Treatment of breast disease

Question 1

What is the incidence of breast cancer?

Answer 1

Affects 1 in 8 women

Question 2

What are risk factors for breast cancer?

Answer 2

Increasing age
Previous breast cancer
BRCA1/2 genes
Early menarche and late menopause
Late or no pregnancy
HRT
Alcohol
High BMI
Post radiotherapy treatment - especially for Hodgkin's disease - chest exposure

Question 3

How may an asymptomatic patient be found to have breast cancer?

Answer 3

In breast screening

Question 4

Who gets invited for breast screening?

Answer 4

Women aged 50-70

Question 5

What are possible symptoms of breast cancer?

Answer 5

Lump
Mastalgia
Nipple discharge
Nipple changes
Change in the size or shape of the breast
Lymphoedema 
Dimpling of the breast skin

Question 6

What is mastalgia?

Answer 6

Persistent unilateral breast pain

Question 7

What will happen as a result of lymphoedema?

Answer 7

Swelling of the arm

Question 8

What will a patient do when they go through the clinic?

Answer 8

History and examination
Bilateral mammogram
FNA or Core Biopsy

Question 9

What is the general history in a patient with breast cancer?

Answer 9

Previous breast problems
Family history
Hormonal status
Drug history

Question 10

What should be examined in examination of suspected breast cancer?

Answer 10

Both breasts

Axillae

Question 11

What is the most sensitive form of breast imaging?

Answer 11

Mammography

Question 12

What is fine needle aspiration used for?

Answer 12

Cytology

Question 13

What is core biopsy used for?

Answer 13

Histo-pathology

Question 14

What are the 2 most common types of invasive breast cancer?

Answer 14

Ductal carcinoma - 80%
Lobular carcinoma - 10%
Other - 10%

Question 15

What are the 2 most common types of non-invasive breast cancer?

Answer 15

Ductal carinoma in situ

Lobular carcinoma in situ

Question 16

What is the general management for breast cancer?

Answer 16

Diagnosis
Staging
Treatment

Question 17

What members of the MDT may be involved in breast cancer treatment?

Answer 17

Breast surgeon
Radiologist
Cytologist
Pathologist
Clinical oncologist
Medical oncologist
Nurse counsellor
Psychologist
Reconstructive surgeon
Patient and partner
Palliative care

Question 18

How can staging be assessed?

Answer 18

FBC

Chest x ray

Question 19

How is the primary tumour T graded?

Answer 19

Tx - primary tumour can not be assessed
T0 - primary tumour not palpable
T1 - tumour <2cm
T2 - tumour 2-5cm
T3 - tumour >5cm
T4a - tumour invading skin
T4b - invading chest wall
T4c - invading both
T4d - inflammatory breast cancer

Question 20

How is the primary tumour N graded?

Answer 20

N0 - no regional lymph nodes palpable
N1 - regional lymph nodes palpable - mobile
N2 - regional lymph node palpable - fixed

Question 21

How is breast cancer treated?

Answer 21

Surgery - may have radiotherapy, chemotherapry, hormonal therapy

Question 22

What are the 2 main types of surgery?

Answer 22

Mastectomy

Breast conservation surgery

Question 23

Who is suitable for surgery?

Answer 23

Patient suitable for radiotherapy

Patient who wants it

Question 24

What is the sentinel lymph node?

Answer 24

The first node to receive lymphatic drainage and therefore the first node the tumour spreads to