Breast

Question 1

Treatment for cyclical mastalgia

Answer 1

Good fitting bra
Low dose tamoxifen
NSAID
Bromicriptine
Danazol

Question 2

Popcorn like density on mammogram

Answer 2

Popcorn like mammographic changes in a young female most classically represent a fibroadenoma.

Invasive ducal cancers usually are associated with spiculated mass lesions on mammographic films.

Fat necrosis may mimic malignancy on imaging and clinically rather than benign processes.

Question 3

What percentage of people with atypical ductal hyperplasia may develop breast cancer

Answer 3

10-15%

Question 4

Nodal mets in breast cancer

Answer 4

Nodal micrometastasis=0.2-2mm of tumour foci

Isolated tumour cells= 0.2mm or less of tumour foci in single node

Question 5

Halo sign on mammogram

Answer 5

Benign cysts are most commonly seen in association with a halo sign which is formed by rings of compressed fat. This is seen less frequently with infiltrative lesions.

Question 6

Indications for radio following mastectomy

Answer 6

Radiotherapy is not routinely used following mastectomy. It is considered beneficial in the following high risk groups:
• Patients with axillary nodal involvement
• T3 and T4 tumours
• Vascular invasion
• Extranodal disease
• Inflammatory breast cancer

Question 7

Risk reduction in BRAC1 mastectomy

Answer 7

85%

Question 8

BRAC1 lifetime risk of breast cancer

Answer 8

60-80% for breast
40-60% for ovarian

Question 9

BRCA 2 lifetime risk

Answer 9

50-85% for breast
10-30% for ivarian

Question 10

Behind which muscles are the level 2 nodes

Answer 10

Pec Minor

Question 11

Which type of breast cancer is associated with lymphocytic infiltrate

Answer 11

Medullary

Question 12

Side effect of trastuzumab

Answer 12

Cardiac toxicity

Question 13

What percentage of breast cancers is due to BRAC1/2 inheritance

Answer 13

5%

Question 14

Conditions causing increased risk of breast cancer

Answer 14

Atypical ducts hyperplasia
Radial scaring

Question 15

Cause if gynaecomastia

Answer 15

• physiological: normal in puberty
• syndromes with androgen deficiency: Kallman’s, Klinefelter’s
• testicular failure: e.g. Mumps
• liver disease
• testicular cancer e.g. Seminoma secreting HG
• ectopic tumour secretion
• hyperthyroidism
• haemodialysis
• drugs

Question 16

Drugs causing gynaecomastia

Answer 16

Drug causes of gynaecomastia
• spironolactone (most common drug cause)
• cimetidine
• digoxin
• cannabis
• finasteride
• estrogens, anabolic steroids
Very rare drug causes of gynaecomastia
• tricyclics
• isoniazid
• calcium channel blockers
• heroin
• busulfan
• methyldopa

Question 17

Breast cancer screening

Answer 17

49-73

Every 3 years

Question 18

Family breast cancer risk

Answer 18

1 first degree relative affected aged <40 = 1 in 6
2 first degree relatives under 40 = 1 in 3
3 first degree relatives under 60= 1 in 4

Question 19

DCIS

Answer 19

Areas of >40mm should be consider for mastectomy

Question 20

L lymph node mets -skipping level 1

Answer 20

3% skip level 1
Rest present there

Question 21

Sensation provided by intercostobrachial nerve

Answer 21

Lateral chest
Medial aspect of the upper arm
Axilla (armpit)

Question 22

BRCA 1 other cancer

Answer 22

BRCA 1 mutation= 35% risk of ovarian cancer

Question 23

Side effects of trastuzumab - Herceptin

Answer 23

• Trastuzumab is a monoclonal antibody targeted at the HER/neu receptor
• Its main use is in HER positive breast cancer and is usually administered with chemotherapy
• It is typically given by infusion over a one year period
• Its most serious adverse effect is one of myocardial toxicity and it increases the risk of serious cardiac malfunction by 2.1%, this risk is increased when administered with anthracycline chemotherapy which is also well known to have cardiac effects.

Question 24

Most comman cause of bloody nipple discharge

Answer 24

Intraductal papilloma

• Commoner in younger patients
• May cause blood stained discharge
• There is usually no palpable lump

Question 25

Lobular breast cancers

Answer 25

Lobular cancers are poorly visualized on conventional imaging. Where a mastectomy is the planned treatment this is of no practical significance. However, the size of the lesion and associated other lesions will not be appreciated unless an MRI scan is performed. This will determine the safety with which breast conserving surgery could be offered. In view of the tumour location the outcome in terms of cosmesis is likely to be poor. Neoadjuvent therapy is unlikely to alter the eventual outcome here.

Question 26

Breast cancer chemo regieme

Answer 26

Where chemotherapy is deemed necessary in the adjuvent setting, the main regime in current use combines anthracycline and taxane.

Question 27

Lobular carcinoma in situ

Answer 27

The direct malignant potential of LCIS is unclear and at the present time advice is generally that these areas be excised in a non oncological manner. These patients require close post operative surveillance as they have a seven fold increased risk of the development of breast cancer.