breast cancer

Question 1

describe normal breast anatomy

Answer 1

branched tubulo-alveolar glands = modified apocrine sweat glands
series of cucts surrounded by strome (CT) and fat
arranged in lobes
each llobe = drained bu collecting duct = terminates at nipple

Question 2

describe collecting duct of breast

Answer 2

ends in terminal ductal-lobular unit (TDLU)
= basic functional + histopath unit of breast
TDLU = small segment terminal duct + cluster of ductules = secretory units

Question 3

describe ductules

Answer 3

each TDLU = 20-200 ductules

formed from successive branching of interlobular duct

Question 4

infleunce of hormones,

Answer 4

oestrogen = growth glands + fat in breast 
progesterone = lobule growth + budding alveoli + secretory changes

Question 5

risk factors for breast cancer

Answer 5

late first period, late menopause, no children or children late in life, prolonges oestrogen exposure, hormone replacement therapy
genetics

Question 6

describe breast lesions: fibrocycstic changes

Answer 6

presents as benign lumps
solid or liquid filled
association with hormonal imbalance (high oes, low prg)
can mimic carcinoma

Question 7

describe breast lesion = firboadenoma

Answer 7

young women
palpable, mobile, firm non-tender amss
proliferation of epithelial + mesenchymal stroma

Question 8

describe pre-malignant breast lesions

Answer 8

no penetration basement mem
uncontrolled prolif in ducts and lobules
carcinoma in situ

Question 9

describe maligngnat breast legions

Answer 9

cell penetrate basememtn mem into stroma
epi cells that line ducts and lobules of breask
invasive carcinoma

Question 10

describe ductal carcinoma i situ

Answer 10

prolif of abnormal epi cells contained within ductal lining
not past basemem
precursor for invasive

Question 11

dscribe lobular carcinoma in situ

Answer 11

prolif abnormal monomorphic cells = fill + distend acini within lobular units (TDLU)
not infiltrated beyond lobule

Question 12

describe ingiltrating ductal carcinoma

Answer 12

most common
firm, cohesive mass
invade haphazard fashion = irregular stellate shape

Question 13

describe infiltrating lobular carcinoma

Answer 13

irregular + poorlr delimited tumours
less cohesive = invade single file
slow grow, usually detected in late stages

Question 14

what is the investigation of breast legions

Answer 14

clinical + physcial exam
radiology (mammography)
MRI
biopsy

Question 15

what factors can affect prognosis

Answer 15

stage
grade = (tubule formation, nucelar pleomorphism, ,mitotic activity)
hormone receptors: hr positive cells drive proliferation
her2 over expression

Question 16

describe the management of breast cancer

Answer 16

surgery = breast conserving 
auxillary lymph node clearance 
radio + chemo
anti-oestrogen therapy 
herceptin

Question 17

describe mamographic screening

Answer 17

1-2 years for women aged over 5-
detect in situ lesions before spread
show as increased densities + calcification