Breast

Question 1

Risk factors for breast cancer?

Answer 1

Female
Increased oestrogen exposure
More dense breast tissue
Obesity
Smoking
Fhx
Prev breast ca
Radiation exposure
Nulliparity

Question 2

What can increase oestrogen exposure to women throughout their life?

Answer 2

Earlier onset of periods
Later onset menopause
COCP
HRT

Question 3

Which genes are most commonly associated with breast cancer?

Answer 3

BRCA1
BRCA2

Question 4

What are the most common different types of breast cancer?

Answer 4

Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS)
Invasive ductal carcinoma (NST)
Invasive lobular carcinoma (ILC)
Inflammatory breast cancer
Paget’s disease of the nipple

Question 5

When should patients be referred for 2ww breast cancer referal?

Answer 5

30+ w/ unexplained breast lump with or without pain

50+ with any nipple changes

Consider: unexplained lump in axilla in 30+
Skin changes

Question 6

What are possible presentations suggesting breast cancer?

Answer 6

Lumps
Nipple retraction
Skin dimpling/oedema
Lymphadenopathy (esp axilla)

Question 7

What is the NHS breast cancer screening program?

Answer 7

Mammogram every 3yrs in women 50-70yrs

Question 8

What assessment is done following 2ww referral for breast cancer?

Answer 8

Triple assessment:
History/exam
Imaging (USS/mammogram)
Biopsy

Question 9

What are the lymph node assessment options if people are diagnosed with breast cancer?

Answer 9

Ultrasound of axilla > US guided biopsy of abnormal nodes

None detected = sentinel lymph node biopsy

Question 10

What are the three main breast cancer receptors that can be targeted?

Answer 10

Oestrogen receptors
Progesterones receptors
HER2

Question 11

Where are the most common sites of metastasis from breast cancer?

Answer 11

LLBB
Lunge
Liver
Bone
Brain

Question 12

What are the surgical options for breast cancer?

Answer 12

Mastectomy
Wide local excision

Question 13

What is a common side effect of lymph node clearance in breast cancer?

Answer 13

Chronic lymphoedema

Question 14

What are some management options for chronic lymphoedema?

Answer 14

Massage techniques
Compression garments
Weight loss (if appropriate)

Question 15

When is radiotherapy offered to patients following breast cancer surgery?

Answer 15

To all undergoing WLE
If mastectomy - for T3-T4 tumours

Question 16

When is chemotherapy used in breast cancer?

Answer 16

Neoadjuvantly
Adjuvantly
In metastatic/recurring cancer

Question 17

What is prescribed to women with oestrogen receptor +ve breast cancer?

Answer 17

Pre/peri-menopause = tamoxifen

Post-menopause = Anastrozole/letrozole

For 5y

Question 18

What biologic treaments may be used for HER2 receptor +ve breast cancer?

Answer 18

Trastuzumab
Pertuzumab

Question 19

What are the two main causes of mastitits?

Answer 19

Obstruction in ducts = accumulation of milk
Infection

Question 20

Features of mastitis?

Answer 20

Painful, tender, red, hot breast
+/- fever, fatigue

Question 21

First line management of mastitis?

Answer 21

Continue breastfeeding
Analgesia
Warm compress

Question 22

When should antibiotics be initiated in mastitis?

Answer 22

12-24 hours no improval of sx (following milk removal)
If systemically unwell
Nipples fissure present

Question 23

Antibiotic choice in mastitis?

Answer 23

PO flucloxacillin 10-14d

Question 24

What is a key risk factor for infective mastitis/breast abscess?

Answer 24

Smoking

Question 25

Presenting features of a breast absess (4)?

Answer 25

Mastitis sx plus: Swollen, fluctuant, tender lump

Question 26

Management of a breast abscess?

Answer 26

Refer to surgical for incision and drainage Antibiotics

Question 27

What is a fibroadenoma?

Answer 27

Benign tumour of breast 'Breast mouse' Painless/smooth/round/firm/mobile

Question 28

Presentation of intraductal papilloma?

Answer 28

Nipple discharge (clear or blood stained) Tenderness or pain Palpable lump

Question 29

Breast screening for those who are BRCA1 carriers?

Answer 29

Annual MRI

Question 30

Indication for excision/removal of fibroadenoma?

Answer 30

>3cm