Q's

Question 1

What is the triple assessment for?

Answer 1

symptomatic patients

Question 2

describe the breast screening programme

Answer 2

50-70 (every 3 years) - mammography

aims to detect DCIS (ductal carcinoma in situ)

Question 3

What is MRI used for in breast imaging

Answer 3

• implant rupture
• Screening: 30-50 w/ high risk FHx (BRCA)
• lobular breast Ca

Question 4

What is good for dense breast?

Answer 4

US (+ MRI)

Question 5

Describe 2 breast biopsy techniques

Answer 5

Core biopsy

Fine needle asouration

Question 6

Describe the triple assessment

Answer 6

• Examination (+ history)
• Imaging
• Pathology (e.g. biopsy)

Question 7

What imaging is used in triple assessment of >40yo?

Answer 7

Mammogram + US

Question 8

What imaging is used in the triple assessment of <40yo?

Answer 8

US

Question 9

RFs for breast Ca

Answer 9

^ oestrogen: HRT, early monarche, no pregnancy, PCOS, obesity, COCP, later menopause

FHx/genetics

^ age

Male: kleinfelters + oestrogen therapy

Question 10

protective factors for breast Ca

Answer 10

multiparous

Question 11

most common type of breast cancer?

Answer 11

Adenocarcinoma (ductal)

Question 12

Where does the second commonest breast cancer arise? What is good for imaging it?

Answer 12

lobular - mRI

Question 13

give some tumour markers (receptors)

Answer 13

ER +ve
Her-2
Progesterone +ve

Question 14

What tumour marker offers good prognosis?

Answer 14

ER +ve

Question 15

What tumour marker offers poor prognosis?

Answer 15

Her-2

Ki67 (proliferation marker)

Question 16

Surgical treatment for breast cancers?

Answer 16

• Breast conservation (wide local excision or lumpectomy)

- Mastectomy

Question 17

How do you identify which nodes are involved?

Answer 17

Sentinel node biopsy (technetium 99)

Question 18

What treatments can be used for the different receptors/tumour markers?

Answer 18

Tamoxifen for ER +ve

Trastuzumab (herceptin) for HER-2 +ve

Question 19

As part of adjuvant therapy (after surgery) what hormonal therapy can you use hormonal therapy. What can be used in pre and post-menopausal women? Why is it different for post-menopausal women?

Answer 19

pre: tamoxifen
post: aromatase inhibitor (selective oestrogen receptor modulator)

Tamoxifen - risk of DVT + endometrial Ca ^ in post-menopausal

Question 20

Give a risk of tamoxifen

Answer 20

DVT + endometrial Ca

Question 21

What characterises paget’s disease of the nipple?

Answer 21

Eczema of nipple

Question 22

commonest site of mets?

Answer 22

bONE > lungs

Question 23

Her-2 +ve treatment

Answer 23

Herceptin (trastuzumab)

Question 24

ER +ve treatment

Answer 24

Tamoxifen

Question 25

give 3 familial breast cancer genes

Answer 25

BRCA 1 BRCA 2 TP53 mutation

Question 26

Which familial breast cancer gene is also assoc with ovarian Ca

Answer 26

BRCA 1

Question 27

What is the commonest cause of lump in <35s

Answer 27

Fibroadenoma

Question 28

causes of gynaecomastia

Answer 28

Kleinfelters, liver disease, spironolactone