Breast Conditions

Question 1

What is the most common benign neoplasm of the breast, usually occuring in women <30 years old?

Answer 1

Fibroadenoma

Mobile soft lump in the breast usually in young women

Question 2

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

Answer 2

True

Question 3

What larger benign tumour can mimic fibroadenoma?

Answer 3

Phyllodes tumour

Question 4

Mastalgia is usually unilateral. True/False?

Answer 4

False

Can be unilateral but usually bilateral

Question 5

List conservative management that can improve mastalgia

Answer 5

Well-fitting firm bra
Regular exercise
Evening primrose oil
Tamoxifen

Question 6

What is the most common aetiology of spontaneous nipple discharge?

Answer 6

Intraductal papilloma

Cauliflower extension forming in milk duct of breast

Question 7

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

Answer 7

Dry, eczematous, scaly lesion

Can be erythematous and weeping

Question 8

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

Answer 8

Flucloxacillin or any Staph aureus sensitive antibiotic

Question 9

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

Answer 9

True

Question 10

A tender lump in the breast, usually in women 30-50 years old is typically indicative of…

Answer 10

Benign cyst

Question 11

Chronic mastitis in the breast which is resistant to antibiotics is typically indicative of…

Answer 11

Breast abscess

Question 12

What term is used to describe the fact that most benign breast disorders are relatively minor aberrations of the normal processes of the breast?

Answer 12

Alterations in normal development and involution of the breast (ANDI)

Question 13

What percentage of all symptomatic women typically have benign breast disease?

Answer 13

80%

Question 14

List clinically relevant risk factors for breast cancer

Answer 14

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

Question 15

List the most common clinical features of breast cancer

Answer 15

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

Question 16

List management options for breast cancer

Answer 16

LOCAL: 
Surgery (reconstruction, lumpectomy, masectomy)
Radiotherapy
SYSTEMIC:
Chemotherapy
Harmonal therapies (oestrogen blockade)
Targeted therapy (antibodies)

Question 17

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

Answer 17

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

Question 18

What is the most common hormonal therapy for breast cancer?

Answer 18

Tamoxifen

Question 19

HER2 overexpression is implicated in some breast cancer (15%) - what treatment targets this specifically?

Answer 19

Trastuzumab monoclonal antibody (Herceptin)

Question 20

What is the screening schedule for breast cancer?

Answer 20

Mammogram every 3 years for women aged 50-70

Question 21

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

Answer 21

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

Question 22

What adjuvant systemic treatment options are there for breast cancer?

Answer 22

HRT (tamoxifen, aromatase inhibitors e.g. letrozole)

Trastuzumab (if HER2 positive)

Question 23

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

Answer 23

True

Question 24

Most women with breast cancer present with symptoms. True/ False?

Answer 24

False
50% asymptomatic via screening route
50% symptomatic and half with a lump

Question 25

State the most common side effect of using radiotherapy in breast cancer

Answer 25

Lymphodema in the arm

Question 26

List common side effects of using chemotherapy in breast cancer

Answer 26

Anorexia
Malaise
Neutropenia
Alopecia
Myalgia
Peripheral neuropathy
Axial skeleton pain

Question 27

List common side effects of oestrogen blockade in the management of breast cancer

Answer 27

Hot flushes
Vaginal bleeding
Vaginal dryness

Question 28

List common side effects of using herceptin in the management of breast cancer

Answer 28

Allergic reactions

Reversible cardiac failure

Question 29

Detection of a new lump in breast cancer is usually indicative of breast cancer. True/ False

Answer 29

False

Typically fat necrosis

Question 30

After treatment of breast cancer, how is a patient followed up?

Answer 30

Surgical review 1 year from surgery

Yearly mammogram for 3 years

Question 31

Outline palliative management of breast cancer

Answer 31

Systemic treatment for widespread disease (oestrogen blockade, chemotherapy)
Radiotherapy for fungating disease or bone mets
Biphosphonates for bone mets as prevention