Breasts

Question 1

Nerve supply to the boob

Answer 1

T3-5

T4 - nipple

Question 2

Breast cancer: causes

Answer 2

increased risk with age
oestrogen exposure
large gap between menarche and menopause
nulliparity, late first pregnancy
obesity
BRCA 1/2 (autosomal dominant)

Question 3

BRCA/HER2 genes: which chromosome, how common, what type of gene?

Answer 3

1 - chromosome 15, 50% of familial cases

2 - chromosome 13, 30-40% familial cases

both tumour suppressors

HER2 - oncogene, chromosome 17

Question 4

Breast cancer: clinical presentation

Answer 4

painless mass
discharge
nipple changes
skin tethering
tethering to underlying tissue
ulceration
erythema./oedema

Question 5

breast cancer: screening

Answer 5

every 3 years women aged 50-70
mammogram

women <50 who:
Have had a previous cancer
Have had a first degree relative with cancer <50 years
Have a known BRCA1, BRCA2 or TP53 gene

Question 6

breast cancer: pathology

Answer 6

adenocarcinoma (nearly always) - epithelial cells of glands or ducts

Question 7

paget’s disease of the nipple

Answer 7

malignant
eczematous appearance
unilateral - burning nipple, eczema, discharge, itchy, inflamed

Question 8

breast cancer: assess spread

Answer 8

sentinel node biosy
technithium and blue dye injected around nipple

lungs and bones most affected by blood spread

Question 9

breast lumps: investigations

Answer 9

triple assessment - examination, fine needle aspiration, imaging

grading of triple assessment:
E1 - normal, no lump
E2 - benign lump
E3 - lump 
E4 - suspicious slump 
E5 - probable cancer 

C1: inadequate
C2: benign
C3: atypical, probably benign
C4: atypical, probably malignant
C5: malignant

R1: normal 
R2: benign 
R3: interdeterminate 
R4: suspicious
R5: malignant

Question 10

breast cancer: staging

Answer 10

T1: tumour <20mm, no tethering or nipple retraction
T2: tumour <20mm with tethering or 20-50mm
T3: tumour <50mm with infiltration, ulceration, fixation or 50-100mm
T4: tumour >100mm or ulceration and infiltration wide of the primary tumour border

N0: no nodal involvement
N1: axillary node involvement, but mobile
N2: axillary nodes fixed
N3: supraclavicular involvement, with or without oedema of the arm

M0: no distant metastases
M1: distant metastases

Question 11

breast cancer: management

Answer 11

surgery best option - wide excision or mastectomy, axillary node clearance at least

local excision and radiotherapy - equal survival to surgery but greater recurrence

mastectomy + radiotherapy - tumours with high risk of reoccurrence

tamoxifen prevents growth of tumours with oestrogen/progesterone receptors

aromatase - oestrogen receptors

herceptin - HER2 positive (trastuzumab)

Question 12

side effects of radiotherapy to chest

Answer 12

rib fracture
pneumonitis 
pericarditis
lymphoedema
brachial plexus injury

Question 13

breast development: tanner stages

Answer 13

1 - prepubertal
2 - breast buds
3 - breast and areolar development, no separation of contours
4 - projection of areola and papilla, secondary mound
5 - adult contour breast, only papilla projection