Breast

Question 1

What is the actual name for Herceptin?

Answer 1

Trastuzumab

Question 2

What is the lifetime incidence of breast cancer?

Answer 2

1 in 8

Question 3

What percentage of breast cancer is related to hereditary predisposition?

Answer 3

10

Question 4

What hereditary predispositions to breast cancer exist?

Answer 4

BRCA 1 and 2

Li Fraumeni Syndrome

Question 5

What is the most common type of breast Ca?

Answer 5

Invasive ductal carcinoma

Question 6

Where does breast Ca commonly met to?

Answer 6

Bone
Lung
Pleura
Adrenal 
Brain

Question 7

What are the risk factors for breast Ca?

Answer 7

Female 
Increasing age
Early menarche
Late menopause
Late 1st pregnancy 
Nulliparity 
HRT 
Family Hx
Hereditary - BRCA1/2 genes

Question 8

What is the treatment for early breast Ca?

Answer 8

Wide local excision

Sentinel LN biopsy

Question 9

What factors increase the risk of breast Ca recurrence?

Answer 9

Tumour >1cm
Presence of disease in axillary LNs
ER negative

Question 10

How do aromatase inhibitors work?

Answer 10

Inhibit aromatase which inhibits peripheral oestrogen production in adipose tissue. This is the main source of oestrogen in post-menopausal women therefore there is significantly less oestrogen to drive tumour growth.

Question 11

What forms the apex of the axilla?

Answer 11

Lateral border of first rib
Superior border of scapula
Posterior border or clavicle

Question 12

What forms the lateral and medial borders of the axilla?

Answer 12

Lateral - intertubecular groove of humerus

Medial - serratus anterior and thoracic wall

Question 13

What forms the anterior and posterior borders of the axilla?

Answer 13

Anterior - pec Major, pec minor and subclavius muscle

Posterior - subscapularis, teres major and latissimus dorsi

Question 14

List some drugs that can cause gynaecomastia

Answer 14

Anti androgens eg. Finasteride
Spironolactone
Anti-retrovirals
Oestrogen 
Cimetidine
Ketoconazole 
Amlodipine and verapamil 
PPIs

Question 15

Which cancers are most likely to met to the breast?

Answer 15

Lymphoma/leukaemia
Melanoma
Sarcoma
Prostate
Lung
Gastric 
Ovarian

Question 16

How does COCP affect the risk of ovarian cancer?

Answer 16

Decreases the risk

Question 17

How does HRT affect the risk of ovarian cancer?

Answer 17

Small increase in risk

Question 18

How does null/low parity affect the risk of ovarian cancer?

Answer 18

Increased risk

Question 19

How does COCP affect the risk of breast cancer?

Answer 19

No effect

Question 20

How does HRT affect the risk of breast cancer?

Answer 20

Increased

Question 21

How does null or low parity affect the risk of breast Ca?

Answer 21

Increased

Question 22

How does COCP affect the risk of endometrial cancer?

Answer 22

Decrease

Question 23

How does HRT affect the risk of endometrial cancer?

Answer 23

Increased if HRT is oestrogen only

Question 24

How does null or low parity affect the risk of endometrial cancer?

Answer 24

Increased

Question 25

Which imaging modality is best for lobular carcinoma?

Answer 25

MRI

Question 26

Where is the oestrogen receptor located?

Answer 26

Nucleus

Question 27

Where is the HER2 receptor located?

Answer 27

Cell surface

Question 28

What is letrozole?

Answer 28

Selective aromatase inhibitor to decrease oestrogen production in peripheral tissue Can only use in post-menopausal women as this is the main oestrogen supply

Question 29

What percentage of breast cancer is triple negative?

Answer 29

15-20

Question 30

What are the symptoms of inflammatory breast cancer?

Answer 30

Redness, swelling, pain Pitted skin Nipple discharge Hot breast

Question 31

What is Paget’s disease of the breast?

Answer 31

Red, scaly rash like eczema on the skin of nipple | DCIS or invasive carcinoma

Question 32

What are the 2 views used on a mammogram?

Answer 32

Cranio-caudal | Mediolateral oblique

Question 33

30-50% of cancers appear as what on the mammogram?

Answer 33

Microcalcifications

Question 34

What is denosumab?

Answer 34

Human monoclonal antibody used for treatment of osteoporosis, mets to bone and bone tumours Given by SC injection

Question 35

How does denosumab work?

Answer 35

Monoclonal antibody that targets RANKL protein needed for the new osteoclasts to be made and function

Question 36

What are the side effects of denosumab?

Answer 36

Muscle spasms and cramps Bone and muscle pain Osteonecrosis of the jaw

Question 37

What is pablociclib?

Answer 37

Targeted biological therapy that is taken alongside endocrine therapy in breast cancer Offered to patients with ER+ and HER- locally advanced or secondary breast cancer

Question 38

What is duct ectasia?

Answer 38

Benign breast condition caused by normal shortening and widening of the ducts behind the nipple. Sometimes a fluid is produced

Question 39

What tumour markers do we look for in breast Ca?

Answer 39

CA 153 | BRCA 1/2

Question 40

What are the breast red flags?

Answer 40

``` Breast lump +/- pain Nipple discharge Nipple retraction Breast skin changes Axilla lump ```

Question 41

Describe T staging of breast

Answer 41

Is in situ 1: <2cm 2: 2-5cm 3: >5cm 4: through the chest wall or skin