Breast Lecture 3

Question 1

What is fibrocystic change?

Answer 1

Benign Breast condition
Fibrosis
Cysts
Adenosis
Apocrine metaplasia 
Ductal epithelial hyperplasia

Question 2

What are fibroadenomae?

Answer 2

Circumscribed nodule in reproductive age
Benign breast tumour
Freely mobile, non-painful

Question 3

What are intraduct papilloma?

Answer 3

Lactiferous ducts

Nipple discharge

Question 4

What are tubular adenomas?

Answer 4

Less common than fibroadenomas
Appear the same
Uniform sized ducts

Question 5

What are lactating adenomas?

Answer 5

Enlarging masses during lactation/pregnancy

Prominent secretory change

Question 6

How do intraduct papillomae present?

Answer 6

Middle aged woman
Nipple discharge
Epithelial hyperplasia

Question 7

How does breast fat necrosis present?

Answer 7

Hx trauma
Histiocytes with foamy cytoplasm
Lipid-filled cysts
Fibrosis/calcifications

Question 8

What are Phyllodes tumours?

Answer 8

Fleshy tumours
Well circumscribed
Rare

Question 9

How do breast carcinomas present on mammogram?

Answer 9

Soft tissue opacity

Microcalcification

Question 10

What are the risk factors for breast cancer?

Answer 10

Female
Old age
Menstrual history
Late/early first pregnancy
Radiotherapy
FH/PMH
Hormone therapy 
Obesity
Alcohol

Question 11

What is the risk of breast cancer associated with epithelial proliferation?

Answer 11

2x RR

Question 12

What is the risk of breast cancer associated with epithelial proliferation (atypical duct)?

Answer 12

4-5x RR

Question 13

What is the risk of breast cancer associated with LCIS/DCIS?

Answer 13

8-10xRR

Question 14

Which genes are associated with breast cancer and how strongly?

Answer 14

BRCA1 (20-40%)
BRCA2 (10-30%)
TP53 (<1%)
PTEN (<1%)

Question 15

What are the non-invasive classifications of breast cancer?

Answer 15

Ductal carcinoma in situ

Lobular carcinoma in situ

Question 16

What is In-situ carcinoma?

Answer 16

Pre-invasive (not a palpable tumour)
No metastatic spread
Risk of invasion

Question 17

What is the risk of progression to cancer for low grade DCIS?

Answer 17

30% in 15 years

Question 18

What is the risk of progression to cancer for high grade DCIS?

Answer 18

50% in 8 years

Question 19

What is the risk of progression to cancer for LCIS?

Answer 19

19% in 25 years

Question 20

What are the special types of breast cancer?

Answer 20

Tubular Carcinoma
Mucinous Carcinoma
Carcinoma with medullary features
Metaplastic carcinoma

Question 21

How is breast cancer diagnosed?

Answer 21

Clinical exam
Radioloy 
FNAC
Needle core biopsy
Wide local excision

Question 22

What is the screening program for breast cancer?

Answer 22

Mammogram every 3y

Women 50-70y/o

Question 23

What are microcalcifications?

Answer 23

Tiny deposits of calcium
Mostly harmless
Some may be precancerous tissue

Question 24

To which nodes do breast cancers most likely spread?

Answer 24

Axillary nodes

Internal mammary nodes

Question 25

Where does breast cancer most likely spread?

Answer 25

Bone Lungs Liver Brain

Question 26

What are the poor prognostic indicators for breast cancer?

Answer 26

``` Node status (best) Grade Type Age Lymphovascular invasion Estrogen/progesterone receptor Status HER2 ```

Question 27

What is the survival rate of breast cancer?

Answer 27

64% at 5 years

Question 28

What is the scoring system used for breast cancer prognosis?

Answer 28

Nottingham Prognostic Index

Question 29

What are the main molecular subtypes of breast cancer?

Answer 29

Luminal A Luminal B Triple -ve HER2 type

Question 30

What is Paget's disease of the nipple?

Answer 30

Intraepithelial spread of intraductal carcinoma Nipple/areolar pain/itching/scaling Ulceration, Crusting, discharge

Question 31

What is gynaecomastia associated with?

Answer 31

``` Hyperthyroidism Liver cirrhosis Chronic renal failure COPD Hypogonadism Hormone use ```