Breast

Question 1

What is a common symptom associated with breast pain?

Answer 1

Breast pain may be associated with breast swelling or nodularity.

Question 2

What factors may exacerbate breast pain?

Answer 2

• Perimenopause
• Exogenous hormone intake

Question 3

What are some considerations in assessing breast pain?

Answer 3

• Correct fitting of bra
• Weight
• Exercise
• Intercurrent life events (stressors)

Question 4

What is a potential treatment for breast pain?

Answer 4

• Evening primrose oil
• Soya milk (Phytoestrogens)
• Reduce fat intake

Question 5

What medications may help with breast pain?

Answer 5

• Tamoxifen
• Danazol
• Zoladex
• Bromocriptine
  (None of these are licensed but can be used if breast pain for more than six months)

Question 6

What does triple assessment for breast lumps include?

Answer 6

• Mammography
• Ultrasound
• Cytology / Histology

Question 7

What types of breast lumps are considered benign?

Answer 7

• Fibroadenoma
• Cysts

Question 8

What is a fibroadenoma?

Answer 8

A discrete, rubbery mass made of stromal tissue and proliferatory epithelium.

Question 9

What is a phyllodes tumor?

Answer 9

A rare fibroepithelial tumor that needs wide local excision. Can be confused with fibroadenoma in older women

Question 10

What is sclerosing adenosis?

Answer 10

A palpable mass with pain, characterized by stromal sclerosis and microcalcification.

Question 11

What are non-ANDI breast lumps?

Answer 11

• Breast infections (lactational and non-lactational)
• Lipomas
• Fat necrosis
• Montgomery’s gland cysts
• Mondor’s disease
• Gynaecomastia in men

Question 12

What features are assessed in a malignant breast lump?

Answer 12

• Size
• Irregular edge
• Fixity
• Consistency
• Lymph node status
• Peau d’Orange

Question 13

What are the categories in triple assessment reporting for breast lumps?

Answer 13

• 1 Normal (or Cytology Insufficient)
• 2 Benign
• 3 Indeterminate probably benign
• 4 Suspicious of cancer
• 5 Cancer

Question 14

What is the most common type of breast cancer?

Answer 14

Infiltrating ductal carcinoma.

Question 15

What does ANDI mean?

Answer 15

Aberrations of normal breast development and involution

Question 16

What is Mondor’s disease?

Answer 16

Thrombophlebitis of superficial veins of the breast

Question 17

What are Montgomery’s glands?

Answer 17

Small perioareloar glands around the nipplee which may develop a cyst

Question 18

What type of women can aromatase inhibitors only be used in and why?

Answer 18

post menopausal women as they inhibit productions of estrogen in the periphery

Question 19

What type of medication is tamoxifen?

Answer 19

An estrogen receptor blocker

Question 20

How often do you get invited for mammography?

Answer 20

Evert 3 years between 50-70

Question 20

Name three genes that genetically predispose you to breast cancer?

Answer 20

BRCA1, BRCA 2 and PALB2

Question 21

What are the T classifications for breast cancer?

Answer 21

Tis - ductal carcinoma in situ
T1 <2cm
T2 >2-<5cm
T3 >5cm
T4 invasion into chest wall, skin, inflammatory

Question 22

What are the N staging classifications for breast cancer?

Answer 22

N1 1-3 axillary lymph nodes
N2 - 4-9 axillary lymph nodes
N3 - 10 or more axillary lymph nodes

Question 23

What does triple negative breast cancer refer to?

Answer 23

Negative for both estrogen and progesterone receptor and HER2

Question 24

Which subtype of breast cancer has best and worst outcomes?

Answer 24

Best - HR pos, Her neg Worst - triple neg

Question 25

What three tissue flaps are often used for breast reconstruction?

Answer 25

Latissimus dorsi, transverse rectus abdominis, deep inferior epigastric perforator

Question 26

How does doxorubicin work for breast cancer?

Answer 26

It stops growth by blocking topo isomerase 2

Question 27

How does paclitaxel work for breast cancer?

Answer 27

Binds to microtubules preventing depolymerisation

Question 28

How do PD-1 and PD-L1 inhibitors work?

Answer 28

They work by blocking the interaction between the PD-1 protein on T cells and the PD-L1 protein on cancer cells, essentially "reactivating" the immune system to attack and kill cancer cells; they are considered "immune checkpoint inhibitors"

Question 29

What does Alpelisib work on?

Answer 29

It blocks the activity of the PI3K-alpha protein which is often mutated in cancer and signals for cells to multiply

Question 30

What does everolimus work on?

Answer 30

Inhibits mTOR which is a kinase that controls cell proliferation, survival, and angiogenesis

Question 31

What type of breast cancers are trastuzumab emtansine used for?

Answer 31

HER2 positive

Question 32

What does trastuzumab emtansine contain?

Answer 32

The monoclonal antibody Herceptin covalently linked to the cytotoxic agent DM1

Question 33

Adjuvant hormonal therapy for ER +ve breast cancer in post-menopausal women?

Answer 33

Anastrozole (aromatase inhibitor) bc the majority of estrogen production occurs via aromatisation process in post-menopausal women