Breast Cancer

Question 1

What are some weak risk factors for breast cancer ?

Answer 1

Family member of post-menopausal breast cancer
Later menopause
Early menarche
Nulliparity
Obesity
Alcohol consumption
HRT long term

Question 2

What are some moderate risk factors for breast cancer ?

Answer 2

Age
Family history of pre-menopausal breast cancer
Personal history of breast cancer
Dense breasts

Question 3

What are some strong risk factors for breast cancer ?

Answer 3

Family history in 3 or more family members
Evidence of BRCA1/2 gene
Dense breasts

Question 4

What are the most commonly identified germline mutations to cause breast cancer and what inheritance are they ?

Answer 4

BRCA1 and 2
Autosomal dominant

Question 5

What is Li-Fraumeni syndrome ?

Answer 5

Loss of function mutation in the p53 tumour suppressor gene

Question 6

What cancers does Li-Fraumeni syndrome increase the risk of ?

Answer 6

Breast
Prostate
Colorectal

Question 7

What is mammography ?

Answer 7

X-ray images of breasts
Medial-oblique view and a cranio-caudal view of both breasts

Question 8

What is the gold standard screening tool for breast cancer ?

Answer 8

Mammography

Question 9

What are the 2 common types of pre-malignant breast conditions ?

Answer 9

Lobular carcinoma in-situ
Ductal carcinoma in-situ

Question 10

What is lobular carcinoma in situ ?

Answer 10

A pre-malignant condition arising from the cells of the breast lobules.
Atypical cells haven’t invaded nearby breast tissue

Question 11

What is Ductal carcinoma in situ ?

Answer 11

Composed of malignant epithelial cells that arise in the breast ducts and have not yet invaded beyond the basement membrane in their site of origin.

Question 12

What is the management of Ductal carcinoma in situ ?

Answer 12

Routinely surgically excised

Question 13

What is the management of lobular carcinoma in situ ?

Answer 13

More frequent screening mammograms
Hormonal therapy can decrease their risk of future breast cancer

Question 14

What are the 2 most common invasive breast cancers ?

Answer 14

Invasive ductal carcinoma
Invasive lobular carcinoma

Question 15

How does invasive lobular breast cancer occur ?

Answer 15

A single-file of infiltrating cells invade into the breast stromal tissue

Question 16

What is inflammatory breast carcinoma and how does it present ?

Answer 16

A rare but highly aggressive form of breast cancer

Red, warm swollen breast, peau d’orange ( orange peel texture )

Question 17

What is Paget’s disease of breast and how does it present ?

Answer 17

Rare form of invasive breast cancer derived from epithelium.

Crusting and scaling of skin around nipple, pruritus, nipple discharge and a lump

Question 18

What is the most favourable hormone receptor status for breast cancer ?

Answer 18

Oestrogen and progesterone receptor positive

Question 19

What is HER2 ?

Answer 19

Human epidermal growth factor receptor 2
A proto-oncogene for a transmembrane growth factor receptor

Question 20

What is a targeted therapy against HER2 positive breast cancer ?

Answer 20

Herceptin - a monoclonal antibody against HER2 protein

Question 21

How can breast cancer present ?

Answer 21

Asymptomatic
Breast lump/mass
Nipple changes - inversion, discharge,
Skin changes - red, warm, peau d’orange
Non-specific B symptoms

Question 22

What imaging can be done when suspecting breast cancer ?

Answer 22

Mammogram
USS
MRI

Question 23

How can a biopsy be taken for breast cancer ?

Answer 23

Fine needle aspiration
Core needle biopsy
USS guided biopsy

Question 24

What is the main treatment for breast cancer ?

Answer 24

Surgery - lumpectomy or mastectomy

Question 25

Other than surgery what are some other ways breast cancer can be managed ?

Answer 25

External beam Radiation
Hormonal therapies
Chemotherapy

Question 26

What are some side effects of radiation for breast cancer ?

Answer 26

Fatigue
Skin changes
Breast pain
Lymphoedema

Question 27

What is the first line hormonal therapy for pre-menopausal breast cancer patients ?

Answer 27

Tamoxifen

Question 28

What is a risk of using tamoxifen for the treatment of breast cancer ?

Answer 28

Endometrial cancer
DVT
PE
Stroke

Question 29

What are some side effects of using hormonal therapies in managing breast cancer ?

Answer 29

Hot flashes
Sexual dysfunction
Weight gain
Constipation or diarrhoea
Nausea
Fatigue