Tumours of which organs commonly spread to the breast?
Lungs
Ovaries
Kidneys
Skin (melanoma)
Smooth muscle (commonly uterus)
Which malignant skin tumour can spread to the breast?
Malignant melanoma
Breast cancer commonly spreads to which structures?
Ovaries
Peritoneum
Bones
Which cells are neoplastic in breast carcinomas?
Epithelial cells
In which specific part of the breast are most carcinomas found?
Lobules
functional units
Apart from the lobules, where else can breast carcinomas arise?
Ducts
What is meant by an in situ carcinoma?
Hasn’t breached basement membrane
So not invasive (yet)
What are the two specific types of lobular neoplasia?
Atypical lobular hyperplasia (<50% of lobule involved)
Lobular carcinoma in situ (>50% involved)
Invasive carcinoma after that
Lobular neoplasms tend to have oestrogen receptors.
What does this mean?
They grow in response to oestrogen
e.g menstrual cycle, OCP, HRT
20% of lobular neoplasms removed by core biopsy are hiding a more ___ lesion.
advanced
so the recurrence rate is really high
How are lobular neoplasms managed?
Excision
What happens to the centre of high grade ductal neoplasms (DCIS)?
Comedo necrosis
because growth outpaces blood supply
High grade ductal carcinomas can spread to involve what breast structures?
Lobules
Nipple
What is a cancer of the nipple which is highly associated with DCIS?
Paget’s disease of breast
What does Paget’s disease of breast look like?
Indrawn nipple
Painful swelling
Eczema around affected area
Which breast cancer is Paget’s disease most associated with?
DCIS
Is Paget’s disease invasive?
No
Still a carcinoma in-situ, bound by the basement membrane, but is likely to invade if not cut out
How is DCIS managed?
Surgical excision +/- radiotherapy, chemo, hormones, Herceptin
depends on the makeup of the tumour
Which proteins are commonly found in epithelial tumours and can be stained?
Cytokeratins
Both lobular and ductal neoplasms have the potential to become which tumours?
Invasive carcinomas
Which structure is breached in invasive carcinomas?
Basement membrane
What is the most common cancer affecting females?
Breast cancer
What is the most common cancer affecting males?
Prostate cancer
The incidence of breast cancer (increases / decreases) with age.
increases with age
thus screening
(Increased / Decreased) age is a risk factor for breast cancer.
Increased age is a risk factor for breast cancer
Genetic mutations in which genes are risk factors for breast cancer?
BRCA1 / 2
TP53 (Li Fraumeni syndrome)
When menstrual abnormalities predispose you to breast cancer?
Early menarche
Late menopause
Multiparity is a risk factor for breast cancer - true or false?
False
Nullparity is a risk factor for breast cancer - true or false?
True
Which lifestyle factors increase a person’s risk of developing breast cancer?
Obesity
Alcohol consumption
Which genetic mutations are best known for causing breast cancer?
BRCA1 / BRCA2
Which local structures can breast cancer spread to?
Breast stroma
Skin
Anterior chest wall muscles
Which lymph nodes does breast cancer commonly spread to?
Axillary nodes (numbered 1 -3 inferior to superior) laterally
Internal mammary (thoracic) nodes medially
Both of these drain to the supraclavicular nodes (which is why you check here in a breast exam)
What are sentinel nodes?
The first lymph nodes which would drain a suspected tumour
What is a sentinel node biopsy?
Excision of the first nodes would drain a tumour to see if they’re positive for cancer
Which type of carcinoma in situ most commonly gives rise to invasive breast cancer?
DCIS
What is the difference between the
a) stage
b) grade
of a tumour?
a) Stage = spread
b) Grade = degree of differentiation
The more differentiated a tumour is, the (better / worse) its prognosis.
worse
because the tumour cells highly metaplastic - not like their parent cells
The more ___ receptors an invasive carcinoma has, the better its prognosis.
hormone receptors
because it can be targeted by drugs
Malignant breast tumours possessing oestrogen receptors are susceptible to which treatments?
Oophorectomy
Tamoxifen
Malignant breast tumours possessing progesterone receptors are vulnerable to which treatments?
Oophorectomy
Tamoxifen
I think it’s just the same as oestrogen receptors
Apart from oestrogen and progesterone, what is another type of hormone receptor which is found in breast cancer?
HER2
Which monoclonal antibody is derived from mice and can be used to target HER2 receptors in breast cancers?
Trastuzamab / Herceptin
which can’t be given to pregnant women
Malignant breast tumours possessing HER2 receptors are vulnerable to which treatment?
Trastuzamab / Herceptin
What is meant by the term triple negative when referring to breast cancer?
Tumour cells don’t have oestrogen, progesterone or HER2 receptors
Rendering it harder to treat
Which gene mutations tend to cause triple negative breast cancers?
BRCA1 / 2
Which organs are a common site of breast cancer metastasis because they produce oestogen?
Ovaries
What are the treatment options for invasive carcinomas?
Surgery
Hormone therapy
Radiotherapy
Chemotherapy inc. trastuzamab
