Breast Cancer

Question 1

Breast Cancer Epidemiology, Histopathology

Answer 1

• Most common cancer in women, second most common cause of death from cancer in the UK
• Arise from epithelial lining of ducts (ductal) or epithelium of terminal ducts of lobules (lobular)
• Invasive or in situ
• Most cancers arise from intermediate ducts and are invasive

Question 2

Breast Cancer RFs

Answer 2

• PHx, age, FHx
• BRCA1, BRCA2, TP53 (only 5% of breast cancers are from mutations)
• Nulliparity, first child after 30
• Never breast feeding
• Early menarche, late menopause
• Radiation
• Western diet
• HRT
• COCP

Question 3

Breast Cancer Presentation

Answer 3

• Most present painless lump (can be painful)
• Breast pain alone is uncommon presentation
• Lump under arm, axilla
• Mammography screening
• Intraductal carcinoma may present as bloody discharge from the nipple

Question 4

Breast Cancer Diagnostic Surgeries

Answer 4

Non-palpable lesions

• Core needle biopsy
• Open biopsy

Palpable lesions

• FNA
• Core needle biopsy
• Excision biopsy (whole mass removed)
• Incisional biopsy (part of mass removed)

Question 5

Breast Cancer Ix

Answer 5

• ER, PR, HER2
• CA15-3 is controversial
• Bloods
• CXR
• CT is mets suspected (abnormal CXR, neurological symptoms, hepatosplenomegaly, lymphadenopathy, LFTs abnormal
• Bone scintigraphy (if bone mets suspected)
• PET

Question 6

Breast Cancer Differentials

Answer 6

-Benign breast disease

Question 7

Breast Cancer Management

Answer 7

• Surgery
• Tamoxifen/aromatase inhibitors if hormone receptor positive
• Monoclonal antibodies if HER2 positive
• Otherwise chemotherapy