CBE 2018 + 2017 Flashcards
Gen Surg 1 - A woman presents with a palpable breast mass. What history will you ask her?
- What 4 specific things do you want to know to rule in/out cancer?
4 things you want to ask patient (targeted Qs to rule breast CA in or out)
1. Palpable breast lump
2. Nipple abnormalities (discharge or inversion)
3. Skin changes to breast,
4. Systemic Fx (red flags)
5. Personal history or family history of breast or ovarian Ca
Other Q’s = further Hx - PMHx of breast or other cancers, increased oestrogen exposure (nulliparity, early menarche, HRT etc.), known BRCA1/BRCA2 gene mutation, +ve FMHx (esp 1st degree relatives), PMHx other breast conditions ie. Fibroadenoma, fibrocystic changes
Gen Surg 1 - A woman presents with a palpable breast mass. What examination will you perform?
List Factors associated with an increased likelihood of breast malignancy?
- How will you investigate any new breast symptom?
Factors associated with a decreased likelihood of malignancy
1. Age < 40 years
2. No family history of breast cancer
3. Mobile mass with well-defined borders
4. Overlying skin appears normal
5. Fluctuating size (e.g., with menstruation)
Factors associated with an increased likelihood of malignancy
1. Age ≥ 40 years
2. Family history of breast cancer
3. Mass that is firm, fixed, or has indistinct borders
4. Associated skin changes (e.g., peau d’orange), nipple inversion, or breast asymmetry
5. Axillary lymphadenopathy,
6. Increasing size
Investigation of a breast lump?
Investigation of new dipple discharge?
Imaging of breast lumps? Best modality?
Findings on breast ultrasound & mammography - malignant vs. not?
Breast lump - Biopsy & Surgical referral?
List the differentialf
Benign breast conditions
Fibroadenoma
Phyllodes tumor
Solitary intraductal papilloma
Breast cysts
Galactocele
Breast abscess
Fat necrosis of the breast
Breast cancer
What is the triple test approach to diagnosis? What does it mean in terms of prognosis?
A triple negative result for breast lumps refers to a type of breast cancer that tests negative for 3 specific receptors that fuel most breast cancer growth:
1. Estrogen receptor (ER) – The cancer cells lack receptors for estrogen.
2. Progesterone receptor (PR) – The cancer cells lack receptors for progesterone.
3. Human epidermal growth factor receptor 2 (HER2) – The cancer cells do not overexpress HER2 protein.
Since these cancers are negative for ER, PR, and HER2, they do not respond to hormonal therapies like tamoxifen or targeted therapies like trastuzumab (Herceptin), which are used to treat hormone receptor-positive or HER2-positive breast cancers.
Triple negative breast cancer (TNBC) tends to:
1. Grow and spread more quickly than other types of breast cancer.
2. Have fewer treatment options.
3. Be more common in younger women and in women of African descent.
Chemotherapy is often the main treatment for triple negative breast cancer, as it does not respond to hormonal or HER2-directed therapies.
Breast Cancer
