Breast

• What is the most common type of breast cancer?

  Invasive ductal carcinoma (no special type)
• What is the recommended adjuvant hormonal therapy for ER +ve breast cancer in post-menopausal women?

  Anastrozole
• What type of nipple discharge is most commonly associated with duct ectasia?

  Brown-green nipple discharge
• What type of discharge is most likely associated with a papiloma?

  Blood-stained discharge
• Is bilateral nipple discharge likely to be associated with breast cancer?

  No, it is unlikely
• What should be done for a woman under 30 with an unexplained breast lump?

  Consider a non-urgent referral
• What is the usual management for breast fibroadenoma if it is larger than 3 cm?

  Surgical excision
• What is duct ectasia?

  Non-malignant breast disease with thick green discharge
• What should be done for women over 30 with an unexplained breast lump?

  Refer using a suspected cancer pathway
• What treatment can HER2 +ve women receive?

  Herceptin (trastuzumab)
• When is tamoxifen used in breast cancer treatment?

  In ER +ve women who are pre- or perimenopausal
• What chemotherapy regimen is used for node +ve breast cancer patients?

  FEC-D chemotherapy
• What does the 'snowstorm' sign on ultrasound indicate?

  Extracapsular breast implant rupture
• What characterizes fibroadenomas in women under 30?

  Non-tender, discrete, and mobile lump
• What is the chance of siblings and children of a BRCA1 carrier also having the gene?

  50/50 chance
• How are fibroadenomas described?

  Mobile, firm lumps often called 'breast mouse'
• What do aromatase inhibitors do in breast cancer treatment?

  Reduce peripheral oestrogen synthesis
• How does cyclical mastalgia vary?

  According to the phase of the menstrual cycle
• What is the first-line treatment for lactational mastitis if symptoms persist?

  Flucloxacillin
• What is the first-line management for mastitis?

  Continue breastfeeding
• What is the treatment for duct ectasia?

  No specific treatment required
• What should be considered for people under 30 with an unexplained breast lump?

  Non-urgent referral
• What does reddening and thickening of the nipple and areola suggest?

  Paget's disease of the breast
• What age group is offered breast cancer screening?

  Women aged 50-70 years
• What are some risk factors for breast cancer?

  BRCA1 mutations, nulliparity, obesity
• What describes a 25-year-old woman with a discrete, non-tender lump?

  Fibroadenoma
• What condition is indicated by a 40-year-old woman with painful, lumpy breasts before menstruation?

  Fibroadenosis
• What describes a 70-year-old woman with a hard, irregular lump?

  Breast cancer
• What condition is indicated by a 65-year-old woman with an itchy, erythematous rash on the nipple?

  Paget's disease of the breast
• What does a tender lump around the areola with green discharge indicate?

  Mammary duct ectasia
• What does watery, blood-stained discharge from the nipple indicate?

  Duct papilloma
• What condition is indicated by a firm round lump after trauma?

  Fat necrosis
• What does a painful, red swelling above the areola in a breastfeeding woman indicate?

  Breast abscess
• What is the recommendation after wide-local excision for breast cancer?

  Whole breast radiotherapy
• What should women with breast cancer and no palpable axillary lymphadenopathy undergo?

  Pre-operative axillary ultrasound
• What should be done if a pre-operative axillary ultrasound is negative?

  Sentinel node biopsy
• What is indicated for patients with clinically palpable lymphadenopathy?

  Axillary node clearance at primary surgery
• What is a complication of axillary node clearance?

  Arm lymphedema and functional impairment
• Why consider neo-adjuvant chemotherapy in breast cancer?

  To downsize the tumour before surgery
• What side effect may aromatase inhibitors cause?

  Osteoporosis