Invasive Breast Cancer

Question 1

What are the risk factors for breast cancer?

Answer 1

Early menarche, late menopause 
1st child >30yrs 
FHx is first degree relative 
Hx of breast feeding 
Previous breast cancer 
Radiation exposure 
Exogenous hormones
High intake of saturated fats, alcohol

Question 2

What bloods and investigation other then the triple assessment should be order in suspected breast cancer?

Answer 2

FBC, LFTs, U&Es, ALP, Ca2+, ESR

CXR

2nd line - Liver USS, bone scans, CT scan - mets

Question 3

What is the surgical treatment for breast cancer?

Answer 3

Wide local excision
Mastectomy +/- reconstruction

Axillary sentinel lymph node biopsy 
Axillary clearance (removal of contents below the level of the axillary vein):
-level 1 = below pec minor 
-level 2 = behind pec minor 
-level 3 = above pec minor

Question 4

What is the systemic treatment for breast cancer?

Answer 4

Can be adjuvant or neo-adjuvant

1. Radiotherapy
2. Chemotherapy
3. endocrine therapy and tamoxifen

Question 5

What are the classifications of breast cancer?

Answer 5

Invasive ductal carcinoma (75-85%)
Invasive lobular carcinoma (10%)
Other subtypes - medullary or colloid

Question 6

Where do all breast cancer arise?

Answer 6

Terminal duct lobular unit

Question 7

What is the widely used clinicopathologcal staging system?

Answer 7

Nottingham prognostic index (NPI)

Question 8

Which three receptors should all breast malignancy be tested for?

Answer 8

Oestrogen receptor (ER)
Progesterone receptor (PR)
Human epidermal growth factor receptor (HER2)

Question 9

What is the NHS breast screening programme?

Answer 9

Women aged 50-70 yrs invited for mammogram every three years