Breast

Question 1

What medication is recommended for oestrogen-receptor positive breast cancer in post-menopausal women ONLY?

Answer 1

Anastrozole

Question 2

How does Anastrozole work?

Answer 2

Aromatase inhibitor

It inhibits the enzyme aromatase and hence reducing the conversion of androgens into oestrogens in peripheral tissues. This is the main source of oestrogen production in postmenopausal women, compared to pre-menopausal women, where the main source of oestrogen is the ovaries.

Question 3

What medication is used for women with oestrogen positive Breast Cancer who are premenopausal or post menopausal?

Answer 3

Tamoxifen

Question 4

How does Tamoxifen work?

Answer 4

Its a selective oestrogen receptor modulator, meaning it antagonises oestrogen receptors on the breast cancer cells and blocks the anabolic effects of oestrogen.

Question 5

What is the treatment for lactational mastitis?

Answer 5

1st - Continue breastfeeding

2nd - PO Flucloxacillin for 10 days

Question 6

What is the most common organism in Lactational Mastitis?

Answer 6

Staph Aureus

Question 7

How does Mastitis present?

Answer 7

Redness
Tender
Warm to the touch
Swelling

Question 8

What are the sentinel lymph nodes?

Answer 8

The first few lymph nodes a cancer can spread to

Question 9

What is the purpose of a sentinel lymph node biopsy?

Answer 9

To see if the cancer has spread from the initial location

Question 10

How do you do a sentinel lymph node biopsy?

Answer 10

A radioactive substance and/or blue dye is injected near the tumour. During the surgery a probe is used to locate the lymph nodes containing the radioactive substance so they can be excised.

Question 11

What is an intra-ductal papilloma?

Answer 11

A benign tumour of fibrovascular tissue that develops within the lactic ducts.

Can grow to become painful and leak blood-stained discharge

Question 12

Above what age does a patient with a breast lump require urgent cancer referral to the breast team?

Answer 12

All women > 30 with unexplained breast lump

Question 13

What is duct ectasia?

Answer 13

Shortening and widening of the terminal breast ducts around the nipple.

Presents as a benign breast lump with thick- green nipple discharge

Occurs after breast involution (around the time of menopause)

Question 14

What is breast involution?

Answer 14

Process by which the breast epithelial tissue is gradually lost with aging of the mammary gland.

Mammary glands are lost as they are now redundant

Question 15

What specific risk should patients undergoing a axillary node clearance be aware of?

Answer 15

Lymphedema causing functional arm impairment

Question 16

What are the types of breast malignancy?

Answer 16

Ductal carcinoma in situ
Invasive ductal carcinoma

Lobular carcinoma in situ
Invasive lobular carcinoma

Mucinous carcinoma

Paget’s disease of the nipple

Question 17

How do you distinguish between ductal and lobular carcinoma on a mammogram?

Answer 17

Calcification is seen more in ductal than lobular - hence it is more visible on mammogram

Question 18

What is the most common type of breast cancer?

Answer 18

Invasive ductal carcinomas

Question 19

What are the typical treatments for breast cancer?

Answer 19

Wide local excision
Mastectomy

Question 20

What are the indications for a Mastectomy?

Answer 20

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
Patient Choice

Question 21

What are indications for a Wide Local Excision?

Answer 21

Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
Patient Choice

Question 22

What drug is used for patients who are HER2 postive?

Answer 22

Herceptin

Question 23

What type of chemotherapy is used in patients who are node negative that require it?

Answer 23

FEC chemotherapy

Question 24

What type of chemotherapy is used for patients who are node positive?

Answer 24

FEC-D chemotherapy

Question 25

What are the treatments available for duct ectasia?

Answer 25

None needed - reassurance Microdochectomy - if condition is bothering patient and they are younger Total duct excision - if symptomatic and bothering the patient and they are older

Question 26

What is a microdochectomy?

Answer 26

A procedure to remove one or more of the milk ducts from your breast

Question 27

What is Total Duct excision?

Answer 27

Removal of a disc of duct tissue from behind the nipple

Question 28

What is a side effect of Aromatase inhibitors?

Answer 28

Osteoporosis

Question 29

What are side effects of SERMs ( Selective Oestrogen Receptor Modulators) i.e Tamoxifen?

Answer 29

Amenorrhoea Endometrial cancer Vaginal bleeding VTE

Question 30

What is another name for Herceptin?

Answer 30

Trastuzumab

Question 31

What is the appropriate management for fibroadenomas that are >3cm?

Answer 31

Surgical excision biopsy

Question 32

What would be a reasonable indication for surgical excision if a fibroadenoma was <3cm ?

