Breast Lectures (pathology, cancer etc)

Question 1

what are the 2 main subtypes of breast cancer?

Answer 1

invasive

non-invasive

Question 2

what are the types of invasive breast cancer?

Answer 2

ductal carcinoma (80%)

lobular carcinoma (10%)

others (like papillary or tubular)

Question 3

what are the types of non-invasive breast cancer?

Answer 3

DCIS (ductal carcinoma in situ)

LCIS (lobular carcinoma in situ)

Question 4

Risk factors for breast cancer

Answer 4

Gender

age

previous breast cancer

menstrual history (early menarche/ late menopause)

hormone treatment (HRT)

age at first pregnancy

FH

personal history

genetic factors

alcohol/ high BM

Radiotherapy

Question 5

what genes make women more susceptible to breast cancer?

Answer 5

BRCA 1 (20-30%)

BRCA 2 (10-30%)

TP53 (1%)

PTEN (1%)

others

Question 6

how do you diagnose breast cancer?

Answer 6

clinical exam

radiology (mammogram, USS, MRI)

FNA cytology

Needle core biopsy

wide local excision with adequate margins

Question 7

when/ who gets screened for breast cancer in the UK?

Answer 7

women aged 50-71 that are registered with a GP are invited every 3 years for a mammogram

Question 8

are deposits of calcium (macro calcifications) on a mammogram normal?

Answer 8

yes - often harmless

but a small percentage are precancerous or in cancerous tissue

Question 9

what are two of the most important mammographic indicators of breast cancer?

Answer 9

masses

macro calcifications (indicates early cancer)

Question 10

what will the histology report of an FNA of cancerous breast tissue likely involve?

Answer 10

invasive or non invasive?

histological types (ductal or lobular)

grade

size

margins

lymph nodes

oestrogen/progesterone receptors

Question 11

spread of breast cancer:

3 types

Answer 11

local (skin, pectoral muscles)

lymphatic (axillary and internal mammary nodes)

blood (bones, lungs, liver, brain)

Question 12

how do you manage breast cancer?

Answer 12

depends on the staging:

surgery (mastectomy, breast conserving surgery)

radiotherapy

antihormonal therapy

chemotherapy

Question 13

Paget’s disease of the nipple is caused by what?

Answer 13

intraepithelial spread of an intraductal carcinoma

Question 14

Paget’s disease of the nipple symptoms

Answer 14

(limited to the nipple or can extend to the areola)

pain or itching

scaling redness

mistaken for eczema

ulceration

crusting

serous or bloody discharge

Question 15

male pathology of the breast is most commonly

Answer 15

gynaecomastia

Question 16

microscopic examination of thin layer of cells on a slide is obtained by what 3 methods?

Answer 16

FNA

direct smear from nipple discharge

scrape of nipple with scalpel

Question 17

how do you ‘cure’ a cyst?

Answer 17

aspiration

Question 18

all breast cases with clinical OR radiological OR cytological suspicion - need to be what?

Answer 18

core biopsied

Question 19

if the breast cancer patient was symptomatic - what symptoms might they have?

Answer 19

lump

mastalgia (unilateral pain)

nipple discharged (blood stained)

nipple changes (pagets disease, retraction)

change in the size or shape of the breast

lymph-oedema

dimpling of the breast skin

Question 20

two types of surgical procedure in breast cancer

Answer 20

mastectomy

breast conservation surgery

Question 21

what do you do is the sentinel lymph node biopsy comes back as positive for a tumour?

Answer 21

you remove ALL of them surgically

or give radio to all axillary nodes

Question 22

factors that increase the chances or reoccurrence

Answer 22

lymph node involvement

tumour grade

tumour size

steroid receptor status

HER2 status

Question 23

two drugs that can be taken as hormonal therapy to prevent reoccurrence of breast cancer:

(hormone therapy is ER positive - aims to block stimulation of cell growth by oestrogen)

Answer 23

tamoxifen (blocks on ER receptor)

aromatase inhibitor (inhibits ER synthesis)

Question 24

Zoladex

Answer 24

inhibits FSH and LH

Question 25

3 drugs used as chemotherapy in breast cancer:

Answer 25

CMF combinations

anthracycline combinations

taxane combinations

Question 26

3 key factors that increase the risk of disease recurrence

Answer 26

tumour grade

tumour size

lymph node involvement

Question 27

who gets invited for a breast cancer screen?

Answer 27

women aged 50-70 every 3 years (that are registered with a GP)