Breast Cancer

Question 1

Compare LCIS and DCIS prognostically and clinically?

Answer 1

Ductal carcinomas in situ are premalignant and can develop directly into an invasive ductal carcimonas

They present as a lump

Lubular carcinomas in situ are only risk factors for the development of adenomas and subsequent malignancies won’t necessarily develop at the same site directly

They don’t present as a lump

Question 2

What are the medical therapies for breast cancer?

Answer 2

SERM - Tamoxifen

Herceptin - if HER2 positive

Chemotherapy - Cyclophosphamide, 5FU, Doxyrubicin, Methotrexate

Radiotherapy

Question 3

Which ethnic group have a higher rate of BRA1 and 2?

Answer 3

Eastern European Jew - Ashkenazi

Question 4

What is the recommended breast cancer screening?

Answer 4

1 mammography every two years for women 50-75 years

Question 5

What are the main types of breast cancer?

Answer 5

Ductal carcinoma

Lobular carcinoma

Tubular carcinoma

Mucinous carcinoma

Question 6

What are the two endocrine therapy for breast cancer?

Answer 6

Oestrogen receptor antagonist - tamoxifen

Aromatase inhibitors - eg Anastrozole

Question 7

Why does obesity increase the risk of breast cancer?

Answer 7

It increases the person’s exposure to oestrogen

Question 8

How are ductal carcinomas in situ treated?

Answer 8

Wide local excision with adjuvant radiotherapy

No chemo or hormal therapy required

Question 9

What is the mechanism of action of aromatase inhibitors?

Answer 9

Block the conversion of testosterone to oestrogens to reduce the tissue concentration of oestrogen

Question 10

What do intraductal papillary lesions present?

Answer 10

Nipple discharge - sometime with blood

Lump if large enough

Question 11

What must you consider when giving a female patient chemotherapy?

Answer 11

Fertility - Chemotherapy induces menopause

Question 12

What can be used if a patient is Her2 positive?

Answer 12

Herceptin

Question 13

What often precipitates fat necrosis?

Answer 13

Trauma - eg seat belt injury

Question 14

What is tamoxifen?

Answer 14

An oestrogen receptor antagonist

Question 15

When is radiotherapy contraindicated?

Answer 15

When it has been performed previously

When the patient has scleroderma

Question 16

Compare low and high grade carcinomas in situ

Answer 16

Low - Punched out cribiform

• Small regular nuclei

High - Large irregular nuclei

• Central necrosis

Question 17

What regimen provides better reduction of risk of recurrence of breat cancer; total mastectomy or wide local excision and radiotherapy?

Answer 17

They are equvalent

Question 18

What lifestyle factors can be modified to reduce the risk of breast cancer reoccurence?

Answer 18

Avoid weight gain

Exercise

Question 19

Where does breast cancer metastasize to?

Answer 19

Bone

Lung/liver

Brain

Question 20

How does fibrocytic disease present?

Answer 20

Lumpy, painful breast

Question 21

What types of biopsies are there for breast Ca?

Answer 21

Fine needle aspirate

Core biopsy

Incisional biopsy

Excisional biopsy

Question 22

What types of cancers on FHx that increase the risk of breast cancer?

Answer 22

Breast cancer

Ovarian cancer

Prostate

Familial gastric cancer

Question 23

What investigations are helpful in breast Ca?

Answer 23

Ultrasound

Mammography

Biopsy

Question 24

What is the most likely diagnosis of a new lump in a young woman?

Answer 24

Fibroadenoma

Cyst

Fibrocyst tissue

Cancer

Question 25

What is Paget’s disease of the nipple?

Answer 25

DCIS involving the nipple - extending into the epidermis

Question 26

When is total mastectomy indicated?

Answer 26

When the patient is a carrier of a high risk gene - eg BRCA1 or 2

Or when wide local excision and radiotherapy is contraindicated