Cancr Y Fron

Question 1

What structures are seen on a mammogram?

Answer 1

Fibroglandular tissue - radiodense and appears white on the mammogram
Fatty tissue - radiolucent and appears dark grey on the mammogram
Axillary lymph nodes in oblique view
Pectoralis major - triangular structure on the oblique view, and is a useful indication that the breast tissue has been well pulled on to the film
Not ribs!

Question 2

Define skin tethering

Answer 2

Means that the lump is attached to the skin, but can be moved in an arc without moving the skin. If the lump is pulled outside the arc, the skin indents

Question 3

Define skin fixation

Answer 3

Where the lump cannot be moved without moving the skin.

Question 4

In what part of the breast do breast cancers most commonly occur?

Answer 4

Approximately 50% of cancers occur in the upper outer quadrant of the breast

Question 5

What is the commonest type of breast cancer?

Answer 5

Invasive ductal carcinoma

Question 6

What is the second commonest type of breast cancer?

Answer 6

Invasive lobular carcinoma is the second most common type of breast cancer, accounting for about 10-15% of cases.

Question 7

Describe invasive lobular carcinoma

Answer 7

In classic lobular carcinoma the cells tend to infiltrate the surrounding tissues in a single-file pattern. As a result, they may present clinically as a thickening rather than a discrete lump, and on mammography any abnormality may be very subtle.

Question 8

What is the goal of adjuvant chemotherapy?

Answer 8

The goal of adjuvant chemotherapy (given after breast surgery) is to eradicate micrometastatic disease and hence increase the chance of a cure.

Question 9

What are the components of a Triple Assessment?

Answer 9

Clinical assessment (history and examination)
Imaging assessment (usually mammography if appropriate, and ultrasound)
Needle biopsy (ideally core biopsy, but may also be fine needle aspiration cytology)

Question 10

What are the indications for mastectomy rather than wide local excision?

Answer 10

Local recurrence after wide local excision
Multifocal breast cancer
Invasive cancer larger than 4cm

Question 11

What are the side-effects of tamoxifen use?

Answer 11

DVT, endometrial thickening (including endometrial polyps, endometrial hyperplasia and (less commonly) endometrial carcinoma.), menopausal symptoms such as hot flushes, vaginal dryness, nausea and low libido

Question 12

Define lactational mastitis

Answer 12

inflammatory condition of the interlobular connective tissue that affects 10% of breastfeeding women. Caused by overproduction or insufficient removal of milk. It may be infectious (retrograde spread of commensal organisms via a milk duct or a traumatised nipple) or non-infectious.

Question 13

Define inflammatory breast cancer

Answer 13

rare form of breast cancer in which cancer cells grow along the lymph vessels causing the breast to become inflamed and swollen. It can mimic mastitis and breast abscess.

Question 14

What would you advise woman who is has mastitis in regards to breastfeeding?

Answer 14

Continue to breastfeed from both nipples as required

Question 15

When would you consider aspirating a breast cyst?

Answer 15

Cyst is painful

Cyst is causing a symptomatic lump

Question 16

Define ductal carcinoma in situ (DCIS)

Answer 16

Cancer cells have formed within the milk ducts but have not invaded through the basement membrane to the surrounding breast tissue. Commonly seen as micro calcifications on mammogram

Question 17

What are degrees of relatives and what do they mean?

Answer 17

First-degree relatives are parents, siblings and children.
Second-degree relatives include grandparents and aunts/uncles.
Third-degree relatives include cousins and great aunts/uncles.