Invasive Breast Cancer

Question 1

What is the definition of invasive breast cancer?

Answer 1

malignant epithelial cells that have breached the basement membrane

Question 2

What is the incidence of breast cancer?

Answer 2

1 in 8 (most common female cancer)

Question 3

What is the peak age of breast cancer?

Answer 3

50-70

Question 4

What are risk factors for breast cancer?

Answer 4

older age
early first birth
not breastfeeding
early first period
late menopause
no births 
exogenous oestrogen - HRT + OCP 
BMI >30
unactive lifestyle 
increased alcohol intake 
high fat intake 
smoking

Question 5

What % lifetime risk does having the BRACA 1 and 2 genes confir?

Answer 5

64%

Question 6

What do you offer when someone has a BRACA1 gene?

Answer 6

prophylactic masectomy

Question 7

What do you do when someone has other gene mutations that encode for breast cancer - BRACA 2, TP53, PTEN, STK11/LKB1, ATM?

Answer 7

do MRI follow up

Question 8

How is the T part of TNM graded?

Answer 8

0 = no tumour
1 = <2cm
2 = 2-5cm
3 = >5cm
4 = extension to skin + chest wall

Question 9

How is the N part of TNM graded?

Answer 9

1 = mobile mass
2 = fixed nodes
3 = ipsilateral internal mammary nodes

Question 10

Where do breast cancers metastasise to?

Answer 10

bone
liver
brain
lungs
abdominal viscera 
female gential tract

Question 11

What is the most common type of breast cancer?

Answer 11

ductal 70%

Question 12

What are breast cancers scored on to determine their grade?

Answer 12

tubular differentiation (1-3)
nuclear pleomorphism (1-3)
mitotic activity (1-3)

Question 13

What does score 3-5 indicate?

Answer 13

grade 1

Question 14

What does score 6-7 indicate?

Answer 14

grade 2

Question 15

What does score 8-9 indicate?

Answer 15

grade 3

Question 16

What % of breast cancers are oestrogen positive?

Answer 16

80%

Question 17

What does a progesterone positive breast cancer indicate?

Answer 17

better survival prognosis

Question 18

What does HER 2 positive breast cancer indicate?

Answer 18

worse prognosis

Question 19

What do HER 2 positive breast cancers respond to?

Answer 19

Trastuzamab

Question 20

What are the signs of breast cancer?

Answer 20

dimpled or depressed skin
nipple change
bloody discharge
texture change
visible lump
colour change

Question 21

What does a unilateral bloody nipple discharge indicate?

Answer 21

papilloma or DCIS

Question 22

What is the preferred surgical treatment for breast cancer?

Answer 22

breast conserving surgery

Question 23

What is breast conserving surgery?

Answer 23

wide local excision with/without oncoplastic reconstruction

Question 24

What usually follows breast conserving surgery?

Answer 24

radiotherapy

Question 25

What is the process of a masectomy?

Answer 25

can remove all or part of the breast

Question 26

What follows a masectomy?

Answer 26

breast reconstruction

Question 27

When is a masectomy followed by radiation?

Answer 27

if involvement of >/= 3 lymph nodes or if the tumour >/= 5cm or positive surgical margins

Question 28

What is a side effect of chemotherapy?

Answer 28

neutropenia

Question 29

What is Tamoxifen used for? For how long?

Answer 29

ER +ve cancers | 5 years

Question 30

What are the side effects of Tamoxifen?

Answer 30

hot flushes and endometrial cancer

Question 31

Name two aromatase inhibitors?

Answer 31

letrozole | anastrozole

Question 32

When are Tamoxifen and Trastuzumab contraindicated?

Answer 32

breastfeeding

Question 33

What do all women that present with a lump get?

Answer 33

Breast triple assessment - history + examination - mammogram or USS - biopsy of mass

Question 34

What is the role of aromatase inhbitors?

Answer 34

stop the production of oestrogen

Question 35

When should a mammogram be offered?

Answer 35

>40

Question 36

When should an USS be offered?

Answer 36

<40

Question 37

Why can mammograms only be done after the age of 40?

Answer 37

breasts are too dense under age of 40

Question 38

Do mammograms have high or low radiation?

Answer 38

low

Question 39

What type of breast cancer do mamograms have a specifically high sensitivity for?

Answer 39

DCIS

Question 40

Do ultrasounds detect DCIS?

Answer 40

no

Question 41

What are the indications for ultrasound?

Answer 41

``` palpable mass breast inflammation breast problems during pregnancy image guided biopsy need of imaging <40 ```

Question 42

What role does elastography play in breast cancer imaging?

Answer 42

assesses the stiffness of tissue as benign fibroadenomas are soft and invasive carcinomas are stiff

Question 43

What role does MRI play in breast cancer imaging?

Answer 43

sizing cancers | can be used in very highly suspicious women when the pathology cannot be found

Question 44

What ages is screening avaliable for?

Answer 44

women aged 50-70

Question 45

How often are women called for breast screening?

Answer 45

every 3 years

Question 46

How often are you called for breast screening if you have a moderate FH of breast cancer?

Answer 46

yearly

Question 47

How often are you called for breast screening if you have a high FH of breast cancer?

Answer 47

you get a yearly MRI

Question 48

What is the follow up once breast cancer is cured?

Answer 48

3 yearly mammograms

Question 49

What should be done if there are suspicious axillary nodes?

Answer 49

ultrasound guided biopsy

Question 50

What happens if there are macrometastasis in the axillary nodes?

Answer 50

axillary node clearance

Question 51

What happens if there are no macrometastasis in the axillary nodes?

Answer 51

sentinal node biopsy

Question 52

Name some problems with implants?

Answer 52

infection, rippling or migration 40% require revisional surgery old ones have a risk of ACL lymphoma