breast

Question 1

3 receptor types in breast cancer

Answer 1

oestrogen receptors (ER)
progesterone receptors (PR)
human epidermal growth factor (HER2)

Question 2

most common form of breast tumour?

Answer 2

ductal carcinoma

Question 3

features inflammatory breast cancer

Answer 3

presents similarly to breast abscess or mastitis
peau d’orange + swollen, warm, tender
does not respond to abx
bad prognosis

Question 4

features paget’s disease of nipple

Answer 4

represents spread to nipple
like eczema - erythematous, scaly rash (starts at nipple and spreads to areolar (opposite in eczema))
could represent DCIS or invasive breast cancer

Question 5

how often is screening for breast cancer + what ages

Answer 5

every 3 years for 50-70 years old

Question 6

breast cancer family history features which indicate a referral

Answer 6

first degree relative with breast cancer <40
male first degree relative with breast cancer
first degree relative with bilateral breast cancer <50
two first degree, or one first + one second with breast cancer
one first/second degree with breast + one first/second with ovarian

Question 7

appropriate breast cancer imaging in <30

Answer 7

ultrasound - distinguish solid lumps from cystic lumps

Question 8

appropriate breast cancer imaging in older women

Answer 8

mammogram

Question 9

common metastases in breast

Answer 9

liver
lung
brain
bones

Question 10

indications urgent referral breast cancer

Answer 10

> 30 + breast mass
50 + nipple discharge, retraction

Question 11

features phyllodes tumour

Answer 11

grow in leaf like pattern
majority benign

Question 12

hormonal management ER positive tumours

Answer 12

pre-menopausal = tamoxifen (oestrogen receptor antagonist)
postmenopausal = anastrozole (aromatase inhibitor)

Question 13

hormonal management HER2 positive tumours

Answer 13

trastuzumab

Question 14

which breast cancer patients are offered radiotherapy

Answer 14

wide local excision - offered adjuvant radio
also mastectomy patients T3 and up

Question 15

pathophysiology tamoxifen

Answer 15

ER inhibitor or stimulator depending on site
inhibits in breast, stimulates in uterus
increase risk endometrial cancer

Question 16

presentation fibrocystic breast changes

Answer 16

multiple smooth, well defined mobile lumps in breast
commonly in upper outer quadrant

Question 17

indications for antibiotics in mastitis

Answer 17

systemically unwell
nipple fissure
symptoms don’t improve after 12-24 hours milk removal

Question 18

complication mastitis

Answer 18

breast abscess

Question 19

presentation duct ectasia

Answer 19

nipple retraction
sometimes creamy nipple discharge

Question 20

management fibroadenoma

Answer 20

if >3cm - surgical excision

Question 21

cause fat necrosis to breast

Answer 21

obese patients
following trauma

Question 22

abx in mastitis

Answer 22

fluclox for 10 days

Question 23

adverse effects tamoxifen

Answer 23

menstrual disturbance
hot flushes
VTE
endometrial cancer

Question 24

side effects aromatase inhibitors

Answer 24

osteoporosis
flushes
joint + muscle pain
insomnia

Question 25

moa anastrozole

Answer 25

inhibits conversion androgens to oestrogen

Question 26

difference pagets disease of nipple and eczema of nipple

Answer 26

Pagets will usually affect the nipple first and then spread to the areolar area opposite in eczema

Question 27

what is comedo necrosis

Answer 27

feature of high grade ductal carcinoma in situ (DCIS)

Question 28

can family members act as chaperones in intimate exams?

Answer 28

no

Question 29

features intraductal papilloma

Answer 29

blood stained discharge from nipple benign tumour within lactiferous duct

Question 30

what size DCIS indicates a mastectomy?

Answer 30

>4cm

Question 31

treatment troublesome duct ectasia

Answer 31

young -microdochectomy older - total duct excision