Invasive breast cancer

Question 1

What are the two main types of invasive carcinoma of the breast?

Answer 1

Invasive ductal carcinoma, Invasive lobular carcinoma

Question 2

What is the most common type of invasive breast cancer?

Answer 2

Invasive ductal carcinoma

Question 3

What are the risk factors for invasive breast cancer?

Answer 3

Female sex and age, BRACA 1 or 2, family history of first degree relative, obesity, previous benign disease, alcohol, geographically (well developed countries) exposure to unopposed oestrogen e.g. early period, late menopause, nulliparous, first pregnancy after 30, oral contraceptives, HRT

Question 4

What are the clinical features of invasive breast cancer?

Answer 4

breast lumps, asymmetry, swelling, abnormal nipple discharge, nipple retraction, skin changes, dimpling, mastalgia, palpable lump in the axilla

Question 5

What are the differential diagnosis for breast cancer?

Answer 5

benign tumours, breast cysts, infective causes

Question 6

What investigations should be done for breast cancer?

Answer 6

Triple assessment- examination, imaging and histology or cytology

Question 7

What determines the prognosis for breast cancer?

Answer 7

nodal status, tumour size, grade, receptor status

Question 8

What are the different receptors for breast cancer?

Answer 8

Oestrogen receptors, progesterone receptors, human epidermal growth factor receptor

Question 9

Who does the breast cancer screening programme invite to screening?

Answer 9

women aged 50-70years to have a mammogram every three years

Question 10

What is Pagets disease of the nipple?

Answer 10

rare condition presenting with roughening, reddening and slight ulceration of the nipple, most have an underlying neoplasm

Question 11

In pagets disease of the nipple what is happening microscopically?

Answer 11

involvement of the epidermis by malignant ductal carcinoma cells

Question 12

What is the clinical presentation of pagets disease of the nipple?

Answer 12

itching, redness in the nipple and areola, flaking and thickened skin on or around the nipple, painful and sensitive, flattened nipple with yellow or bloody discharge

Question 13

What are the differential diagnosis for pagets disease of the nipple?

Answer 13

dermatitis or eczema, but eczema usually spares the nipple

Question 14

What investigations will be done for pagets disease of the nipple?

Answer 14

biopsy, breast and axilla examination, mammogram, ultrasound and MRI of the breast

Question 15

What is the management for pagets disease of the nipple?

Answer 15

surgery due to the underlying breast cancer, radiotherapy as well