Breast Cancer

Question 1

examples of miscellaneous tumours that arise in the breast

Answer 1

angiosarcoma
lymphoma
metastatic (carcinomas, melanomas, leiomyosarcomas)

Question 2

precursor lesions

Answer 2

1. ductal carcinoma in-situ (DCIS)

2. lobular carcinoma in-situ (LCIS)

Question 3

what is ductal carcinoma in-situ of the nipple?

Answer 3

Paget’s disease of the nipple

Question 4

what is in-situ carcinoma confined within?

Answer 4

basement membrane of acini and dcuts

Question 5

management of carcinoma in-situ

Answer 5

excision
vacuum biopsy
adjuvant radiotherapy
chemoprevention (endocrine therapy)
follow up

Question 6

what is microinvasive carcinoma?

Answer 6

DCIS with invasion of <1mm

Question 7

what is invasive carcinoma?

Answer 7

cells have breached the basement membrane

Question 8

risk factors for breast cancer

Answer 8

age
reproductive history (menarche, parity, breastfeeding, menopause)
hormones (OCP, HRT)
previous
lifestyle (physical activity, NSAIDs lower risk)
genetics

Question 9

cancer syndromes/ genetics for breast cancer

Answer 9

BRCA1 and 2
TP53= Li Fraumeni syndrome
PTEN= Cowden’s syndrome
Peutz-Jegher’s syndrome
ATM= ataxia telangiectasia

Question 10

how is breast cancer classified?

Answer 10

based on receptor

Question 11

breast cancer receptor classification

Answer 11

ER
PgR
HER2
triple negative

Question 12

most common breast cancer

Answer 12

ductal carcinoma

Question 13

what does ER expression mean in terms of therapy/ management

Answer 13

anti-oestrogen therapies work

Question 14

examples of anti-oestrogen therapies

Answer 14

oophorectomy
tamoxifen
aromatase inhibitors e.g. letrozole
GnRH antagonists e.g. goserilin

Question 15

presentation of breast cancer

Answer 15

lump
blood/discharge from nipple
skin changes
texture changes
colour change

Question 16

diagnosis (triple assessment)

Answer 16

1. clinical= history + examination
2. imaging= mammography or USS
3. pathology

Question 17

how to check receptors?

Answer 17

immunohistochemistry

HER2 FISH

Question 18

prognostic indices

Answer 18

• Nottingham prognostic index= histopathology only
• Adjuvant! Online= histopathology + ER + clinical
• NHS PREDICT= histopathology + ER + clinical + HER2 + mode of detection

Question 19

local management of breast cancer

Answer 19

1. surgery

2. radiotherapy

Question 20

surgery options in breast cancer

Answer 20

• breast conservation options

- mastectomy

Question 21

breast conservation surgery options

Answer 21

• wide local excision

- image guided local excision

Question 22

does breast conserving surgery have better outcomes?

Answer 22

the same survival as mastectomy if radiotherapy used as adjuvant

Question 23

oncoplastic breast conservation surgeries

Answer 23

therapeutic reduction mammoplasty
therapeutic mastopexy
volume replacement

Question 24

mastectomy otions

Answer 24

• traditional transverse= entire breast + skin + axillary nodes
• skin sparing + reconstruction

Question 25

reconstruction options

Answer 25

``` external prosthesis implants and flaps nipple reconstruction lipo-modelling contralateral symmetrising ```

Question 26

how is radiotherapy used around breast cancer?

Answer 26

started within 12 weeks of surgery

Question 27

side effects of radiotherapy

Answer 27

``` fatigue skin reactions hair loss breast changes telangiectasia lymphodema/ swelling heart vessel damage fibrosis ```

Question 28

when is whole breast radiotherapy not indicated?

Answer 28

>70 ductal pathology ER+ve HER2 -ve

Question 29

systemic breast cancer therapies

Answer 29

chemotherapy hormonal therapy targeted therapies

Question 30

when is neoadjuvant chemotherapy indicated?

Answer 30

HER2 positive with trastuzumab downsizing tumour check response locally advanced

Question 31

side effects of chemotherapy

Answer 31

``` fatigue risk of infection (neutropenia) N&V alopecia (anthracyclines + taxanes) mucositis diarrhoea, constipation renal neurotoxicity infertility ```

Question 32

what are hormonal therapies?

Answer 32

oestrogen blockers

Question 33

examples of hormonal therapies

Answer 33

- aromatase inhibitors - tamoxifen - GnRH analogues

Question 34

examples of aromatase inhibitors

Answer 34

letrozole | anastrozole

Question 35

action of aromatase inhibitors

Answer 35

prevent formation of oestradiol from testosterone

Question 36

side effects of aromatase inhibitors/ other oestrogen blockers

Answer 36

``` joint/ bone pain hot flushes fatigue weight gain mood swings ```

Question 37

action of tamoxifen

Answer 37

blocks oestrogen receptor

Question 38

example of GnRH analogues

Answer 38

goserelin

Question 39

examples of targeted therapies

Answer 39

- monoclonal antibodies - antibody-drug conjugates - kinase inhibitors

Question 40

what monoclonal antibody is used in breast cancer?

Answer 40

herceptin trastuzumab (HER2)

Question 41

adverse of trastuzumab

Answer 41

headaches | blurred vision

Question 42

example of kinase inhibitors

Answer 42

CK4/6 inhibitors interrupt cell cycle from G1 to S

Question 43

when are adjuvant bisphosphonates given?

Answer 43

bone metastases ovarian suppression post-menopausal

Question 44

axillary node treatment options

Answer 44

- Axillary clearance | - Axillary radiotherapy

Question 45

diagnosis of axillary node mets

Answer 45

- Pre-operative axillary staging: USS axilla +/- core biopsy | - Sentinel node biopsy (closest lymph node sampled)

Question 46

what does axillary node clearance risk?

Answer 46

lymphoedema