253b breast cancer Flashcards Preview

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Flashcards in 253b breast cancer Deck (15):
1

Breast cancer - mortality in the past decade?

declining and incidence has flattened

largely due to less postmenopausal hormone use

2

Breast cancer - who gets it more?

White > AA > other groups

3

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)

4

breast histology - where do hormones act?

Estrone --> ductal system

progesterone --> TDLU (where Breast cancer arises)

5

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

6

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.

7

Breast Cancer - overview (first aid): who? where? receptors? prognostic indicator? location?

Commonly postmenopausal.

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.

8

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).

9

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

10

ER+ BC Rx

Tamoxifen

11

HER2/neu+ BC Rx

Trastuzumab

12

does mastectomy improve survival in BC?

not for the majority of cases

radiation reduces recurrence in the breast

present treatment: breast conservation surgery + radiotherapy

13

triple negative BC Rx

chemotherapy (no hormone/endocrine drugs work)

14

breast cancer prevention

tamoxifen for prevention in high risk women

15

Breast cancer in postmenopausal women Rx? prevention?

Aromatase inhibitor (anastrozole) + other SERMS if useful; don't use if osteoporotic though

aromatase inhibitors only prevent hormone receptor positive cancers though