Breast - Carcinoma

Question 1

What are some risk factors for breast cancer, relating to uninterrupted oestrogen exposure?

Answer 1

Early menarche, late menopause, nulliparity, not breastfeeding, first pregnancy aged > 30

Question 2

What are some medications which are risk factors for breast cancer?

Answer 2

HRT and COCP

Question 3

What histological type of cancer are breast cancers?

Answer 3

Adenocarcinoma

Question 4

What are the two main types of breast cancer and how common is each?

Answer 4

Ductal (80%) and lobular (10-15%)

Question 5

What type of breast cancer can also be known as ‘no specific type’?

Answer 5

Ductal carcinoma

Question 6

What effect do ER and PgR positive breast cancers have on prognosis?

Answer 6

Improve prognosis

Question 7

What effect do HER2 positive breast cancers have on prognosis?

Answer 7

Worsen prognosis

Question 8

HER2 positive breast cancers preferentially metastasise to where? Therefore, you should always be aware when these patients present with what symptom?

Answer 8

CNS / headache

Question 9

Which combination of hormone receptors seen in breast cancers is associated with the best prognosis?

Answer 9

ER+, PgR+, HER2-

Question 10

Which combination of hormone receptors seen in breast cancers is associated with the worst prognosis?

Answer 10

ER-, PgR-, HER2-

Question 11

How is a malignant breast lump most likely to feel on examination?

Answer 11

Painless, hard, fixed, irregular

Question 12

Any red, scaly lesion around the nipple should always be biopsied to check for what diagnosis?

Answer 12

Paget’s disease of the nipple

Question 13

How often, and for what age range, is mammographic breast screening provided for women in the UK?

Answer 13

Every 3 years for women aged 50-70

Question 14

Peau d’orange is usually a feature of what type of breast cancer?

Answer 14

Inflammatory breast cancer

Question 15

What is the most widely accepted tool for calculating the prognosis of a breast cancer?

Answer 15

Nottingham Prognostic Index

Question 16

For women with no palpable axillary lymphadenopathy at presentation, what investigation should they undergo before their primary surgery?

Answer 16

Axillary ultrasound

Question 17

If a woman has no palpable axillary lymphadenopathy and an axillary ultrasound has come back positive, what should be done with regards to lymph nodes at their primary surgery?

Answer 17

Sentinel node biopsy

Question 18

If a woman has palpable axillary lymphadenopathy, what should be done with regards to lymph nodes at their primary surgery?

Answer 18

Axillary node clearance

Question 19

What are the two main complications of axillary node clearance?

Answer 19

Lymphoedema and functional arm impairment

Question 20

What is the preferred surgical treatment for breast cancer? What must be performed in addition?

Answer 20

Breast conserving surgery (WLE) with adjuvant radiotherapy

Question 21

What structures are removed in a modified mastectomy?

Answer 21

The entire breast, the overlying skin and the axillary lymph nodes

Question 22

What structure is spared in a modified mastectomy?

Answer 22

Pectoralis minor muscle

Question 23

How long is radiotherapy required for after WLE for breast cancer?

Answer 23

5 days per week for 3-6 weeks

Question 24

Why is radiotherapy required in addition to WLE for breast cancer?

Answer 24

To reduce the risk of recurrence and improve overall survival

Question 25

What are the indications for radiotherapy post-mastectomy?

Answer 25

Tumour > 5cm, involvement of > 3 lymph nodes, positive surgical margins

Question 26

If axillary lymph nodes are found to be positive on sampling, but clearance is not performed at primary surgery, what should be done?

Answer 26

Axillary radiotherapy

Question 27

What are some side effects of breast radiotherapy?

Answer 27

Skin reactions, pneumonitis, pericarditis, rib fractures

Question 28

Why is neoadjuvant chemotherapy sometimes useful in the treatment of breast cancer?

Answer 28

To shrink the tumour to allow breast conserving surgery instead of mastectomy

Question 29

Other than radiotherapy, what are some adjuvant treatment options for breast cancer?

Answer 29

Chemotherapy, endocrine therapy, targeted therapy

Question 30

In which breast cancers can endocrine therapy be used adjuvantly?

Answer 30

In those which are ER or PgR positive

Question 31

What type of drug is Tamoxifen?

Answer 31

Oestrogen receptor blocker

Question 32

Which endocrine therapy drug is given to women with ER/PgR positive breast cancers who are pre-menopausal?

Answer 32

Tamoxifen

Question 33

How long should patients be on Tamoxifen for after surgery for breast cancer?

Answer 33

5-10 years

Question 34

Which endocrine therapy drug is given to women with ER/PgR positive breast cancers who are post-menopausal?

Answer 34

Aromatase inhibitors e.g. letrozole

Question 35

What are some potential side effects of Tamoxifen?

Answer 35

Increased risk of endometrial cancer and VTE, menopausal side effects

Question 36

What treatments can be given neoadjuvantly in breast cancer to shrink a tumour before surgery?

Answer 36

Chemotherapy, endocrine therapy

Question 37

What targeted therapy drug can be given to patients with HER2+ breast cancers?

Answer 37

Trastuzumab (Herceptin)

Question 38

How is traztuzumab (Herceptin) given and how long for?

Answer 38

SC injection every 3 weeks for 1 year

Question 39

What is the main side effect of trastuzumab (Herceptin) to be aware of? For this reason, who should the drug be avoided in?

Answer 39

Cardiac failure - avoid in those with pre-existing cardiovascular disease

Question 40

What scan is used to assess for complications of treatment with trastuzumab every 4 months?

Answer 40

ECHO

Question 41

Which systemic therapies for breast cancer can be used palliatively?

Answer 41

Chemotherapy and endocrine therapy

Question 42

When may radiotherapy be used palliatively for breast cancer?

Answer 42

For fungating breast disease or bony metastases

Question 43

What medication can be given to breast cancer patients with bony metastases to reduce the risk of pathological fractures and to improve pain?

Answer 43

Bisphosphonates