Breast Cancer

Question 1

What is the most common type?

Answer 1

DCIS

Question 2

Which type has a higher incidence of multicentric tumours?

Answer 2

Lobular carcinoma

Question 3

What are the 3 most common sites of mets from breast cancer?

Answer 3

bone, lung & liver

Question 4

what is the Nottingham prognostic index?

Answer 4

used to determine prognosis following surgery for breast cancer, based on:

1. tumour size
2. grade
3. lymph node involvement

Question 5

How does oestrogen exposure affect breast cancer risk?

Examples

Answer 5

Higher exposure = greater risk

Late childbearing, nulliparity, early menarche, late menopause, obesity

Question 6

What two medications can increase risk?

Answer 6

OCP

HRT

Question 7

BRCA1 and BRCA2

Answer 7

BRCA1: increased susceptibility to breast & ovarian cancer
BRCA2: early-onset breast cancer & male breast cancer

Question 8

What is the breast screening programme?

Answer 8

Regular mammography offered to all women age 50-70 every 3 years

Question 9

What is the triple assessment?

Answer 9

1. Full history & exam
2. Bilateral mammography
3. USS & biopsy

Question 10

What else should be included in an USS?

Answer 10

Axillae & LN biopsy (if required)

Question 11

How is cytological diagnosis confirmed?

Answer 11

Fine needle aspiration cytology (FNAC) or biopsy

Question 12

Prognosis for

a) ER/ PR expression
b) HER2

Answer 12

a) better prognosis

b) worse prognosis

Question 13

Which breast cancers are highly chemo-sensitive?

Answer 13

HER2 positive & triple negative

Question 14

What does ER status mean?

How common?

Answer 14

Oestrogen receptor status (80% of breast
cancers +)
Means that cancer cells (like normal breast cells) receive signals from oestrogen that promote growth

Question 15

What is trastuzumab AKA?

Answer 15

Herceptin

Question 16

What is important to monitor in a patient on herceptin?

Answer 16

Cardiac monitoring - can have cardiac SEs

Question 17

Who is tamoxifen given to?

Answer 17

Pre-menopausal women

ER/ PR positive

Question 18

What is a complication of tamoxifen?

How long is it usually given for?

Answer 18

Increased risk of thrombosis & endometrial carcinoma

5 years

Question 19

What can be given as an alternative to tamoxifen?

What is a SE?

Answer 19

Aromatase inhibitor (e.g. anastrazole)
SE: osteoporosis

Question 20

Is radiotherapy commonly used?

Answer 20

Yes - all patients require adjuvant radiotherapy to reduce chance of local recurrence

Question 21

What are 4 common mets of breast cancer?

Answer 21

Bone, liver, lung & brain