Condition- Breast Cancer

Question 1

What is the most common type of breast cancer?

Answer 1

Invasive Ductal Carcinoma

Question 2

What are the different types of breast cancer?

Answer 2

• Non-invasive ductal carcinoma in situ (DCIS) – pre-malignant
• Non-invasive lobular carcinoma - rarer
• Invasive ductal carcinoma – 70%
• Invasive lobular carcinoma – 10-15%
• Medullary cancers – 5%
• Colloid/mucoid cancers – 2%
• Others: papillary, tubular, adenoid-cystic, Paget’s

Question 3

What % of breast cancers are oestrogen receptor +ve- which type has a better prognosis?

Answer 3

60-70% are oestrogen receptor +ve – better prognosis – hormone therapy

Question 4

Overexpression of which gene may

Question 5

List some risk factors for developing breast cancer

Answer 5

• female
• age
• genetics (BRCA-1/2)
• FHx of breast cancer
• Prolonged exposure to oestrogen
  
  • Nulliparity (not having kids)
  • Early menarche and Late menopause
  • First pregnancy >30 yrs
  • Obesity
  • COCP
  • Not breast feeding
  • Past breast cancer
  • High alcohol intake
• Increased breast density

Question 6

List some of the presenting symptoms of breast cancer…

Answer 6

• Breast lump – painless, irregular, indistinct border, hard, immobile, may be fixed to structures
• Changes in breast shape
• Nipple discharge (may be bloody)
• Axillary lump
• Symptoms of malignancy:
  
  • Weight loss
  • Bone pain- bone is common site of metastasis
  • Paraneoplastic syndromes- bone, liver

Question 7

List some of the signs of breast cancer on physical examination

Answer 7

• Breast lump
  
  • Firm
  • Irregular
  • Fixed to surrounding structures
• Lymphadenopathy
• Peau d’orange
• Skin tethering
• Fixed to chest wall
• Skin ulceration
• Nipple inversion
• Paget’s disease of the nipple - eczema-like hardening of the skin on the nipple.

Question 8

Which sign of breast cancer is this? And what is it caused by?

Answer 8

• Paget’s disease of the nipple - eczema-like hardening of the skin on the nipple
  
  • Usually caused by ductal carcinoma in situ infiltrating the nipple

Question 9

Which sign of breast cancer is this? and why does it occur?

Answer 9

PEAU D’ORANGE

• skin tethering because of odema- causes expansion of breast, but skin is tethered to tissue, so this creates the dimples

Question 10

List how a pt with a breat lump and suspicion of breast cancer would be managed…

Answer 10

1. Clinical Assessment
2. Imaging:
   
   1. Ultrasound (<35yrs)
   2. Mammogram (>35yrs)
3. Tissue Diagnosis:
   
   1. Fine Needle Aspiration
   2. Core Biopsy

Question 11

How can you identify the presence of a breast cancer on a mammogram?

Answer 11

On mammogram: cancer is suggested by increased density, irregular margins, speculation (like shards of glass) and accompanying clustered irregular microcalcifications

Question 12

Where are the most common sites of breast cancer metastasis?

Answer 12

• Bone-ribs, hips
• Liver
• Lungs
• Brain