Viva

Question 1

—year old lady presents with a breast lump. What is your next step?

Answer 1

Full hx, in particular FHx and menstrual hx.
Examination assessing location, size & fixation of the lump, skin involvement and regional LN.
Routine bloods including pregnancy test if appropriate
Refer for triple assessment which includes clinical exam, mammogram and US breast & Scilla with core biopsy.

Question 2

Triple assessment shows breast cancer. What further investigations are needed?

Answer 2

Need stage, ER,PR&HER2 status.

CT staging & bone scan needed in:
>=T3
>=N2
HER2+
Triple negative

Young/triple negative/FHx - refer for genetics

Question 3

Who would you consider neoadjuvant chemotherapy for?

Answer 3

HER2+ (>0.5cm)
Triple negative
ER+ - if advanced to allow BCS

Question 4

What investigations are needed prior to neoadjuvant chemotherapy

Answer 4

MR breast
Upfront SLNB if cN0
Clips in tumour & nodes
CT staging
ECHO
Fertility review and referral if appropriate

Question 5

What neoadjuvant chemotherapy would you give for HER2 + BC?

Answer 5

Docetaxel 75mg/m2 with carboplatin AUC6, pertuzumab 840mg loading (then 420mg) and trastuzumab 8mg/kg loading (then 6mg/kg). Q21 X6 cycles

Or
Epirubicin 90mg/m2 & cyclophosphamide 600mg/m2 x3cycles followed by docetaxel 100mg/m2 with pertuzumab & trastuzumab as above

Or as above but with paclitacel 80mg/m2 weekly instead of docetaxel