer?

Answer 6

Nottingham grading system

Question 7

What are the invasive and non-invasive forms of breast cancer?

Answer 7

Non-invasive - DCIS (ductal carcinoma in situ)

Invasive - infiltrative ductal carcinoma (75%), infiltrative lobular carcinoma, Paget’s disease of the breast

Question 8

Risk factors for breast cancer?

Answer 8

Age
FHx - 1st degree relative
Obesity
Increased oestrogen exposure
Alcohol
Fatty diet
Previous chest radiation
Nulliparity
Familial breast cancer

Question 9

Evidence of increased oestrogen exposure?

Answer 9

Early menarche (<11)
Late menopause (>55)
HRT/OCP

Question 10

What gene and other cancers is breast cancer associated with?

Answer 10

BRCA 1/2

- ovarian and pancreatic cancer

Question 11

SCTF presentation of breast cancer?

Answer 11

S - increased size, lump, skin changes

C - hard lump, irregular margins, redness, non-compressible

T - generally painless, inflammatory breast cancer (painful + warm)

F - tethered to underlying tissue, immobile

Question 12

Symptoms of metastases from breast cancer?

Answer 12

Bone pain
Shortness of breath
Neurological symptoms (rare)

Question 13

Skin changes in breast cancer?

Answer 13

• Armpit skin thickening
• Peau d’orange
• Skin dimpling
• Nipple discharge (sometimes bloody)
• Nipple inversion
• Eczematous-looking skin (Paget’s)

Question 14

Investigation process to confirm suspected breast cancer?

Answer 14

Triple assessment

• clinical examination
• imaging (<35 = USS, >35 = mammogram)
• tissue diagnosis (FNA, core biopsy)

Question 15

Appropriate investigations once breast cancer is diagnosed?

Answer 15

Staging (commonly mets to liver, lung, bones)

• CXR
• Liver USS
• CT (brain/chest)
• bone scan

Bloods (same principle)

• FBC
• U&Es
• calcium + bone profile
• LFTs
• ESR

Question 16

Management of breast cancer?

Answer 16

Depends on type, stage, and grade of cancer
Includes:
- surgery
- medications
- chemotherapy
- monoclonal antibodies
- radiotherapy

Question 17

Appropriate surgical management options for breast cancer?

Answer 17

Total mastectomy
Lumpectomy
Sentinel LN biopsy or axillary LN clearance (depends on number of LNs removed)

Question 18

Appropriate medication management options for breast cancer?

Answer 18

Oestrogen receptor antagonists (tamoxifen)

Aromatase inhibitors (letrozole)

Question 19

Types of chemotherapy viable in management of breast cancer?

Answer 19

Neo-adjuvant or adjuvant

Question 20

Why/when is radiotherapy useful in management of breast cancer?

Answer 20

Reduces risk of recurrence post-surgery