Breast

Question 1

RFs for breast cancer?

Answer 1

• obesity
• smoking
• FH in 1st degree relative
• oestrogen exposure
  
  • increased no of ovulations
• female

Question 2

outline screening for breast cancer

Answer 2

• mammogram every 3 years from 50-70
• if BRCA gene: MRI every year from 20-49, then mammogram thereafter

Question 3

outline risks of BRCA gene

Answer 3

• BRCA 1- chromosome 17
  
  • 50-85% risk of breast cancer
  • 40-60% ovarian cancer
• BRCA2- chromosome 13
  
  • same risk as above for breast
  • 15% risk ovarian cancer
  • increased risk for male breast cancer & prostate cancer

Question 4

Outline benign breast lumps

Answer 4

• cysts
• fibroadenoma
• lipoma
• fat necrosis
• abscess
• phyllodes tumour

Question 5

outline benign conditions that present w nipple discharge

Answer 5

duct ectasia

intraductal papilloma

Question 6

Mx of benign breast lumps?

Answer 6

treat conservatively or local excision

apart from cyst / abscess & phyllodes tumour

Question 7

describe breast cysts + Mx

Answer 7

• benign
• well circumscribed, mobile, fluctuant lump
• Mx: needle aspiration or local excision

Question 8

describe fibroadenomas + Mx

Answer 8

• most common breast pathology
• epi: 15-35years
• well circumscribed, firm, highly mobile
• 10% disappear every year- excision based on pt preference

Question 9

describe fat necrosis

Answer 9

• lump formed by degeneration/scarring of fat
• aetiology: often post breast surgery/trauma
• firm, irregular, fixed lump
• radiologically similar appearance to breast cancer

Question 10

describe lipoma

Answer 10

• benign fat lump
• soft, painless, mobile lump >20cm

Question 11

mx of abscess?

Answer 11

may require incision and drainage surgically

Question 12

describe phyllodes tumour and mX

Answer 12

• benign but has potential to become malignant
• Mx: wide local excision/mastectomy if large

Question 13

describe duct ectasia

Answer 13

• smoking major RF
• nipple discharge that may be blood stained
• nipple inversion/retraction
• may be assoc w subareolar mass

Question 14

describe intraductal papilloma + Ix

Answer 14

• benign but increased risk of cancer
• subareolar region
• blood stained/sticky nipple discharge
• Ix: ductography
• Mx: excision and vigilant breast screening

Question 15

what is gynaecomastia?

Answer 15

benign enlargement of male breast

Question 16

aetiology of gynaecomastia?

Answer 16

• obesity
• anabolic steroids
• cannabis
• prostate/pituitary/testicular cancer
• liver cirrhosis
• medications

Question 17

what medications may cause gynaecomastia?

Answer 17

• spironolactone
• 5 alpha reductase inhibitors
• PPI
• ACEI
• amiodarone

Question 18

Mx of gynaecomastia?

Answer 18

• stop precipitating cause
• SERM
• surgery

Question 19

outline categories of malignant breast lumps

Answer 19

• In-Situ carcinoma: pre-invasive, not detected clinically (on X-Ray)
  
  • ductal
  • lobular
• Invasive carcinoma
  
  • ductal - 80%
  • lobular - 15%
• Pagets disease
• Inflammatory breast cancer

Question 20

describe pagets disease

Answer 20

• malignant cells infiltrate into epidermis
• cell proliferation–> skin thickening
• causes a red, eczematous rash on nipple
• discharge & inversion are possible

Question 21

describe inflammatory breast cancer

Answer 21

• presents as red, swollen, warm, itchy and inflamed breast
• caused by blockage of lymphatic vessels
• increased breast size

Question 22

epidemiology of breast cancer?

Answer 22

1/8 women in their lifetime will have breast cancer

Question 23

macroscopic signs of breast cancer

Answer 23

• firm lump
• fixed mass
• tethering/dimpling of skin

Question 24

what does triple assessment involve? and when does this get done?

Answer 24

w 2ww cancer referral & suspicious lump

• Clinical
  
  • history&examination
• Imaging
  
  • US<35
  • Mammogram >35
• Histology
  
  • FNAC
  • Core biopsy

Question 25

mets of breast ca?

Answer 25

2b's + 2L's bone brain liver lung

Question 26

staging?

Answer 26

TNM

Question 27

what is the most important prognostic indicator?

Answer 27

node status

Question 28

Medical Mx of breast cancer?

Answer 28

* hormonal therapy * ER+ve (80%) * pre menopausal: tamoxifen (SERM) * post menopausal: aromatase inhibitors * PR+ve * Her-2+ve (assoc w worse prognosis) * herceptin * bisphosphonate * reduced risk of recurrence in post-menopausal women

Question 29

how long is hormonal therapy indicated for?

Answer 29

increasing evidence for 10 years, esp node positive women

Question 30

surgical Mx of breast cancer?

Answer 30

* Wide local excision * if tumour \<4cm * Mastectomy * Sentinel LN biopsy * if clear --\> no further treatment required * if +ve --\> removal of all nodes surgically or w radiotherapy to all nodes

Question 31

complications of surgical Mx?

Answer 31

* lymphedema * nerve injury- long thoracic nerve --\> winging of scapula

Question 32

who is chemo indicated for?

Answer 32

* advanced hormone receptor negative cancer * aggressive disease

Question 33

outline the follow-up to breast cancer treatment

Answer 33

triple assessment once yearly for 5 years after