Malignant breast pathology

Question 1

common breast cancer after radiotherapy

Answer 1

angiosarcoma

Question 2

common metastatic tumours to breast

Answer 2

lung
ovary
kidney
melanoma
soft tissue (leiomyosarcoma)

Question 3

what type of cancer is breast carcinoma

Answer 3

adenocarcinoma

Question 4

what does breast carcinoma arise in

Answer 4

terminal duct lobular unit

Question 5

what are the 2 precursor lesions to breast carcinoma

Answer 5

ductal carcinoma in situ

lobular in situ neoplasia

Question 6

what are the precursor cancers contained in

Answer 6

basement membrane

if passes basement membrane - invasive and malignant

Question 7

histology of LISN

Answer 7

intralobular proliferation
small-intermediate sized nuclei
intracytoplasmic lumens/vacuoles

Question 8

what does LISN test positive for

Answer 8

ER

Question 9

what does LISN test negative for

Answer 9

E-cadherin (a tumour suppressor gene)

loss of this means unopposed proliferation

Question 10

what precursor is mire common

Answer 10

DCIS

Question 11

what is DCIS involving nipple called

Answer 11

paget’s

Question 12

risk factors for breast carcinoma

Answer 12

age (40-60)
early menarche
late menopause 
first pregnancy >30
nulliparity 
not breastfeeding
HRT and OCP
 previous breast Ca 
lifestyle

Question 13

what gene is associated with breast cancer

Answer 13

BRCA 1 and 2

Question 14

where is breast carcinoma likely to metastasize to

Answer 14

bone 
liver 
brain 
lungs 
abdo viscera 
female genital tract

Question 15

what hormone receptors can breast cancer express

Answer 15

oestrogen (ER)
progesterone (PR)
HER2

Question 16

what hormone receptor expression is an indication of a poor prognosis

Answer 16

HER2

Question 17

if the tumour expresses oestrogen receptors, what medication can be given

Answer 17

tamoxifen 
aromatase inhibitors (letrozole)
GnRH antanoists (goserilin - zoladex)

Question 18

why can aromatase inhibitors only be given to post-menopausal women

Answer 18

initiates menopause

Question 19

what can be given if tumour expresses HER2 receptors

Answer 19

Herceptin - trastuzamab

Question 20

TNM staging for breast cancer

Answer 20

T1 - <2cm
T2 - 2-5cm
T3 - >5cm
T4 - pos d’orange/fixed to chest wall

N1 - mobile ipsilateral nodes
N2 - fixed nodes

M1 - distant metastases

Question 21

Breast carcinoma stages

Answer 21

stage 1 - confined to breast and mobile
stage 2 - confined to breast, monile, nodes in ipsilateral axilla
stage 3 - tumour fixed to pec major but not chest wall, fixed ipsilateral nodes or skin involvement
stage 4 - complete fixation to chest wall or distal mets

Question 22

management of early invasive breast cancer

Answer 22

breast conserving surgery and radiotherapy

if tumour >5mm, mastectomy and radiotherapy