Breast Tumours

Question 1

What is the screening age in Scotland?

Answer 1

50-70

Question 2

Is having your first child at an older age protective against or a risk factor for ovarian cancer?

Answer 2

Risk factor for

Question 3

A younger age of menarche and older age of menopause are both risk factors for breast cancer. True or false?

Answer 3

True

Question 4

Multiparity and breastfeeding are both risk factors for breast cancer. True or false?

Answer 4

False - nulliparity is a risk factor and breast feeding is protective

Question 5

Is the OCP protective against or a risk factor for ovarian cancer?

Answer 5

Risk factor

Question 6

What is the most common type of breast cancer?

Answer 6

Ductal carcinoma

Question 7

What is a ductal carcinoma in situ?

Answer 7

Cytologically malignant epithelial cells but non-invasive (confined within basement membrane). A non–obligate but true precursor of invasive carcinoma

Question 8

What is atypical ductal hyperplasia?

Answer 8

A precursor lesion associated with an increased risk of ductal carcinoma

Question 9

What is atypical lobular hyperplasia?

Answer 9

<50% of lobule involved and increased risk of lobular carcinoma

Question 10

What is lobular carcinoma in situ?

Answer 10

> 50% of lobule involved. Malignant but non-invasive (confined within basement membrane). Non-obligate precursor of invasive lobular carcinoma

Question 11

When does a precursor lesion become invasive breast carcinoma?

Answer 11

When it has breached the basement membrane and infiltrated normal tissue

Question 12

What are the 3 main hormone receptors expressed in breast cancer?

Answer 12

• Oestrogen receptor (ER) - 80% ER positive
• Progesterone receptor (PR) - 67% PgR positive
• HER2 - 14% HER2 positive

Question 13

What is the best imaging technique for women <40 vs women >40 in breast cancer?

Answer 13

<40 = uss
>40 = mammogram

Question 14

When should radiotherapy be used in breast cancer?

Answer 14

o As part of breast conserving surgery or

o After mastectomy if involvement of more than three nodes, positive surgical margins and/or tumors larger than 5 cm or

o Palliative

Question 15

When should hormone therapy or chemotherapy not be used in breast cancer?

Answer 15

Not given in low grade with good prognosis

Question 16

What anti-oestrogen therapy should be given in pre- vs post-menopausal women with breast cancer

Answer 16

Pre-menopausal = Tamoxifen

Post-menopausal = aromatase inhibitors (letrozole, anastrozole) or

Question 17

What is paget’s disease of the nipple?

Answer 17

High grade DCIS extending along ducts to reach the epidermis of the nipple

Question 18

What are the main side effects of tamoxifen?

Answer 18

Thromboemolic events & endometrial hyperplasia (+ hot flushes and joint pain)

Question 19

What is the main side effect of aromatase inhibitors?

Answer 19

Osteoperosis (+ hot flushes and joint pain for all hormonal therapy)

Question 20

Breast cancer is the commonest cancer in women. True or false?

Answer 20

True

Question 21

Breast cancer is the commonest cause of death from cancer in women. True or false?

Answer 21

False - it is the second commonest (lung is the most common)

Question 22

What is the screening age for breast cancer?

Answer 22

50-70 (every 3 years)

Question 23

What does radiotherapy given postoperatively do?

Answer 23

Reduces risk of recurrence

Question 24

What medication can help with bony mets?

Answer 24

Bisphosphonates

Question 25

What medication is used if a tumour is HER2 +ve

Answer 25

Trastuzumab