Flashcards in 253b breast cancer Deck (15):
Breast cancer - mortality in the past decade?
declining and incidence has flattened
largely due to less postmenopausal hormone use
Breast cancer - who gets it more?
White > AA > other groups
Breast cancer - risk factors
genetics (small group of people w/ BRCA1/2, larger group with SNPs and low penetrance)
hormonal exposure (early menarche, late menopause, nulliparity, late first pregnancy, HRT, long reproductive span)
breast histology - where do hormones act?
Estrone --> ductal system
progesterone --> TDLU (where Breast cancer arises)
Breast cancer - histo patterns with non-invasive and invasive
non-invasive: ductal carcinoma in situ (precursor, cancer occurs at same location, excise) and lobular carcinoma in situ (risk factor, cancer can occur anywhere in breast so removal not as important)
invasive: #1 ductal, #2 lobular, then many special types
DCIS histo appearance (first aid)
Fills ductal lumen. Arises from ductal atypia. Often seen early as microcalcifications on mammography.
Early malignancy without basement membrane penetration.
Breast Cancer - overview (first aid): who? where? receptors? prognostic indicator? location?
Usually arise from terminal duct lobular unit.
Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common
triple negative (ER -, PR -, and Her2/Neu -) more aggressive
Axillary lymph node involvement indicating metastasis is the single most important prognostic factor.
Most often located in upper-outer quadrant of breast.
invasive BC - ductal (first aid)
Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells.
Grossly, see classic “stellate” infiltration.
Worst and most invasive. Most common (76% of all breast cancers).
invasive BC - locular (first aid)
Orderly row of cells (“Indian file”).
Often bilateral with multiple lesions in the same location.
better prognosis but diagnosed later and in older women
ER+ BC Rx
HER2/neu+ BC Rx
does mastectomy improve survival in BC?
not for the majority of cases
radiation reduces recurrence in the breast
present treatment: breast conservation surgery + radiotherapy
triple negative BC Rx
chemotherapy (no hormone/endocrine drugs work)
breast cancer prevention
tamoxifen for prevention in high risk women