Breast Cancer Case

Question 1

How will a breast cancer patient typically present?

Answer 1

1 - Nipple discharge & inversion

2 - Lumps and bumps on breast

3 - Changes in skin on breast (orange peel appearance)

Question 2

What are the risk factors for developing breast cancer?

Answer 2

1 - Female

2 - Older age

3 - Early menarrche and late menopause

4 - Older age when having first child

5 - +ve FH of breast cancer

6 - BRCA 1 & BRCA2

7 - HRT/OCP

8 - Obesity

Question 3

How will the patient be investigated for breast cancer?

Answer 3

Triple assessment:

1 - Clinical examination

2 - Mammogram or USS (or both)

3 - Biopsy of breast tissue

Question 4

How is breast cancer staged?

Answer 4

TNM staging

T1 - < 2cm

T2 - 2-5cm

T3 - > 5cm

T4 - Fixed to chest wall + orange peel skin

N1 - Nodal involvement

M1 - Distant mets

Question 5

How is breast cancer treated surgically?

Answer 5

1 - Wide local excision

2 - Mastectomy

Question 6

When would chemo or radiotherapy be used in breast cancer patients?

Answer 6

Lymph node involvement

> Stage 3

Question 7

What type of treatment is used for distant metastases?

Answer 7

Hormone therapies

Question 8

What are examples of hormone therapies?

Answer 8

Tamoxifen

Anastrozole

Herceptin

Question 9

Which type of tumours would be treated by Tamoxifen?

Answer 9

Those which have Estrogen receptors

Question 10

Which type of tumours would be treated with Herceptin?

Answer 10

Those which have HER-2 receptors

Question 11

What factors would indicate a poor prognosis for someone with breast cancer?

Answer 11

1 - Lymph node involvement

2 - Large size of tumour

3 - High grade tumour

4 - Her-2 +ve