Treatment of Breast Disease

Question 1

What are the 2 types of breast cancer?

Answer 1

In situ carcinoma

Invasive carcinoma

Question 2

What are the subtypes of in situ carcinoma?

Answer 2

Ductal carcinoma in situ

Lobular carcinoma in situ

Question 3

What are the subtypes of invasive carcinoma?

Answer 3

Ductal 
Lobular
Tubular 
Cribriform 
Medullary

Question 4

What is used to establish a diagnosis in breast cancer?

Answer 4

History and clinical examination 
Mammography 
Utrasonography 
Magnetic resonance mammography 
Cytology (FNAC) 
Core biopsy 
Image guided cytology/ core biopsy 
Open (surgical biopsy)

Question 5

What are the risk factors for breast cancer?

Answer 5

Age 
Age at menarche and menopause 
Age at first pregnancy 
Family history 
Previous benign breast disease 
Cancer in other breast 
Radiation 
Oral contraceptive or HRT 
Lifestyle (high fat, alcohol)

Question 6

What are the signs and symptoms of breast cancer?

Answer 6

Lump or thickening or breast, often painless
Discharge or bleeding
Change in size or contours of breast
Change in colour or appearance of areola
Redness or pitting of skin (orange)

Question 7

How do you assess of beast cancer once the diagnosis is made?

Answer 7

Hb FBC, U&Es, LFTs
CXR
Isotope bone scan

Question 8

What technique is used to stage breast cancer?

Answer 8

Tumour Node Metastases

Question 9

What are the 2 main surgical procedures for breast cancer?

Answer 9

Breast conservation (Wide local incision, quadranectomy, segmentectomy) 
Mastectomy

Question 10

What patients are suitable for breast conservation as a surgical treatment?

Answer 10

Tumour size <4cm 
Breast/tumour size ratio 
Suitable for radiotherapy 
Single tumour 
Minimal in situ cancer component present

Question 11

How many axilla levels are there?

Answer 11

3

Question 12

What is the first axilla level?

Answer 12

Below and lateral to pec minor

Question 13

What is the second axilla level?

Answer 13

Behind pec major

Question 14

What is the third axilla level?

Answer 14

Above and medial to pec minor

Question 15

Why is a sentinel lymph node biopsy important in the treatment of breast cancer?

Answer 15

First node to receive lymphatic drainage and to which tumour spreads
If negative, rest of nodes in lymphatic basin are negative

Question 16

What is involved in the treatment of the axilla?

Answer 16

If SLN negative no further treatment

If SLN positive remove nodes surgically or give radiotherapy to all axillary nodes

Question 17

What are the complications of axilla treatment?

Answer 17

Lymphoedema 
Sensory disturbance 
Decrease ROM of shoulder joint 
Nerve damage 
Vascular damage 
Radiation induced sarcoma

Question 18

What are the treatments for micrometastases?

Answer 18

Hormone therapy
Chemotherapy
Targeted therapies

Question 19

What types of hormone therapies are given?

Answer 19

Premenopausal - tamoxifen for 5 yrs

Postmenopausal - tamoxifen for 5 yrs if goof prognosis, aromatase inhibitor for 5 yrs if poorer

Question 20

What type of chemotherapy is used to treat micrometastases?

Answer 20

Antracyclines

Taxanes

Question 21

How are patients managed who have over expression of HER2

Answer 21

Anti HER2 therapy (Trastuzumab)

Question 22

What follow up is given fro breast cancer?

Answer 22

Examination 6 monthly for 5 years

Yearly after that