Breast

Question 1

Discrete, mobile painless lump

Answer 1

Fibroadenoma

Question 2

What breast condition is known as a ‘breast mouse’?

Answer 2

Fibroadenoma

Question 3

How is a fibroadenoma treated?

Answer 3

Watch and wait - majority will get smaller

Can do lumpectomy if >3cm

Question 4

‘Lumpy tender breasts, especially just before period is due’

Answer 4

Fibrocystic breast disease

Question 5

How is fibrocystic breast disease managed?

Answer 5

Reassurance, Analgesia, Good fitting bra, Warm compresses, Evening Primrose Oil

Question 6

‘Painful hot red swelling in breast’

Answer 6

Breast abscess

Question 7

Who normally get breast abscesses?

Answer 7

Breastfeeding women

Question 8

What organism commonly causes breast abscesses?

Answer 8

Staph Aureus

Question 9

How are breast abscesses treated?

Answer 9

Antibiotics +/- drainage

Question 10

What breast condition commonly presents as ‘bloody/serous nipple discharge’?

Answer 10

Duct papilloma

Question 11

What breast condition presents as a tender lump and green nipple discharge?

Answer 11

Duct ectasia

Question 12

What predisposes to mammary duct ectasia?

Answer 12

Smokers

Peri-menopause

Question 13

What breast condition presents as a hard irregular lump with a history of trauma to the area?

Answer 13

Fat Necrosis

Question 14

What condition can mimic breast cancer on mammogram?

Answer 14

Sclerosing adenosis

Question 15

What are some hormonal causes of gynaecomastia?

Answer 15

Teratomas (BHCG)
Adrenal tumours (oestrogens)
Acromegaly (GH)
Prolactinoma (PRL)
Cushings (cortisol)

Question 16

What are some metabolic causes of gynaecomastia?

Answer 16

Hyperthyroidism
Primary Biliary Cirrhosis
Cirrhosis
Alcoholism

Question 17

What are some drug causes of gynaecomastia?

Answer 17

Digoxin
Cannabis
Spironolactone
Diamorphine
Vincristine

Question 18

How does breast cancer present?

Answer 18

Hard, irregular fixed breast lump
May or may not be mastalgia
May be nipple discharge/inversion
Skin changes (tethering, orange peel)

Question 19

What are the 3 aspects of the triple assessment?

Answer 19

Clinical history and examination
Imaging
Biopsy

Question 20

What imaging assessment is done?

Answer 20

Over 35s - mammogram +/- USS

Under 35s and men - USS (more dense breast tissue)

Question 21

What is the commonest type of breast cancer?

Answer 21

Ductal

Question 22

What is the cancer referred to if it has no spread further than local tissue?

Answer 22

‘In-Situ’ - e.g. ductal carcinoma in situ (DCIS)

Question 23

What is Paget’s disease?

Answer 23

Eczematoid change of the nipple, which often signifies an underlying ductal malignancy

Question 24

What hormone receptors should be tested in someone diagnosed with breast cancer?

Answer 24

E2 (oestrogen)
Her2
Progesterone

Question 25

What should women under 50 with triple negative breast cancer be offered?

Answer 25

BRCA screening

Question 26

What are some risk factors for breast cancer?

Answer 26

BRCA, family history, early menarche, late menopause, nulliparity, HRT, COCP, past breast cancer, obesity (oestrogen excesses basically)

Question 27

Where does breast cancer commonly metastasise to?

Answer 27

``` Local = chest wall, skin, nipple Distant = collateral breast, liver, lung, brain, bone ```

Question 28

What are the 3 main surgical stages of treatment for breast cancer?

Answer 28

Mastectomy/WLE Reconstruction Axillary surgery

Question 29

When is a mastectomy performed rather than a WLE?

Answer 29

Multifocal tumours Central tumours Large tumours in small breasts DCIS >4cm

Question 30

When is radiotherapy usually given for breast cancer?

Answer 30

Adjuvantly (after all WLEs and some mastectomies)

Question 31

When is chemotherapy given in breast cancer?

Answer 31

Can be given neoadjuvantly or adjuvantly. | Generally works better in younger women or those who have more adverse prognostic factors

Question 32

What treatment should pre and perimenopausal women with E2+ve cancer receive?

Answer 32

Tamoxifen

Question 33

What treatment should post menopausal women with E2+ve cancer receive?

Answer 33

Letrozole

Question 34

What should women with Her2+ve cancer receive?

Answer 34

Transtuzumab (Herceptin)

Question 35

Who gets breast screening and how often?

Answer 35

Women aged 50-70 every 3 years

Question 36

How is breast screening performed?

Answer 36

Mammogram