A 51-year-old perimenopausal woman has had thick, greenish-brown discharge from several ducts of both nipples for a year, staining her clothes. The right nipple shows a transverse slit-like retraction. Mammography shows coarse, rod-like calcifications along the ducts behind both areolae, with no mass, and discharge cytology is benign. The discharge from the right breast troubles her most and she wants it stopped. Which operation is most appropriate for the right breast?

Total major duct excision (Hadfield operation)

Subcutaneous mastectomy with implant

Excision of the nipple-areola complex

Microdochectomy of the discharging duct

A 46-year-old woman presents with a 2 cm hard, painless lump in the left axilla. Core biopsy shows metastatic adenocarcinoma that is CK7-positive, CK20-negative and strongly oestrogen receptor-positive. Clinical examination of both breasts is normal, and bilateral mammography and breast ultrasound show no lesion. CT of the chest and abdomen shows no other disease. What is the most appropriate next investigation?

Upper GI endoscopy and colonoscopy

Breast diseases and breast cancer

37 NEET-PG practice questions on Breast diseases and breast cancer, part of General Surgery. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A 20-year-old college student has a painless, firm, smooth, 2 cm lump in the upper outer quadrant of the left breast that slips away easily under the examining fingers. There is no nipple discharge and no axillary lymph node. What is the most likely diagnosis?
1. AFibrocystic change
2. BPhyllodes tumour
3. CFibroadenoma
4. DFat necrosis
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Answer: C · Fibroadenoma
A smooth, firm, highly mobile ('breast mouse') painless lump in a woman under 30 is most often a fibroadenoma, a benign tumour of both stroma and glands arising from a lobule. It is still confirmed by triple assessment: clinical examination, ultrasound (the imaging of choice under 35 years) and core needle biopsy. Small, confirmed fibroadenomas can be left alone with reassurance; large or growing ones are excised.
- A: Fibrocystic change gives tender, nodular areas that vary with the cycle.
- B: Phyllodes tumours occur in older women, around 40-50, and grow rapidly to a large size.
- D: Fat necrosis follows trauma and gives a hard, irregular, often fixed lump.
Question 2 · Medium
A 61-year-old man comes to the OPD with a 2 cm hard, painless lump just to one side of the left nipple, with nipple retraction and tethering of the overlying skin. His daughter had breast cancer at 39 and his brother has prostate cancer. Core biopsy shows invasive carcinoma that is ER-positive. A germline mutation in which gene is most strongly linked to his cancer?
1. ABRCA2
2. BPTEN
3. CBRCA1
4. DSTK11
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Answer: A · BRCA2
A hard, eccentric subareolar lump with nipple retraction in an older man is male breast cancer, which is usually ER-positive. Among inherited causes, a germline BRCA2 mutation (chromosome 13q) carries the strongest risk, and BRCA2 also raises the risk of prostate and pancreatic cancer, fitting this family. Other risk factors include Klinefelter syndrome and high oestrogen states. Every man with breast cancer should be offered genetic counselling and testing, with cascade testing of relatives.
- B: PTEN mutations cause Cowden syndrome, with breast, thyroid and endometrial cancer and hamartomas.
- C: BRCA1 raises male breast cancer risk far less than BRCA2 and is linked to triple-negative tumours.
- D: STK11 mutations cause Peutz-Jeghers syndrome with GI polyps and mucocutaneous pigmentation.
Question 3 · Medium
A 51-year-old perimenopausal woman has had thick, greenish-brown discharge from several ducts of both nipples for a year, staining her clothes. The right nipple shows a transverse slit-like retraction. Mammography shows coarse, rod-like calcifications along the ducts behind both areolae, with no mass, and discharge cytology is benign. The discharge from the right breast troubles her most and she wants it stopped. Which operation is most appropriate for the right breast?
1. ASubcutaneous mastectomy with implant
