Breast

Question 1

What anti-oestrogen drugs are there for ER+ breast cancers?

Answer 1

SERMs like tamoxifen (pre)

Aromatises inhibitors like anastrazole (post menopausal).

Question 2

Side effects of anastrozole

Answer 2

Osteoporosis (dexa before and during), hot flushes.

Question 3

Side effects of tamoxifen

Answer 3

Periods: amenorrhea or vaginal bleeding.
VTE
Hot flushes
Endometrial cancer.

Question 4

Who and how does fibroadenoma present?

Answer 4

Under 30, discrete non-tender, highly mobile lump.

Develop from a whole lobule. Can naturally get smaller.

Question 5

Who and how does fibroadenosis/fibrocystic disease present?

Answer 5

Middle aged. Lumpy breasts. Potentially painful. Sx worse prior to period.

Question 6

When might chemo be used?

Answer 6

After surgery, or neo-adjuvant to downsize the primary so breast conserving surgery may be possible instead of mastectomy.

Question 7

How does a cyst present?

Mx

Answer 7

Smooth discrete lump, possibly fluctuant. Small increase in ca risk if young.
Aspirate. Biopsy if blood filled or keep refilling.

Question 8

Fibroadenoma mx

Answer 8

Surgical excision if > 3cm

Question 9

When is radiotherapy recommended?

Answer 9

Whole breast radio is recommended following wide local excision.
Offered following mastectomy if T3/4 or 4 +ve nodes.

Question 10

Sx of intraductal pappiloma

Answer 10

Single duct affected. Discharge is clear or blood stained. No relation to malignancy.

Question 11

Who and how does duct ectasia present?

Answer 11

Over 50s.

Thick green discharge from one or multiple ducts. Seen in 25% of normal breasts.