Breast Carcinoma

Question 1

Breast Cancer Epidemiology

Answer 1

Affects 1 in 11 women

~20,000 new cases a year in UK but increasing

Question 2

Intrinsic Risk factors for Breast Cancer

Answer 2

Intrinsic:

• Age and gender
• Family history
• Genes
• Menstrual cycle
• Atypical hyperplasia: women with benign disease whose biopsy show atypical epithelial hyperplasia

Question 3

Extrinsic Risk factors for Breast Cancer

Answer 3

Extrinsic:

• Parity/childbirth
• Hormones
• Diet & exercise
• Radiation
• Alcohol consumption

Question 4

What are the two main types of breast cancer and which one is most common?

Answer 4

1. Ductal carcinoma
2. Lobular carcinoma

Ductal is more common

Question 5

Signs & Symptoms of Breast Cancer

Answer 5

Often painless increasing mass that persists throughout menstrual cycle.

May be associated with:

• nipple discharge
• skin tethering/skin changes (peau d’orange)
• Ulceration
• Ordema and erythema

Question 6

Where are common sites of metastases?

Answer 6

• Lung: dyspnoea
• Bone: bone pain
• Liver: hepatomegaly/jaundice
• Pleura
• Adrenals

Question 7

Investigation of breast carcinoma

Answer 7

Triple assessment:

1. Clinical History & Examination
2. Radiology: mammography & US
3. HIstology/cytology: fine-needle aspiration cytology

Question 8

Describe the 4 stages of breast cancer

Answer 8

1. Confine to breast, mobile
2. Growth confined to breast, mobile, lymph nodes in ipsilateral axilla
3. Tumour fixed to muscle (not chest wall) ipsilateral lymph nodes may be matted and fixed
4. Compete fixation of tumour to chest wall & distant mets.

Question 9

Surgical treatment for breast cancer

Answer 9

• Wide local excision
• Mastectomy
• Surgical Clearance

Question 10

Chemotherapy drugs for breast cancer

Answer 10

Chemo improves survival 
examples:
- anthracycline + 5FU + cyclophosphamide + methotrexate
- tratstuzumab
- capecitabine + docetaxel

Question 11

Endocrine therapy for breast cancer

Answer 11

Tamoxifen: ER blocker, reduce effects
Aromatase inhibitor (anastrozole): reduce synthesis of oestrogen

Question 12

What is the term for premalignant breast cancer and how is it seen on mammography

Answer 12

Ductal carcinoma in situ.

Seen as microcalcification on mammography

Question 13

What are the prognostic factors in breast cancer

Answer 13

Tumour size
Grade
Lymph node status
ER/PR status
Presence of vascular invasion 

• the first 3 are used in the Nottingham Prognostic Index