A 32 year old women presents to her GP with a 2-3 cm lump that she discovered that morning. She is very anxious about it as she has an aunt who was recently diagnosed with breast cancer.

The GP notes that the lump is smooth, non tender, firm and mobile lump in the lower inner quadrant of her left breast. Her breasts are approximately equal in size and shape and there are no skin or nipple changes.

What is the most likely diagnosis?

What does triple assessment of breast cancer consist of? Check three answers.

1. What is the name of the ligament that attaches breast lumps to the skin and underlying tissues?

A 42 year old women presents to her GP complaining of pain and discomfort in her breasts. This has been happening for several years and she notices it happens particularly in the week before her period, and resolve after menstruation. She has noticed they can be lumpy during the periods of tenderness, but cannot identify a specific lump. She has not noticed any nipple discharge and has no family history of note. Examination is unremarkable. She generally copes well with the symptoms but has been on the internet and is now anxious that her symptoms may represent cancer.

What is the most appropriate initial management?

A 40 year old women presents to A&E with a painful, red and hot left breast. She has had these symptoms for the last 6 days and they have been getting progressively worse. She has not had any nipple discharge. She has been otherwise well but has noticed feeling hot and cold at night over the past few days.

She has a past medical history of Type 2 Diabetes for which she takes metformin. She has no known allergies. Her sister has recently been diagnosed with breast cancer and her grandfather died of cancer of the pancreas.

On examination you notice the skin swelling and erythema in her upper inner left breast. This is firm, tender and warm to palpation. She is apyrexial and haemodynamically stable.

Bloods test show a CRP of 46 (normal range <10), WBC of 12.6 (normal range 3.6 – 11) and a glucose of 9.4 (normal range 4 – 7) but are otherwise normal.

What is the most appropriate initial management plan?

Which of the following management options would NOT be appropriate in fibrocystic breast disease?

A 43 year old lady presents to her GP with a left breast lump. She says the lump has been there for several years, and is unsure whether it is changing in size. She thinks that it may have gotten slightly bigger over time. It seemed to start after she was hit in the breast with a tennis ball whilst playing tennis. This injury lead to a significant bruise and tenderness, after which the lump developed. She is otherwise well and has had not had any other symptoms. She presented now because her older sister, aged 52, has been diagnosed with breast cancer and she is worried about the lump.

Examination reveals a 3cm discrete lower inner left breast lump. It is hard with craggy edges. It is tethered to the breast tissue but not to the skin or underlying chest wall. Otherwise there are no abnormalities on examination.

What is the most likely diagnosis?

A 38 year old female presents to her GP with unilateral occasional minimal right nipple discharge for the past 2 months. This is occasionally has some small blood stains mixed in with the discharge. She also complains of occasional right breast soreness, and has not noted a relationship between this and her menstrual cycle. She is a smoker and has never had children or breastfed. She is not sexually active.

Examination is unremarkable other than slight right nipple retraction and the right breast being slightly more tender to palpation than the left. There are no palpable lumps.

Given the potential diagnosis of mammary duct ectasia, what is the most appropriate management plan?

A 34 year old lady presents with a 1 week history of a left breast lump. This lump has been rapidly growing in size, lies just left of the nipple, is causing some erythema to the overlying skin and has been very tender. When asks she admits to feeling hit and cold over this period. She is not pregnant or breastfeeding. She denies any other health problems or family history.

On examination there is a fluctuant 3cm x 4cm superficial area just left and inferior of her left nipple (subareolar / lower-inner quadrant), with erythematous nipple involvement.

Other than standard blood tests, what additional investigation would you consider in this patient?

A 22 year old male presents with gynaecomastia and reduced libido. He admits some erectile dysfunction. He says this has gradually changed over the past 4 months. He is otherwise fit and well. It is having a serious effect on his relationship with his partner.

On examination he has bilateral breast tissue enlargement and suppressed secondary sexual characteristics (sparse pubic, axillary and facial hair and small testes). You examine his visual fields and note that he has a reduction in his peripheral vision.

Given your suspected diagnosis, what hormone is most likely to be involve?

What chromosome is the BRCA 1 tumour suppressor gene located on?

What chromosome is the BRCA 2 tumour suppressor gene located on?

A 47 year old patient presents with a breast lump under her left breast and a rash across her nipple for the past month. She has tried various creams but it has not improved the rash. She feels it is getting worse. She is a smoker, but it otherwise fit and well.

On examination you not an erythematous, scaly rash over her left nipple. She has a small (1.5 cm x 2 cm) hard, irregular lump under her nipple.

What is the most likely explanation of the rash across her nipple?

What screening tool is primarily used to screen women aged 50 – 70 in the UK?

A 36 year old patient is diagnosed oestrogen receptor positive breast cancer. What additional medication should be added to her breast cancer treatment regime?

A 36 year old patient is diagnosed HER2 receptor positive breast cancer. What additional medication should be added to her breast cancer treatment regime?

A 67 year old lady is found to have oestrogen receptor positive invasive breast cancer. What would be an appropriate addition to her breast cancer treatment regime?

A 53 year old lady is having a wide local excision for an invasive breast cancer. Options for reconstructive surgery are discussed with her, and she decides she would like to have a transverse rectus abdominis flap (TRAM flap).

What complication is it particularly important to warn her about?

Which of the following will form part of the follow-up care in a women who has undergone treatment (including successful wide local excision) for invasive breast cancer?