Breast cancer

Question 1

What is breast screening?

Answer 1

50-70 year old women invited through GP practice to attend mammogram every 3 years

Question 2

What ae the pathological types of breast carcinoma?

Answer 2

In situ carcinoma

Invasive carcinoma

Question 3

What are the types of carcinoma in situ?

Answer 3

Ductal carcinoma IS

Lobular carcinoma IS

Question 4

What is the % chance of developing cancer from a ductal CIS annually?

Answer 4

2-4%

Question 5

What is the % of developing cancer from a lobular CIS annually?

Answer 5

2%

Not necessarily in area of CIS

Question 6

What are the types of invasive carcinoma?

Answer 6

Cancers of no special type- ductal, lobular

Cancers of special type- tubular, cribriform, medullary

Question 7

What % of breast cancers are ductal?

Answer 7

70%

Question 8

What % of breast cancers are lobular?

Answer 8

20%

Question 9

What type of breast cancer has the best prognosis?

Answer 9

Cancers of special type

Question 10

What are the risk factors for breast cancer?

Answer 10

Older age
Younger age at menarche
Older age at menopause
Older age at first pregnancy
FH
Previous benign breast disease
Cancer in other breast
Radiation
Obesity
Alcohol
OCP
HRT

Question 11

What is done in triple assessment?

Answer 11

History and exam
Imaging
Biopsy

Question 12

Why is triple assessment done?

Answer 12

Eliminate the risk of missing anything

Question 13

What imaging is done for breast cancer?

Answer 13

Mammogram

US

Question 14

What biopsies can be done for breast cancer?

Answer 14

FNA cytology
Core biopsy
Image guided cytology or core biopsy
Open biopsy
Sentinel node biopsy

Question 15

What investigations are done to stage breast cancer?

Answer 15

FBC, U&Es, LFTs
CXR
Isotope bone scan- if thee is lymph node spread
Others as clinically indicated

Question 16

Where does breast cancer spread to locally?

Answer 16

Skin

Pectoral muscles

Question 17

What lymph nodes does breast cancer typically spread to?

Answer 17

Axillary

Internal mammary

Question 18

Where does breast cancer most often metastasise to?

Answer 18

Bone
Liver
Lungs
Brain

Question 19

What causes Paget’s disease of the nipple?

Answer 19

Intraepithelial spread of intraductal carcinoma

Question 20

What are the signs and symptoms of Paget’s disease of the nipple?

Answer 20

Pain or itching
Scaling
Redness
Mistaken for eczema
Ulceration or crusting
Serous or blood discharge

Question 21

What are the T stages of breast cancer?

Answer 21

1- 0-2cm
2- 2-5cm
3- >5cm
4- fixed to skin or muscle

Question 22

What are the surgical management options of breast cancer?

Answer 22

Breast conservation surgery

Mastectomy

Question 23

What are the types of breast conservation surgery?

Answer 23

Wide local excision
Quadrantectomy
Segmentectomy

Question 24

What patients are suitable for breast conservation surgery?

Answer 24

<4cm
Breast:tumour ratio
Suitable for radiotherapy
Single tumour- or rarely multiple
Patients wishes

Question 25

What are the options for treating lymph node spread in breast cancer?

Answer 25

Surgical clearance or radiotherapy

Question 26

What are the possible complications of lymph node treatment?

Answer 26

Lymphoedema
Sensory disturbance
Decrease ROM of shoulder
Nerve damage
Vascular damage
Radiation induced sarcoma

Question 27

What are the options fr treatment of micrometers?

Answer 27

Hormone therapy
Chemotherapy
Targetted therapy

Question 28

What is the hormonal treatment in premenopausal women?

Answer 28

Tamoxifen for 5 years

Question 29

What is the hormonal treatment in postmenopausal women?

Answer 29

Excellent prognosis= tamoxifen

Others= anastrozole for 5-10 years

Question 30

When is chemo given?

Answer 30

If nodes + or grade 3

Question 31

What targeted therapy is available for some breast cancers?

Answer 31

Anti Her2 therapy

Question 32

What increases the risk of disease recurrence?

Answer 32

Lymph node involvement
Tumour grade
Tumour size
Absence of oestrogen receptors
Her2 receptors
Lymphovascular invasion