Examination Book

Question 1

Breast lump

Answer 1

Malignant (invasive ductal carcinoma most common)

Benign: fibroadenoma, cyst (may be painful), abscess (painful, hot, swollen)

Question 2

Triple assessment

Answer 2

1. Clinical assessment
2. Imaging (USS / mammography)
3. Biopsy

Question 3

Breast dimpling

Answer 3

Does not necessarily imply invasion of cancer into underlying musculature
Intra-mammary tumour can pull on ligament of Astley Cooper, causing dimpling of the skin
The action of raising the hands above the head tends to accentuate this

Question 4

Surgery

Answer 4

Breast conserving: lumpectomy, wide local excision /9if < 4cm diameter)
Mastectomy: partial, total, radical (underlying musculature removed)
Axillary lymph nodes: sentinel node biopsy if clinically / USS -ve, axillary node clearance if clinically / USS / sentinel biopsy +ve

Question 5

Chemo

Answer 5

Neo-adjuvant - shrink

Adjuvant (depends on multiple factors including tumour size, grade, node and receptor status)

Question 6

Radiotherapy

Answer 6

Neo-adjuvant NOT USED
Adjuvant following most breast-conserving surgery
Adjuvant following some mastectomies

Question 7

Hormonal therapy

Answer 7

Use depends on hormone receptor status
Neo-adjuvant and adjuvant can be used
Examples: tamoxifen, anastrozole, letrozole, trastuzumab (Herceptin)

Question 8

Describing a lump

Answer 8

1. Size
2. Site
3. Consistency
4. Border
5. Fixed

Question 9

Characteristics

Answer 9

Malignant - hard, irregular, painless, fixed to skin / chest wall, nipple change

Fibroadenoma - smooth and firm, well-defined, painless, solitary, moveable

Fibrocyst - smooth, regular, mulitple, moveable, cyclical

Fat necrosis - firm, round, painless, secondary to trauma