Breast Oncology

Question 1

What are the risk cancers for breast cancer?

Answer 1

increasing age
family history
Endogenous factors - lower age menarch, older age menopause, obesity in post menopausal women
Exogenous factors- hormone replacement therapy
High socio-economic status
Genetic (BRC 1&2 P52)
Previous exposure to IR e.g. Hodgkins

Question 2

What are the four different types of breast cancer?

Answer 2

Ductal carcinoma in situ
Lobular carcinoma in situ

Ductal carcinoma

Lobular carcinoma

Question 3

What is ductal carcinoma in situ

Answer 3

proliferation of malignant cells in the ducts that does not breach the basement membrane.

Question 4

What is lobular carcinoma in situ?

Answer 4

proliferation of malignant cells in the ducts that does not breach the basement membrane.

Question 5

What is ductal carcinoma

Answer 5

It is invasive

Proliferation of malignant cells that breach the basement membrane

(consist of most priamry breast cancers)
Usually make up Grade 1 -3

Question 6

How does breast cancer usually spread?

Answer 6

Carcinoma in situ –> invasion beyond basement membrane–> nvasion of lymphatics—>risk of spread to LN (supraclavicular, internall mammary) –> invasion of blood vessels (risk of distant mets)

Question 7

What are the benefits of screening mammography?

Answer 7

significantly reduces breast cancer mortality (20-35%)

generally reccommended every 2 years for women between 50 -69

Question 8

What are some negatives of screening?

Answer 8

False + : patient is told theu have cancer but furhter invesitgations prove that it is benign or not abnormal

False -: the patient is told they dont have cancer when in fact they do.

(young women have the higherst risk of fals- or false+ because they have denser breasts)

Question 9

What is stage 1

Answer 9

Early disease tumour confined to the breast

Question 10

Stage 2?

Answer 10

Early disease, tumour spread to moveable ipsilateral node (node-positive)

Question 11

Stage 3?

Answer 11

Locally advanced disease tumour spread to superficial strucutres of ipsilateral internal mammary LN.

Question 12

Stage 4?

Answer 12

Advanced metastatic disease

bone, brain, liver and lung

Question 13

What are the categories of breast malignancy?

Answer 13

Carcinoma in situ

Early stage breast cancer

Locally advanced

Metastatic

Recurrent

Question 14

What are the treatment modalities for early breast cancer?

Answer 14

surgery
Radiotherapy
Chemotherapy
Endocrine (hormonal) therapy

Question 15

What is the primary treatment modality for breast cancer?

Answer 15

breast conserving therapy- lumpectomy

masectomy- removal of whole breast, fascia on pec major and axilliary dissection

Question 16

What makes a patient unsuitable for breast conserving therapy?

Answer 16

If the patient has multicentric disease - 2 or more primaries from separate quadrants

inflammatory breast cancer

previous RT

Pregnancy

large positive margins after attempts at re-excision

large tumour size relative to breast, nipple or skin involvement, connective tissue disease

Question 17

Why is PORT (post- operative therapy) essential?

Answer 17

local reccurence rates (even with just a lumpectomy are high)