Breast Doc

Question 1

Which ribs does breast tissue extend from

Answer 1

Ribs 2-6

Question 2

Where does breast tissue sit in relation to the pec major

Answer 2

Sits on top of the deep fascia that covers pec major and serratus anterior

Question 3

What is the retromammary space

Answer 3

The space between the fascia (covering pec major) and breast tissue

Question 4

What are the three main arteries supplying the breast tissue

Answer 4

Internal mammary
Posterior intercostal
Lateral thoracic

Question 5

Give an outline of the path that most lymph takes from the breast

Answer 5

Majority of lymphatic will drain to ipsilateral axillary node then to supra-clavicular nodes then to thoracic duct

Question 6

Apart from the ipsilateral axillary nodes, what 3 other groups of nodes receive lymph from the breast tissue

Answer 6

Parasternal
Abdominal
Nodes of contralateral breast

Question 7

What is the basic functional secretory unit of breast tissue

Answer 7

Terminal Duct Lobular Unit (TDLU) –> site of milk production

Question 8

What is the largest of the ducts, which connect the nipple and acini, called

Answer 8

Lactiferous duct

Question 9

What happens to the lactiferous ducts just before they reach the nipple

Answer 9

Expansion of ducts called the lactiferous sinus –> storage site for milk

Question 10

What special epithelium is lines the ducts and what is its function

Answer 10

Myoepithelium –> contracts in response to oxytocin

Question 11

The nipple is the only place in the body where sebaceous glands do what

Answer 11

Open up directly to the skin

Question 12

What kind of epithelium is the nipple composed of

Answer 12

highly pigmented keratinised epithelium

Question 13

What is the difference in tissue composition of the breasts in young adults and older adults

Answer 13

Young –> higher proportion of glandular tissue compared to adipose tissue
Older –> loss of glandular tissue and replacement with adipose tissue

Question 14

What happens to the breast tissue in pregnancy

Answer 14

The glandular tissue proliferates in response to oestrogen and progesterone

Question 15

What makes up the triple assessment that is offered to all women who attend the breast clinic

Answer 15

Clinical: history and examination
Radiological: mammography +/- ultrasound
Cyto-pathology: cytology or biopsy

Question 16

During breast examination, which three arm positions should you get the patient to hold

Answer 16

Resting on thighs
Above head
Hands on hips

Question 17

What is the general rule of thumb on when to use ultrasound or mammography to visualise breast tissue

Answer 17

> 40 y/o –> Mammography

<40 y/o –> Ultrasound

Question 18

On a mammogram, what colour is fat and what colour is glandular tissue

Answer 18

Fat –> grey

Glandular tissue –> white

Question 19

A popcorn shaped calcification on mammogram suggests what pathology

Answer 19

Fibroadenoma

Question 20

A rod shaped calcification on mammogram suggests what pathology

Answer 20

Duct ectasia

Question 21

Which benign breast disease is associated with a seatbelt injury and what drug can be associated with it as well

Answer 21

Fat necrosis

Warfarin therapy

Question 22

How is fat necrosis managed

Answer 22

Analgesia

can spontaneously resolve

Question 23

Which benign breast disease is strongly associated with smoking and how does it present

Answer 23

Duct ectasia

Pain and nipple discharge

Question 24

How is duct ectasia managed

Answer 24

Duct excision

Question 25

What pathology presents as multiple lumps within breast and cyclical mastalgia

Answer 25

Fibrocystic change

Question 26

Blue domed cysts filled with pale fluid is suggestive of which disease

Answer 26

Fibrocystic change

Question 27

Which breast disease will present as a painless, firm and mobile mass and what classic appearance will it have on ultrasound

Answer 27

Fibroadenoma | Breast mouse on USS

Question 28

Young women of which ethnicity are prone to fibroadenomas and how is it treated

Answer 28

Afro-caribbean | Excise if unsure

Question 29

What is Mondor's disease

Answer 29

Thrombophlebitis of the subcutaneous veins of the chest well and breast

Question 30

Which two benign breast conditions can be described as biphasic

Answer 30

Phyllodes tumour | Fibroadenoma

Question 31

When is the peak incidence for breast cancer

Answer 31

60-70

Question 32

Describe the breast cancer screening program

Answer 32

50-70 | Mammogram every 3 years

Question 33

What is the most common type of breast cancer

Answer 33

Carcinoma

Question 34

What are the two most common pre-cursors for breast carcinoma

Answer 34

Ductal carcinoma in situ (DCIS) | Lobular carcinoma in situ (LCIS)

Question 35

What are the three receptors that a breast cancer can express

Answer 35

Estrogen Progesterone HER 2

Question 36

What is the best combination of receptor expression of a breast cancer, in terms of prognosis

Answer 36

ER positive PR positive HER 2 negative

Question 37

What is the worst combination of receptor expression of a breast cancer, in terms of prognosis

Answer 37

Triple negative

Question 38

Which three lifestyle factors are risks for breast cancer

Answer 38

Obesity Alcohol Smoking

Question 39

Which form of contraception increases your risk of breast cancer

Answer 39

COCP

Question 40

What is Paget’s Disease of the Nipple

Answer 40

High grade DCIS extending along ducts to reach the epidermis of the nipple

Question 41

What is the most common finding on mammogram which is almost pathognomonic for DCIS

Answer 41

Micro-calcification

Question 42

Where does DCIS typically arise from

Answer 42

Arises in TDLU

Question 43

What are the two types of Lobular in situ neoplasia and what is the difference between them

Answer 43

Atypical Lobular Hyperplasia (ALH) <50% of lobule involved | Lobular Carcinoma in situ (LCIS) >50% of lobule involved

Question 44

What are the two surgical options available for someone with breast cancer

Answer 44

Wide Local Excision + radiotherapy | Radical mastectomy + radiotherapy

Question 45

In general how small must the breast cancer be in order to be excised by Wide Local Excision instead of mastectomy

Answer 45

<4cm

Question 46

Tumours can be shrank prior to surgery using drugs; what is this process called

Answer 46

Neo-Adjuvant chemotherapy

Question 47

Which anti-oestrogen therapies can be given for an ER positive tumour

Answer 47

Tamoxifen Aromatase inhibitors(Letrozole) GnRH antagonists - (Goserilin)

Question 48

What is the main risk of using tamoxifen and how does this risk arise

Answer 48

Endometrial cancer | tamoxifen acts as an anti-oestrogen agent in breast tissue but like an oestrogen in the uterus

Question 49

What kind of drug is Trastuzamab and how can it be used in breast cancer therapy

Answer 49

Monoclonal antibody against HER2 (use in HER 2 + tumours) | Also called herceptin