Breast

Question 1

fibroadenoma

Answer 1

conservative
watch and wait
surgery if big/causing distress

Question 2

fibroadenosis

Answer 2

excluded breast carcinoma
aspirate + test fluid if unusual looking
surgical excision if localised pain
bromocriptine for diffuse pain

Question 3

Cyst

Answer 3

watch and wait
aspirate if painful
send fluid if dodgy looking

Question 4

stage 1

Answer 4

o Confined to breast, no nodes, mobile

Question 5

stage 2

Answer 5

o Growth confined to breast, mobile, lymph nodes in ipsilateral axilla

Question 6

stage 3

Answer 6

o Tumour fixed to muscle (but not chest wall)
o Ipsilateral lymph nodes may be matted or fixed
o Skin involvement larger than tumour

Question 7

stage 4

Answer 7

o Complete fixation of tumour to chest wall

o Distant metastases

Question 8

T

Answer 8

 T1 - <2cm
 T2 – 2-5cm
 T3 - >5cm
 T4 – fixed to chest wall or peu d’orange

Question 9

N

Answer 9

 N1 – mobile ipsilateral nodes

 N2 – Fixed nodes

Question 10

M

Answer 10

 M1 – distant mets (any number)

Question 11

Stage 1/2

Answer 11

WLE/mastectomy
radiotherapy after all WLE if invasive
ask patient re reconstruction

Question 12

Radiotherapy

Answer 12

o Decreases risk of recurrence to <10% at 10 years – corresponding increase in survival
o Axillary radiotherapy used if sentinel node biopsy comes back positive and clearance not performed
o SEs include pneumonitis, pericarditis and rib fractures

Question 13

Chemo

Answer 13

something + CMF

Question 14

Endocrine agents

Answer 14

ER+ve - tamoxifen only for 5 years, if pre menopausal.

if post, then GnRH analogues/ovarian ablation (aromatase inhibitors)