Cancer & Benign breast lumps

Question 1

Describe atypical ductal hyperplasia

Answer 1

Neoplastic proliferation of epithelial cells but does not fulfill the criteria of a non-invasive carcinoma

Question 2

What are complex sclerosing lesions? Are they benign or malignant?

Answer 2

Complex Sclerosing lesions are radial scars that are benign lesions (but can appear malignant radiologically)

Question 3

The NHS Breast screening programme is provided for women in which age range?

Answer 3

50 - 70

Question 4

How often should mammogram be done? What are the things to look out for in a mammogram?

Answer 4

Mammogram should be taken every three years. Look out for calcifications and densities.

Question 5

Which two genes are the most common cause of breast cancer?

Answer 5

BRCA2 and p53 genes

Question 6

Breast cancer is derived from which cells?

Answer 6

Breast cancers are developed from epithelial cells that line the terminal duct lobular unit

Question 7

What is the most common cause of cervical carcinoma?

Answer 7

Human papilloma virus (16 and 18)

Question 8

Cervical carcinoma is usually squamous, columnar or glandular carcinoma?

Answer 8

Squamous cancers

Question 9

Describe the stages of cervical carcinoma

Answer 9

Stage I: Tumours are confined to the cervix
Stage II: Tumours have extended locally to upper 2/3 of the vagina, IIb if in parametria.
Stage III: Tumours have spread to lower 1/3 of vagina, IIIb if to pelvic wall
Stage IV: Tumours have spread to bladder or rectum, IVb if spread to distant organs

Question 10

Why must postmenopausal vaginal bleeding be promptly investigated?

Answer 10

Postmenopausal bleeding may suggest endometrial carcinoma

Question 11

Which is more common: cancer in the uterine body or cancer of the cervix?

Answer 11

Cancer of the cervix

Question 12

What is a common cause of endometrial carcinoma?

Answer 12

Excessive exposure to oestrogen unopposed by progesterone

Question 13

Which 2 medications are risk factors of endometrial carcinoma?

Answer 13

Tamoxifen and tibolone

Question 14

Describe the presentation of endometrial carcinoma

Answer 14

Usually postmenopausal bleeding. There is initially scanty and occasional bleeding with watery discharge. Then, bleeding gets heavy and frequent.

Premenopausal women will have intermenstrual bleeding or just menorrhagia.

Question 15

What is the HPV vaccine protective against?

Answer 15

HPV vaccine is protective against cervical cancer.

Question 16

Which HPV strains are the most common cause of cervical cancer?

Answer 16

HPV 16 and 18

Question 17

Which gynaecological cancer have the best prognosis?

Answer 17

Endometrial cancer

Question 18

Which gynaecological cancer is most common?

Answer 18

Ovarian cancer

Question 19

What are the hallmark features of cancer in Gynae?

Answer 19

Haemorrhage and necrosis

Question 20

Which is the most common benign breast tumour?

Describe its presentation.

Answer 20

Fibroadenoma.

Most common benign breast growth that is highly mobile on palpation (historically termed as “breast mouse”)

Question 21

What are the indications for potential excision of fibroadenomas?

Answer 21

If is grows >3cm in diameter or under patient preference.

Question 22

What is an adenoma?

Answer 22

An adenoma is a benign glandular tumour.

Question 23

What is a lipoma?

Answer 23

A lipoma is a soft, mobile, benign adipose tumour.

Question 24

What tissues is a fibroadenoma composed of? Which other tumour is also composed of these tissues and are difficult to distinguish from fibroadenomas?

Answer 24

Fibroadenoma is composed of stromal and epithelial tissue.
Phyllodes tumour (high malignant potential).

Question 25

Which of the following breast masses infer an increased risk of developing breast cancer?
A) Atypical ductal hyperplasia
B) Fibrocystic changes
C) Non-proliferative tumours
D) All benign tumours infer an increased risk of malignancy

Answer 25

A) Atypical ductal hyperplasia

Question 26

What is a papilloma?
Who and where does it normally occur in?
What is a common presentation of a papilloma?
They can appear similar to which type of carcinoma?

Answer 26

A papilloma is a benign breast lesion that occurs in women in their 40s and 50s.
They are usually found in the subareolar region.
Hence, a common presentation is bloody or clear nipple discharge.
Similar to ductal carcinomas.

Question 27

Which of the following statements about atypical ductal hyperplasia is false?
A) It is a proliferative breast lesion
B) It infers up to 5 times increased risk of breast cancer.
C) It is considered a pre-malignant lesion
D) It is histologically similar to in-situ carcinoma.

Answer 27

C) Atypical ductal hyperplasia is NOT considered a pre-malignant lesion.