2. BExcision of the nipple-areola complex
3. CTotal major duct excision (Hadfield operation)
4. DMicrodochectomy of the discharging duct
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Answer: C · Total major duct excision (Hadfield operation)
Multi-duct, coloured, thick discharge with slit-like retraction and periductal rod-shaped calcification is mammary duct ectasia, a dilatation of the major subareolar ducts filled with inspissated secretion and surrounded by chronic (plasma cell) inflammation. When the discharge from several ducts is troublesome, all the major ducts are excised through a circumareolar incision (Hadfield operation), keeping the nipple. Microdochectomy suits a single discharging duct, as with a papilloma. The transverse slit retraction of duct ectasia differs from the circumferential, progressive retraction that raises concern for carcinoma.
- A: Mastectomy is far beyond what a benign discharge needs.
- B: Removing the nipple and areola is unnecessary for a benign duct disease.
- D: Microdochectomy removes one duct and leaves the other diseased ducts to keep discharging.
Question 4 · Hard
A 46-year-old woman presents with a 2 cm hard, painless lump in the left axilla. Core biopsy shows metastatic adenocarcinoma that is CK7-positive, CK20-negative and strongly oestrogen receptor-positive. Clinical examination of both breasts is normal, and bilateral mammography and breast ultrasound show no lesion. CT of the chest and abdomen shows no other disease. What is the most appropriate next investigation?
1. AMRI of both breasts
2. BUpper GI endoscopy and colonoscopy
3. CRepeat mammography in 6 months
4. DSerum CA 15-3 and CEA levels
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Answer: A · MRI of both breasts
An ER-positive, CK7-positive, CK20-negative adenocarcinoma in an axillary node of a woman is almost always from an occult breast primary. When clinical examination, mammography and ultrasound find nothing, contrast-enhanced MRI of the breasts is the next investigation and detects the primary in many such women. Finding it allows targeted biopsy and breast-conserving treatment instead of treating the whole breast blindly. If MRI is also negative, the disease is treated as a stage II/III breast cancer with axillary dissection and either mastectomy or whole-breast radiotherapy.
- B: The CK7-positive, CK20-negative, ER-positive profile points away from a gastrointestinal primary.
- C: Waiting 6 months delays treatment of known metastatic carcinoma.
- D: Tumour markers cannot localise the primary and are not diagnostic.
Question 5 · Medium
A 56-year-old woman has a vague thickening in the upper outer quadrant of the right breast; mammography shows only a subtle architectural distortion. Core biopsy shows small, uniform, discohesive cells infiltrating in single files, and immunohistochemistry shows loss of E-cadherin. The tumour board discusses four statements: 1. This tumour type is more often multicentric and bilateral than ductal carcinoma. 2. It can metastasise to the peritoneum, ovaries and gastrointestinal tract. 3. It is usually oestrogen receptor-negative. 4. MRI helps define its extent before surgery. Which statements are correct?
1. A1, 3 and 4 only
2. B1 and 2 only
3. C3 and 4 only
4. D1, 2 and 4 only
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Answer: D · 1, 2 and 4 only
Single-file, discohesive cells with loss of E-cadherin (from CDH1 inactivation) define invasive lobular carcinoma. Statements 1, 2 and 4 are true: it is more often multicentric and bilateral, it spreads unusually to the peritoneum, ovaries, gastrointestinal tract and meninges, and because it infiltrates without forming a mass it is underestimated by mammography, so MRI is useful to map it. Statement 3 is false: classic lobular carcinoma is almost always ER-positive and HER2-negative, so endocrine therapy is central to treatment.
- A: Includes ER negativity and omits its unusual spread to the peritoneum and gut.
- B: Omits the value of MRI in mapping a tumour that mammography underestimates.
- C: Includes ER negativity and omits its multicentricity and unusual spread.
Question 6 · Medium
