breast disease

Question 1

what factors make a person high risk for breast cancer ( Give 4 )

Answer 1

• breast cancer in a first degree male relative of any age
• breast cancer in a first degree relative under the age of 40
• bilateral breast cancer in a first degree relative under 50
  -breast cancer in 2 first degree relatives

Question 2

give 4 symptoms of fibroadenomas

Answer 2

-firm non tender breast mass
-rounded and smooth edges
-mobile upon palpation, often referred to as having a ‘’ rubbery’’ consistency
- 3 cm at max

Question 3

which type of breast cancer presents with a thickened area of breast tissue alongside nipple changes

Answer 3

invasive lobular carcinoma

Question 4

which is the most common type of breast cancer ?

Answer 4

Invasive ductal carcinoma

Question 5

which condition presents with eczema like changes ?

Answer 5

Paget’s disease of the breast

Question 6

what are the main differentials for Paget’s disease of the breast ?

Answer 6

Atopic dermatitis
contact dermatitis
intraductal papilloma
mastitis
psoriasis

Question 7

which breast condition is characterised by ‘’ lumpy’’ breasts

Answer 7

Fibrocystic disease of the breast / fibroadenosis

Question 8

what is the management of fibrocystic disease of the breast ?

Answer 8

soft + well fitting bra
analgesia
avoid caffiene

Question 9

what is the management of lactational breast abscess

Answer 9

-drainage of abscess via needle aspiration or surgical drainage
- antibiotics

Question 10

should you continue breastfeeding in lactational abscess ? why ?

Answer 10

continue breast feeding as milk stasiscan and promote development of abscesses

Question 11

how do you distinguish between ductal carcinoma in situ vs invasive ductal carcinoma ?

Answer 11

In situ - basement membrane intact
invasive - basement membrane breached

Question 12

what type of therapy is recommended for estrogen positive, HER2 negative breast cancer ?

Answer 12

Endocrine therapy - including tamoxifen, an aromatase inhibitor or combination of both

Question 13

what is TNBC

Answer 13

triple negative breast cancer
lacking estrogen receptors, progesterone receptors and does not have an excess of the HER2 protein on the cancer cell surfaces.
More aggressive and fewer targeted treatments.

Question 14

what is a side effect of letrozole? what needs to be monitored ?

Answer 14

osteoporosis, monitor bone mineral density

Question 15

what is the management of triple negative breast cancer with axillary involvement ?

Answer 15

Neoadjuvant chemotherapy followed by surgery and adjuvant therapy

Question 16

what is the management of fat necrosis of the breast

Answer 16

conservative management

Question 17

what is triple assessment

Answer 17

clinical examination
imaging - mammography and / or ultrasound
tissue sampling - fine needle aspiration cytology or core biopsy

Question 18

what is puerperal mastitis ? How does it present ?

Answer 18

Inflammation of the breast tissue, associated with breastfeeding due to obstruction in the ducts / infection.
presents with a painful tender and hot breast along with systemic symptoms such as fevers, rigors, myalgia, fatigue, nausea and headaches.

Question 19

which type of breast cancer presents as a rapidly enlarging, smooth hard palpable breast mass

Answer 19

Malignant Phyllodes tumour

Question 20

which type of cancer may be visible as a smooth bulge under the breast skin

Answer 20

Malignant Phyllodes tumour

Question 21

which condition presents with an accumulation of pus in the breast tissue

Answer 21

Infectious mastitis

Question 22

how are symptomatic breast cysts managed

Answer 22

aspiration

Question 23

management of breast cancer patients who are -
node +ve
node -ve

Answer 23

FEC-D : node positive
FEC : node negative

Question 24

when is a wide local excision preferred

Answer 24

solitary lesion
peripheral tumour
small lesion in large breast
DCIS < 4 cm

Question 25

when is a mastectomy preferred

Answer 25

multifocal , central tumour
large lesion in small breast
DCIS > 4cm

Question 26

when is radiotherapy recommended in breast cancer

Answer 26

after wide local excision, T3,T4 tumours for women who have had a mastectomy

Question 27

fat necrosis

Answer 27

obese women with large breasts following trauma , may develop into hard irregular lump

Question 28

mucinous carcinoma

Answer 28

grey gelatinous surface

Question 29

ductal carcinoma situ

Answer 29

has not breached basement membrane and can present with comedo necrosis

Question 30

what index can be used to give an indication of survival

Answer 30

Nottingham prognostic index

Question 31

duct ectasia

Answer 31

menopause
cheese like nipple discharge
slit like retraction of the nipple

Question 32

breast cysts

Answer 32

perimenopausal females
soft fluctuant swellings
hallo appearance on mammography

Question 33

what does snowstorm sign on ultrasound of axillary lymph nodes indicate

Answer 33

snowstorm sign on ultrasound indication extracapsular breast implant rupture

Question 34

intraductal papilloma

Answer 34

growth of papilloma in a single duct - tumour of fibrovascular tissue within the lactic ducts
clear or blood stained discharged

Question 35

bilateral breast discharge in adolescent

Answer 35

hormonal changes

Question 36

nature of inheritance of the BRCA1 gene

Answer 36

autosomal dominant

Question 37

mammary duct ectasia vs duct papilloma

Answer 37

tender lump around areola + green nipple discharge - mammary duct ectasia
ductal papilloma - blood stained discharge

Question 38

when are the following recommended -
radiotherapy
chemotherapy

Answer 38

after wide local excision , 4/more positive lymph nodes and t3/t4 tumours that have undergone mastectomy

chemotherapy is recommended either to downstage a lesion or afterwards if there is axillary node disease