Breast cancer

Question 1

What percentage of cases of breast cancer happens in males?

Answer 1

1%

Question 2

What proportion of women will develop breast cancer in their lifetime?

Answer 2

1 in 12

Question 3

What increases the risk of male breast cancer?

Answer 3

Klinefelter’s
Male to female transexuals
Men treated with oestrogen for prostate cancer

Question 4

What is the most common type of breast cancer?

Name some other types

Answer 4

Adenocarcinoma (95%)

Primary sarcoma eg angiosarcoma

Question 5

Where is breast cancer most common?

Answer 5

Upper outer quadrant (about 50% occur here)

Question 6

Hormonal risk factors for breast cancer?

Answer 6

Gender
Uninterrupted menses
Early menarche (

Question 7

Other risk factors for breast cancer?

Answer 7

Geographic - higher in US and Europe
Atypical changes on previous biopsy
Previous breast cancer
Therapeutic radiation exposure especially in childhood/adolescence eg Hodgkin’s lymphoma
Genetics - mutations to BRCA1 and BRCA2 genes

Question 8

What do the BRCA1 and 2 genes normally do?

Answer 8

Tumour suppressor gene - their proteins repair damaged DNA

Question 9

Lifetime risk for female carriers of BRCA1/2 gene?

Answer 9

60-85%

Question 10

Classifications of breast carcinoma?

Answer 10

In situ or invasive

Ductal or lobular

Question 11

For in situ carcinoma, what limits the spread of neoplastic populations of cells? Where is the spread limited to?

Answer 11

Limited to ducts and lobules
Limited by basement membrane so that myoepithelial cells are spared
Does not invade into vessels so cannot metastasise

Question 12

How does ductal carcinoma in situ (DCIS) often present?

Answer 12

Mammographic calcifications (clusters or linear branching)

Sometimes as a mass

Question 13

How does DCIS appear histologically?

Answer 13

Central necrosis with calcification

Question 14

What can DCIS be a pre-cursor be a precursor to?

Answer 14

Invasive carcinoma (but not always)

Question 15

Where can DCIS spread to?

Answer 15

Through ducts and lobules, can be very extensive

Question 16

What is Paget’s disease of the nipple?

Answer 16

When DCIS cells extend to nipple skin without crossing the basement membrane
Get unilateral red and crusting nipple

Question 17

What is invasive carcinoma?

Answer 17

When DCIS has invaded beyond the membrane

Can invade into vessels and therefore metastasise to lymph nodes

Question 18

How does invasive carcinoma usually present?

Answer 18

As a mass or mammographic abnormality

-by the time a mass is palpable, more than half will have axillary lymph node metastases

Question 19

What is peau d’orange?

Answer 19

When lymphatic drainage of skin is involved

Question 20

Types of invasive carcinoma?

Answer 20

Invasive ductal carcinoma, no special type (IDC NST)
-70-80%

Invasive lobular carcinoma
-5-15%

Tubular (good prognosis), mucinous (good prognosis, older women)

Question 21

Histological appearance of IDC NST?

Answer 21

Well-differentiated type - tubules lined by atypical cells

Poorly differentiated type - sheets of pleomorphic cells

Question 22

Histological appearance of invasive lobular carcinoma?

Answer 22

Infiltrating cells in a single file, cells lack cohesion

Question 23

Prognosis of IDC NST and invasive lobular carcinoma?

Answer 23

35-50% 10 year survival

Question 24

Patterns of metastasis of breast cancer?

Answer 24

Lymph nodes via lymphatics, usually in ipsilateral axilla

Distant mets via blood vessels - bones, lungs, liver, brain

Question 25

Which cancer can spread to odd sites?

Answer 25

Invasive lobular carcinoma (peritoneum, retroperitoneum, leptomeninges, GI, ovaries, uterus)

Question 26

Factors determining prognosis in breast cancer?

Answer 26

``` In situ disease or invasive Histologic subtype - IDC NST has poor prognosis Tumour grade Tumour stage Gene expression profile ```

Question 27

How are breast tumours staged?

Answer 27

Tumour size Locally advanced disease - invading into skin or skeletal muscle Lymph node mets Distant mets

Question 28

How to diagnose breast cancer?

Answer 28

Triple approach - clinical - history, family history, examination - radiographic - mammogram and ultrasound - pathology - fine needle aspiration cytology and core biopsy

Question 29

Therapeutic approach to local and regional breast cancer?

Answer 29

Breast surgery -mastectomy or breast conserving surgery Axillary surgery -extent depending on whether there are nodes involved Post-op radiotherapy to chest and axilla

Question 30

Systemic control of breast cancer?

Answer 30

Chemo Hormonal treatment -tamoxifen if high amount of oestrogen receptors found on assessment Herceptin treatment -depends on amount of HER2 receptors found on assessment