A 29-year-old woman who smokes 20 cigarettes a day comes to the OPD with her third episode of a painful swelling beneath the left areola; two earlier abscesses were drained at a nursing home. Her last child was weaned 5 years ago. There is now a small opening at the edge of the areola that discharges pus, and the nipple is slightly indrawn. Which factor most strongly predisposes to her condition?
1. AOral contraceptive use
2. BCigarette smoking
3. CPrevious breast trauma
4. DRecent breastfeeding
Answer and explanation in LearnFree account
Question 7 · Medium
A 47-year-old woman with HER2-positive (IHC 3+) node-positive breast cancer has completed anthracycline and taxane chemotherapy after mastectomy and is starting a year of adjuvant trastuzumab at a regional cancer centre. Which test must be done before starting and repeated at intervals during treatment?
1. ANerve conduction studies for neuropathy
2. BPure tone audiometry for hearing loss
3. CEchocardiography for left ventricular ejection fraction
4. DPulmonary function tests for diffusion capacity
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Question 8 · Medium
A 54-year-old woman has a screening mammogram showing a 2 cm cluster of fine, linear, branching microcalcifications in the left upper outer quadrant; there is no palpable lump. Stereotactic vacuum-assisted biopsy shows high-grade ductal carcinoma in situ with comedo necrosis and no invasion. MRI shows a single area of disease. What is the most appropriate treatment?
1. AObservation with mammography every year
2. BWide local excision with clear margins, then radiotherapy
3. CModified radical mastectomy with axillary clearance
4. DTamoxifen alone without any surgery
Answer and explanation in LearnFree account
Question 9 · Medium
A 52-year-old woman with a 2.5 cm invasive carcinoma in a medium-sized left breast asks to keep her breast. The surgeon reviews four features: 1. A tumour of 2.5 cm in a medium-sized breast. 2. Mantle-field radiotherapy to the chest for Hodgkin lymphoma at the age of 20. 3. Diffuse suspicious microcalcifications throughout the left breast on mammography. 4. Margins still involved after two attempts at re-excision. Which features make breast-conserving surgery unsuitable?
1. A2, 3 and 4 only
2. B1, 2, 3 and 4
3. C1, 3 and 4 only
4. D3 and 4 only
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Question 10 · Medium
A 48-year-old woman with a 2.2 cm invasive carcinoma of the left breast is planned for wide local excision. No axillary nodes are palpable, and axillary ultrasound shows normal nodes. How should her axilla be staged?
1. ASentinel lymph node biopsy
2. BPET-CT in place of axillary surgery
3. CLevel I-III axillary clearance
4. DNo axillary staging is needed
Answer and explanation in LearnFree account
Question 11 · Medium
A 50-year-old woman has a 4 cm hard lump in the right breast with peau d'orange over a small area of skin above it; there is no ulceration and no generalised redness. Two mobile, firm right axillary nodes are palpable. CT of the chest and abdomen and a bone scan show no distant metastases. What is her clinical stage by the AJCC TNM system?
1. AStage IIIC
2. BStage IIIB
3. CStage IIB
4. DStage IIIA
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Question 12 · Medium
A 52-year-old woman has a 2.5 cm hard, irregular lump in the upper outer quadrant of the right breast, with one mobile ipsilateral axillary node. Mammography shows a spiculated mass with fine pleomorphic microcalcifications, reported as BI-RADS 5. She is seen at a district hospital that has ultrasound and a pathologist. What is the best next step to establish the diagnosis?
1. AExcision biopsy under general anaesthesia
2. BWhole-body PET-CT scan
3. CUltrasound-guided core needle biopsy of the lump
4. DFine-needle aspiration cytology of the lump
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Question 13 · Easy
A 28-year-old software engineer has dull, aching pain and heaviness in both breasts in the week before each period, easing once bleeding starts. Examination shows diffuse nodularity in both upper outer quadrants with no discrete lump, and breast ultrasound is normal. What is the most appropriate first-line management?