Answer 32

Cosmesis ( Aesthetic/ Body image issues)

Question 33

What is a Phyllodes tumour?

Answer 33

Rare breast tumour that starts in the connective tissue ( fatty tissue, ligaments around area) rather that the ducts or lobules. Most are benign A fibroepithelial lesion ( stroma and epithelial components )

Question 34

What is Paget's disease of the nipple?

Answer 34

Reddening Thickening May resemble eczema ( itchy, crusty) Inverted nipple Affects nipple first then areola It is associated with underlying breast malignancy

Question 35

How does eczema spread on the nipple?

Answer 35

Areolar then to the nipple

Question 36

What is FIbroadenosis?

Answer 36

Fibrocystic breast disease Most common in middle-aged women 'Lumpy' breasts which may be painful. Symptoms may worsen prior to menstruation

Question 37

What is Duct Papilloma?

Answer 37

Local areas of epithelial proliferation in large mammary ducts May present with blood stained discharge

Question 38

What is Fat necrosis?

Answer 38

More common in obese women with large breasts May follow trivial or unnoticed trauma Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump

Question 39

What is a breast abscess?

Answer 39

More common in lactating women Red, hot tender swelling Can result from mastitis

Question 40

What is a key reason for Neo-Adjuvant Chemotherapy?

Answer 40

Try to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy. Reduce peri-operative risks Better cosmetic outcome

Question 41

What do Breast Cysts show on mammogram?

Answer 41

Halo appearance

Question 42

What treatment is required following a wide local excision?

Answer 42

Whole breast radiotherapy Then Anastrozole, Tamoxifen or Herceptin can be used as maintenance therapy following the radiotherapy

Question 43

What sign on ultrasound indicates extracapsular breast implant rupture?

Answer 43

Snowstorm sign of axillary lymph nodes Leakage of silicone is drained by lymphatic system

Question 44

Who is breast cancer screening offered to?

Answer 44

All women age 50-70 every 3 years

Question 45

A 52-year-old woman with early-stage breast cancer is undergoing breast-conserving surgery. During the procedure, the sentinel lymph node biopsy reveals two nodes with micrometastatic involvement. There are no clinical signs of further axillary disease, and the patient is scheduled for adjuvant radiotherapy. Considering these findings, what is the most appropriate next step?

Answer 45

Close without additional axillary surgery Micrometastases or 2 micrometastases on sentinel lymph node

Question 46

What is Triple Negative breast cancer?

Answer 46

A type of breast cancer that does not have any of the receptors ( Oestrogen, Progesterone, HER2 )

Question 47

Who is Periductal Mastitis common in?

Answer 47

Smokers

Question 48

What age is screening with a mammogram as opposed to an US used?

Answer 48

Over 35 - more dense breast tissue

Question 49

What nerve injury can be a complication of axillary node clearance?

Answer 49

Brachial Plexus injury

Question 50

What treatment is recommended for Triple Negative breast cancer?

Answer 50

Aggressive Neoadjuvant chemo Lumpectomy/Mastectomy Adjuvant chemo/radiation

Question 51

What is cyclical mastalgia?

Answer 51

Breast pain associated with menstrual cycle

Question 52

What is the treatment for Fat Necrosis?

Answer 52

Conservative as in most cases the body will break it down over time Safety net - gets bigger or other breast changes come back

Question 53

What is a radial scar?

Answer 53

A radial scar is a benign breast condition which can mimic a breast carcinoma. It describes idiopathic sclerosing hyperplasia of the breast ducts. Patients are typically asymptomatic, and it is usually picked up incidentally. A mammogram typically shows a star or rosette-shaped lesion with a translucent centre.

Question 54

What should be monitored before and during usage of Herceptin?

Answer 54

Cardiac function - causes cardiotoxicity

Question 55

What is a Galactocele?

Answer 55

A breast lesion most commonly occurring in women who have recently ceased breastfeeding. Milk builds up and stagnates within the lactiferous ducts, leading to the formation of a mobile, cyst-like lesion which can be tender.

Question 56

What are risk factors for breast cancer?

Answer 56

Increased hormone exposure (Early menarche or late menopause Nulliparity or late first pregnancy Oral contraceptives or Hormonal Replacement Therapy) BRCA1/BRCA2 Older White Obesity Alcohol/Smoking Family Hx

Question 57

What is a Seroma?

Answer 57

A localised accumulation of fluid beneath the skin surface

Question 58

What is recommended in any woman who undergoes a WLE?

Answer 58

Adjuvant radiotherapy If ER+ , Tamoxifen or Anastrozole (Post-Menopasual) would also be given If HER2 + , Herceptin would also be given