Week 9: Breast, Ovarian cancer

Question 1

Which tumour marker is useful for detecting relapse of breast cancer

Answer 1

Ca 15-3

Levels often raised before clinical signs of cancer

Question 2

First line investigation for breast mass.

Why is this first line

Answer 2

USS

Tells you if cancer is cystic or solid

Question 3

Signs on breast of breast cancer

Answer 3

1. P’eau d’orange
2. Breast lump
3. Nipple retraction/ discharge
4. Paget’s diseae

Question 4

Do breast cancer lumps tend to be painful or painless

Answer 4

Painless

Question 5

Which type of cancer is Paget’s disease

Answer 5

Cancer of terminal ducts

Question 6

Signs of Paget’s disease

Answer 6

1. Eczematoid changes to nipple
2. Bloody nipple discharge/ burning/ itching
3. Breast lump

Question 7

Mammography should not be performed in women under what age

Answer 7

don’t do <50yo

Question 8

What does triple assessment consist of

Answer 8

1. Clinical exam
2. USS/ mammography
3. FNA/ core biopsy

Question 9

When is a breast biopsy indicated in case of a

• solid mass
• cyst

Answer 9

Solid mass: always, to study cell architecture

Cyst: bloody fluid/ recurrent cyst/ not resolved completely after aspiration

Question 10

Where is Ca125 produced

Answer 10

derivatives of coelomic epithelium

(pleura, pericadium, peritoneum, fallopiean tube, endometrium, endocervix)

Not found in a normal ovary

Question 11

Tumour markers are usually not 100% specific.

Which 2 markers can be 100% specific, and in what setting?

Answer 11

1. beta-HCG -> 100% specific for prostate cancer

2. Ca125 -> 100% specific for relapse of ovarian cancer (if 2x upper limit of normal)

Question 12

Most common ovarian cancer.

What epithelium is it made of

Answer 12

Serous

Made of fallopian tube epithelium

Question 13

Most aggressive ovarian cancer

What epithelium is it made of

Answer 13

Clear cell

Made of gestational epithelium

Question 14

Tumour markers that should be done in a women <40yo suspected of ovarian cancer

Answer 14

1. Ca125
2. CEA
3. AFP
4. betaHCG
5. LDH

Question 15

Tumour markers that should be done in a women >40yo suspected of ovarian cancer

Answer 15

1. Ca125

2. CEA

Question 16

Signs of ovarian cancer

Answer 16

(consider Ovarian Ca in any woman with a recent change in bowel habit and vague abdo symptoms)

Question 17

Treatment of ascites

Answer 17

1. Paracentesis

2. Indwelling catheters

Question 18

Why is malignant ascites not treated with diuretics

Answer 18

Diuretics won’t do anything as sodium retention is not a cause of malignant ascites

Question 19

Complication of bilateral oophrectomy surgery to treat ovarian cancer

Answer 19

Akin to having early menopause

-osteoporosis

Question 20

What are the 3 factors in a risk of malignancy index score (RMI)

Answer 20

1. Menopause status
2. USS findings
3. Serum Ca125 levels

Question 21

5 Suspicious findings on USS (which could indicate ovarian cancer)

Answer 21

1. Multi-locular cysts
2. Solid areas
3. Mets
4. Ascites
5. Bilateral lesions

Question 22

How is USS score calculated in RMI

Answer 22

0 findings = 0
1 finding = 1
2-5 findings = 3

Question 23

How is menopause score calculated in RMI

Answer 23

pre-menopausal = 1
post-menopausal = 3

Question 24

How is Ca125 score calculated in RMI

Answer 24

Score is whatever the Ca125 level is