1. ATamoxifen for six months
2. BExcision of the most nodular area
3. CDanazol for three months
4. DReassurance and a well-fitting supportive bra
Answer and explanation in LearnFree account
Question 14 · Easy
A 44-year-old schoolteacher comes to the surgical OPD with spontaneous bloodstained discharge from one duct opening of the right nipple for a month. Pressing at the 9 o'clock position on the edge of the areola reproduces it. There is no palpable lump, and mammography and ultrasound show only a slightly dilated duct behind the areola. What is the most likely cause?
1. AIntraductal papilloma
2. BMammary duct ectasia
3. CGalactorrhoea from a prolactinoma
4. DPeriductal mastitis
Answer and explanation in LearnFree account
Question 15 · Easy
A 46-year-old woman with no breast symptoms has a screening mammogram at a private hospital. The report describes an 8 mm oval, well-circumscribed mass in the left breast, graded BI-RADS 3. Clinical examination is normal. What is the recommended next step?
1. AUltrasound-guided core biopsy now
2. BRepeat imaging after about 6 months
3. CRoutine screening again after a year
4. DWide local excision of the mass
Answer and explanation in LearnFree account
Question 16 · Medium
A 49-year-old woman has a core biopsy of a 3 cm left breast lump showing invasive breast carcinoma of no special type, grade 3. Immunohistochemistry shows ER 0%, PR 0% and HER2 score 2+ (moderate, incomplete membrane staining in more than 10% of cells). What is the next step regarding her HER2 status?
1. ATreat as triple-negative breast cancer
2. BSerum CA 15-3 to decide the HER2 status
3. CStart trastuzumab, as the tumour is HER2-positive
4. DIn situ hybridisation for HER2 gene amplification
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Question 17 · Hard
A 32-year-old woman has a 3 cm left breast lump. Her mother died of ovarian cancer at 48 and a maternal aunt had breast cancer at 38. Core biopsy shows a grade 3 carcinoma with pushing borders, sheets of large pleomorphic cells and a dense lymphocytic infiltrate. Immunohistochemistry: ER 0%, PR 0%, HER2 score 0. A germline mutation in which gene is most likely?
1. ACDH1
2. BBRCA2
3. CBRCA1
4. DTP53
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Question 18 · Easy
A 60-year-old woman has a 5 cm hard lump in the lower half of the left breast. The skin over it is thickened and pitted, like the skin of an orange. What causes this skin change?
1. ADirect infiltration of the epidermis
2. BTumour pulling on the Cooper ligaments
3. CBlocked dermal lymphatics with skin oedema
4. DTumour invading the lactiferous ducts
Answer and explanation in LearnFree account
Question 19 · Medium
A 64-year-old postmenopausal woman with ER-positive breast cancer is choosing between adjuvant tamoxifen and letrozole. Her doctor explains four statements: 1. Tamoxifen raises the risk of endometrial carcinoma. 2. Letrozole causes loss of bone mineral density. 3. Tamoxifen helps preserve bone density after menopause. 4. Letrozole carries a higher risk of venous thromboembolism than tamoxifen. Which statements are correct?
1. A2 and 3 only
2. B1 and 3 only
3. C1, 2 and 3 only
4. D1, 2 and 4 only
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Question 20 · Medium
A 55-year-old obese woman had a car accident 3 months ago in which the seat belt bruised her left breast. She now has a 2 cm hard, irregular lump at the site of the bruise, with slight tethering of the overlying skin. There are no palpable axillary nodes. She is sure it is 'only the old injury'. What is the most appropriate next step?
1. AModified radical mastectomy without delay
2. BWarm compresses and anti-inflammatory tablets
3. CTriple assessment including core needle biopsy
4. DReassurance that it is post-traumatic fat necrosis
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Question 21 · Medium
Three weeks after a left modified radical mastectomy with axillary clearance, a 50-year-old woman says she cannot raise her left arm fully above her head. When she pushes with both hands against a wall, the lower angle and medial border of the left scapula stand out from the chest wall. Which nerve was injured during the axillary dissection?
