Breast Cancer

Question 1

What is the triple assessment for breast cancer?

Answer 1

1) Breast examination
2) Imaging - US/mammography (XR)
3) Core biopsy (histology/cytology)

Question 2

How do you diagnose breast cancer?

Answer 2

Biopsy

Question 3

What targeted treatment can you use if a pt is HER2 positive?

Answer 3

Herceptin (trastuzumab) ± pertuzumab

Question 4

What % of breast cancer patients are HER2 positive?

Answer 4

30%

Question 5

What targeted hormone therapy can you use if a pt is ER/PR positive?

Answer 5

• Tamoxifen - premenopausal women

- Aromatase inhibitors (anastrozole + letrozole) - postmenopausal women

Question 6

What type of medication is tamoxifen?

Answer 6

Selective Oestrogen Receptor Modulator (SERM)

Question 7

What do aromatase inhibitors do?

Answer 7

Reduce peripheral oestrogen synthesis

Question 8

What imaging do you do for staging breast cancer?

Answer 8

• MRI
• PET-CT
• FDG-PET

Question 9

What other investigation can you do in breast cancer?

Answer 9

Genetic tests

Question 10

What is a common treatment-related complication of breast cancer?

Answer 10

Lymphoedema - swollen arm

Question 11

How do you curatively treat breast cancer?

Answer 11

• Surgery - WLE (wide local excision)/mastectomy
• Radio - adjuvant
• Chemo - Neo/adjuvant - anthracycline
  ± Targeted herceptin (HER2+)/hormone therapy (PR/ER_)

Question 12

Is hormone therapy adjuvant or neoadjuvant?

Answer 12

Adjuvant

Question 13

What might be the only sign present in early breast cancer?

Answer 13

Breast/axillary mass/lump (otherwise asymptomatic)

Question 14

What are breast symptoms in breast cancer?

Answer 14

• Skin changes - puckering/deformity/dimpling, erythema, peau d’orange, nipple ulcer/eczema
• Nipple changes - discharge, inversion

Question 15

What are risk factors for breast cancer?

Answer 15

• Early menarche/late menopause
• HRT/COCP
• Nulliparity
• Genetics (BRCA, TP53)
• FH
• Alcohol, obesity
• XR, RT
• Not breast feeding
• Caucasian

Question 16

What % of all breast cancer cases are due to genetics?

Answer 16

25%

Question 17

What are the 2 classifications of breast cancer?

Answer 17

• In-situ vs invasive

- Ductal vs lobular

Question 18

What are the 4 types of breast cancer in decreasing order of how common they are?

Answer 18

1) IDC (invasive ductal carcinoma)
2) ILC (invasive lobular carcinoma)
3) DCIS (ductal carcinoma in situ)
4) LCIS (lobular carcinoma in-situ)

Question 19

When would you do an urgent referral for breast cancer?

Answer 19

• > 30 yrs + unexplained lump

- >50 yrs + symptoms/change to a nipple

Question 20

What procedure is done during breast cancer surgery?

Answer 20

Sentinel lymph node biopsy (SLNB)

Question 21

What medication is used when cancer is resistant to tamoxifen?

Answer 21

Fulvestrant (full antagonist)

Question 22

How is screening carried out for breast cancer?

Answer 22

Mammogram every 3 years for those aged 50-70

Question 23

When does breast cancer start to often cause pain?

Answer 23

When it spreads

Question 24

What is the most common cancer in women?

Answer 24

Breast cancer

Question 25

Where does breast cancer typically metastasise?

Answer 25

• Brain
• Bone
• Liver
• Lung