Breast Week general

Question 1

what percentage of breast cancers are male

Answer 1

0.6-1%

Question 2

peak age of male breast cancer

Answer 2

75

Question 3

is gynecomastia associated with male breast cancer

Answer 3

no

Question 4

male breast cancer presentation

Answer 4

• lump (75%)
• early nipple involvement
• very rarely Paget’s

Question 5

do men get lobular breast cancer

Answer 5

no, because lobules and acini are not found in normal male breast tissue.

Question 6

male breast cancer surgery

Answer 6

mastectomy

Question 7

what is most commonly used for male breast cancer endocrine therapy

Answer 7

tamoxifen

Question 8

gynaecomastia treatment

Answer 8

• correct underlying cause or drug
• medical treatment e.g. tamoxifen
• surgical treatment if failure of others options, psychological complications

Question 9

what is the most common benign growth in the breast

Answer 9

fibroadenoma

Question 10

true or false, fibroadenomas are highly mobile

Answer 10

true

Question 11

do fibroadenomas need to be removed

Answer 11

no

Question 12

do phyllodes tumours need to be removed? explain your answer

Answer 12

yes because around 1/3 of Phyllodes tumours havemalignant potential

Question 13

what is a hamartoma (fibroadenolipoma)

Answer 13

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

Question 14

what is a radial scar

Answer 14

a growth that looks like a scar when the tissue is viewed under a microscope. It has a central core containing benign ducts. Growing out of this core are ducts and lobules that show evidence of unusual changes such as cysts and epithelial hyperplasia (overgrowth of their inner lining)

Question 15

what is an intraduct papilloma

Answer 15

Benign breast lesion

Question 16

who does an intraduct papilloma typically affect

Answer 16

females in their 40-50yrs

Question 17

where does an intraduct papilloma most typically occur

Answer 17

thesubareolar region

Question 18

intraduct papilloma presentation

Answer 18

clear or bloody nipple discharge

asymptomatic

Question 19

what is a lipoma

Answer 19

Soft and mobilebenign adipose tumour that are normally otherwise asymptomatic

Question 20

does a lipoma need removed - explain your answer

Answer 20

not usually - low malignant potentialand are usually only removed if they are significantly enlarging or causing symptomatic compressive or aesthetic issues

Question 21

mastitis management

Answer 21

flucloxacillin 500mg orally every 6 hours for 7 days

or augmentin 625mg every 8hrs for 7 days

Question 22

what does a breast abscess most commonly develop from

Answer 22

acute mastitis

Question 23

describe a breast cyst on examination

Answer 23

typically palpable, clearly defined, soft, mobile, and smooth, with distinct borders

often somewhat tender

Question 24

how can a breast cyst be identified on mammography

Answer 24

halo shape

Question 25

what is duct ectasia

Answer 25

dilation and shortening of the major lactiferous ducts

Question 26

what % of women having significant duct dilatation by 70 yrs

Answer 26

40%

Question 27

duct ectasia is associated with smoking, true or false

Answer 27

true

Question 28

what is mammoplasty

Answer 28

breast reduction

Question 29

neoadjuvant meaning

Answer 29

prior to surgery

Question 30

adjuvant meaning

Answer 30

after surgery

Question 31

NACT meaning

Answer 31

neoadjuvant chemotherapy

Question 32

risks of anthracyclines chemotherapy

Answer 32

• affect heart, small risk of leukaemia

Question 33

usually course of chemotherapy

Answer 33

Usually total of 6 to 8 cycles, at 3 weekly intervals

Question 34

treatment of neutropenic sepsis (complication of chemo)

Answer 34

IV Tazocin

Question 35

indications for NACT

Answer 35

• inflammatory breast cancer
• downstaging required e.g. huge nodal burden
• T2 (at least 2cm) - if HER2 positive/Triple negative
• Tany N 1 or above - if HER2 positive/Triple negative

Question 36

how often are bloods checked in neoadjuvant chemotherapy

Answer 36

prior to administration of each cycle (usually neuts need to be >1and platelets >100)

Question 37

indication for adjuvant chemotherapy

Answer 37

• Usually if Her2 positive/triple negative who have NOT got chemotherapy neoadjuvantly
• Node positive premenopausal patients (ER positive)
• NHS PREDICT score – 3-5% get Oncotype

Question 38

cancer driven by hormones - more or less sensitive to chemo?

Answer 38

less

Question 39

name two drugs you can NOT use in the adjuvant setting

Answer 39

carboplatin
pembrolizumab

Question 40

after adjuvant chemotherapy, wait ______ weeks, then commence _______ and ______ treatment

Answer 40

3-4
radiotherapy
endocrine (hormone)

Question 41

mainstay of drug treatment for endocrine treatment

Answer 41

Tamoxifen and Letrozole

Question 42

is letrozole used as endocrine treatment pre or post menopausal

Answer 42

post

Question 43

what does tamoxifen do (what is the mechansim)

Answer 43

ANTAgnosies the oestrogen receptors around breast tissue

AGONISTIC around Uterus, hence small risk of uterine cancer

Question 44

letrozole mechanism

Answer 44

essentially stops fat cells from producing oestrogen (this is why it’s not used premenopausal because the ovaries would just bypass this)

Question 45

how long is hormone treatment given for

Answer 45

generally 5 years
can extend to 10 years if high risk

Question 46

in oestrogen driven breast cancer, are HRT and hormonal contraception recommended or contraindicated

Answer 46

contraindicated

Question 47

when is radiotherapy used in breast cancer

Answer 47

after breast conservation

after mastectomy if 4 or more nodes involved and/or T3-T4 tumours

Question 48

how many radiotherapy treatments are given

Answer 48

Usually 5 treatments to the breast/chest wall or 15 treatments if lymphatics involved.