1. AThoracodorsal nerve
2. BMedial pectoral nerve
3. CIntercostobrachial nerve
4. DLong thoracic nerve
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Question 22 · Medium
A 41-year-old woman with regular periods has had wide local excision and sentinel node biopsy for a 1.8 cm invasive breast carcinoma, node-negative, ER-positive, PR-positive and HER2-negative. Whole-breast radiotherapy is planned. Which endocrine drug is most suitable for her adjuvant treatment?
1. ALetrozole alone
2. BTamoxifen
3. CMedroxyprogesterone acetate
4. DTrastuzumab
Answer and explanation in LearnFree account
Question 23 · Medium
A 44-year-old woman has a breast lump that has grown rapidly from 2 cm to 6 cm over 4 months. It is firm, smooth and bosselated, freely mobile over the chest wall, with stretched, shiny skin and dilated veins over it but no ulceration; there are no axillary nodes. Core biopsy shows leaf-like fronds of epithelium-lined stroma with increased stromal cellularity and occasional mitoses. Her breast is large. What is the most appropriate treatment?
1. AModified radical mastectomy with axillary clearance
2. BWide excision with sentinel lymph node biopsy
3. CEnucleation of the lump through a periareolar incision
4. DWide local excision with a clear margin of at least 1 cm
Answer and explanation in LearnFree account
Question 24 · Hard
A 30-year-old woman at 20 weeks of pregnancy has a 3 cm hard lump in the right breast. Core biopsy shows invasive carcinoma, ER-negative and HER2-positive (IHC 3+), and axillary node FNAC is positive; there are no distant metastases. The multidisciplinary team discusses four statements: 1. Termination of the pregnancy will improve her chance of survival. 2. Anthracycline-based chemotherapy can be given in the second trimester. 3. Trastuzumab should be started now along with chemotherapy. 4. Radiotherapy, if needed, is usually deferred until after delivery. Which statements are correct?
1. A1, 2, 3 and 4
2. B1, 2 and 4 only
3. C2, 3 and 4 only
4. D2 and 4 only
Answer and explanation in LearnFree account
Question 25 · Hard
An 84-year-old woman from a village in Kerala has a 3 cm hard lump in the left breast. She has severe COPD on home oxygen and heart failure with an ejection fraction of 25%, and the anaesthetist rates her as ASA IV. Core biopsy shows invasive carcinoma, ER strongly positive (Allred 8), HER2-negative; the axilla is clinically normal and staging shows no metastases. She and her family do not want surgery. What is the most appropriate treatment?
1. AModified radical mastectomy under general anaesthesia
2. BNo tumour treatment, symptom care only
3. CAnthracycline and taxane chemotherapy
4. DLetrozole as primary endocrine therapy
Answer and explanation in LearnFree account

12 more Breast diseases and breast cancer questions

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Study General Surgery

Breast diseases and breast cancer

A 20-year-old college student has a painless, firm, smooth, 2 cm lump in the upper outer quadrant of the left breast that slips away easily under the examining fingers. There is no nipple discharge and no axillary lymph node. What is the most likely diagnosis?

A 48-year-old woman with a 2.2 cm invasive carcinoma of the left breast is planned for wide local excision. No axillary nodes are palpable, and axillary ultrasound shows normal nodes. How should her axilla be staged?

A 46-year-old woman with no breast symptoms has a screening mammogram at a private hospital. The report describes an 8 mm oval, well-circumscribed mass in the left breast, graded BI-RADS 3. Clinical examination is normal. What is the recommended next step?

A 60-year-old woman has a 5 cm hard lump in the lower half of the left breast. The skin over it is thickened and pitted, like the skin of an orange. What causes this skin change?

A 41-year-old woman with regular periods has had wide local excision and sentinel node biopsy for a 1.8 cm invasive breast carcinoma, node-negative, ER-positive, PR-positive and HER2-negative. Whole-breast radiotherapy is planned. Which endocrine drug is most suitable for her adjuvant treatment?