Breast Cancer Again

Question 1

What is a liminal A breast cancer and how do you treat

Answer 1

Er/pr strongly positive, her2 negative
Treat with Tamoxifen

This is most common and offers best prognosis

Question 2

What is a luminal b breast cancer

Answer 2

Er/pr weakly positive, her2 positive

Question 3

What is basal like aka triple negative molecular classification of breast cancer

Answer 3

Er /pr negative, her 2 negative
Poor prognosis
Treat with ibranz

Question 4

What is the primary treatment for stage 1 and 2 breast cancer and what is stage 1 and 2

Answer 4

Stage 1: <2cm no node involved
Stage 2: > 2cm and less fhan 5cm , no nodes or mobile ipsilateral

Treated using bcs with axilary node dissection and radiotherapy or mastectomy with axillary node dissection/slnb

Question 5

When is chemo given as adjuvant therapy in stage 2 breast ca

Answer 5

In premenopausal women or postmenopausal and er negative

Tamoxifen if er positive

Question 6

Contraindications to bcs

Answer 6

Large tumor to breast ratio
Central lesion near nipple
Multifocal tumor
High risk of recurrence

Contraindications to radiotherapy- previous radiotherapy exposure to chest, pregnant, collagen vascular disorders

Question 7

When is sentinel lymph node biopsy indicated

Answer 7

Indicated in clinically normal axilla and primary tumor less than 5 vm (stage 1&2)

Methylene blue injected in periareolar area prior to surgery to identify sentinel nodes (first axillary node or nodes draining breast. Excuse the nodes and intra operative frozen section
Proceed with alnd if positive

Question 8

Describe axillary lymph node dissection

Answer 8

Done if slnb positive or nodes are clinically suspicious

Surgical clearance of the Scilla requires removing all nodes up to level 2

Must remove at least 12 nodes

Question 9

Where are level 2 lymph nodes

Answer 9

Lateral and deep to pec minor

Question 10

With regards to hormonal therapy, which is only used in post menopausal women

Answer 10

Aromatose inhibitors like anastrozole

Question 11

Main side effect of tamoxifen

Answer 11

Endometrial ca

Also dvt, pe,cataracts

Question 12

Treatment option for her 2 receptor positive patients

Answer 12

Trastuzumab ak herceptin

Poor prognosis for her 2 receptor positive patients

Question 13

With relation to period, when are fibrocystic breast diseases noted mostly and when do they regress

Answer 13

10 days before period and end on first day of period

Question 14

Symptoms of fibrocystic breast?

Answer 14

Symptoms can affect different areas of the breast, or both breasts, with:

Lumpiness
Breast pain or tenderness (mastalgia)
Fluctuation of breast size

Question 15

Treatment of fibrocystic breast

Answer 15

Wearing a supportive bra
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
Avoiding caffeine is commonly recommended
Applying heat to the area
Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance

Question 16

What is a galactocele and how does it present

Answer 16

Galactoceles occur in women that are lactating (producing breast milk), often after stopping breastfeeding. They are breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk. They present with a firm, mobile, painless lump, usually beneath the areola.

Question 17

How does a mammary duct ectasia present

Answer 17

Mammary duct ectasia may present with:

Nipple discharge
Tenderness or pain
Nipple retraction or inversion
A breast lump (pressure on the lump may produce nipple discharge)

It may be picked up incidentally on a mammogram, leading to further assessment and investigations.