Breast Conditions

Question 1

List clinically relevant risk factors for breast cancer

Answer 1

Increasing age
Gene mutation
Early menarche
Late menopause
Nulliparity
Obesity
Previous breast cancer

Question 2

List the most common clinical features of breast cancer

Answer 2

Dimpled/depressed skin
Visible lump
Nipple change (inversion)
Bloody discharge
Colour change

Question 3

What is the most common histological subtype of breast cancer?

Answer 3

Ductal carcinoma

Question 4

What is the preferred treatment for breast cancer - mastectomy or breast-conserving therapy?

Answer 4

Breast-conserving therapy involving radiotherapy/chemotherapy and/or wide local excision

Question 5

What is removed and left in modified radical mastectomy?

Answer 5

Whole breast, skin and axillary lymph nodes removed

Pectoralis major left

Question 6

When can breast reconstruction be carried out?

Answer 6

Immediately (during mastectomy operation) or delayed until afterwards

Question 7

What is a flap in breast reconstruction?

Answer 7

Taking skin from another part of the body with its blood supply and using it to reconstruct a breast

Question 8

What flaps are typically used for breast reconstruction?

Answer 8

Latissimus dorsi
Deep inferior epigastric perforator (DIEP)
Transverse rectus abdominis myocutaneous (TRAM)
Superior/inferior gluteal artery perforator (SGAP/IGAP)

Question 9

What are the indications for post-mastectomy radiotherapy?

Answer 9

Involvement of more than 3 nodes
Positive surgical margins
Tumours larger than 5cm

Question 10

What is the most common hormonal therapy for breast cancer?

Answer 10

Tamoxifen

Question 11

HER2 overexpression is implicated in some breast cancer - what treatment targets this specifically?

Answer 11

Trastuzumab (Herceptin)

Question 12

What is the most common benign neoplasm of the breast?

Answer 12

Fibroadenoma

Question 13

Fibroadenomas usually become non-palpable after the menopause. True/False?

Answer 13

True

Question 14

What larger benign tumour can mimic fibroadenoma?

Answer 14

Phyllodes tumour

Question 15

Mastalgia is usually unilateral. True/False?

Answer 15

False

Can be unilateral but usually bilateral

Question 16

List conservative management that can improve mastalgia

Answer 16

Well-fitting firm bra
Regular exercise
Evening primrose oil
Tamoxifen

Question 17

What is the most common aetiology of spontaneous nipple discharge?

Answer 17

Intraductal papilloma

Question 18

How does Paget’s disease usually present on the nipple?

Answer 18

Dry, eczematous, scaly lesion

Can be erythematous and weeping

Question 19

What antibiotic should be administered as soon as mastitis is suspected?

Answer 19

Flucloxacillin or any Staph aureus sensitive antibiotic

Question 20

Breastfeeding should be continued even if there is mastitis. True/False?

Answer 20

True

Question 21

What is the screening schedule for breast cancer?

Answer 21

Mammogram every 3 years for women aged 50-70

Question 22

What is carried out in the “one-stop” clinic?

Answer 22

Clinical (history and examination)
Imaging (mammogram, ultrasound)
Pathology (biopsy)

Question 23

When is adjuvant radiotherapy following breast-conserving therapy done on the breast alone?

Answer 23

Negative sentinel node biopsy
Nodes containing micrometastases (less than 2mm)
Less than 4 nodes involved in axillary clearance

Question 24

When is adjuvant radiotherapy following mastectomy done?

Answer 24

Tumour size greater than 5cm
4 or more involved nodes
T4 disease

Question 25

What adjuvant systemic treatment options are there for breast cancer?

Answer 25

HRT (tamoxifen, letrozole)

Trastuzumab (if HER2 positive)

Question 26

Letrozole can only be used in postmenopausal women. True/False?

Answer 26

True