Breast Cancer

Question 1

Describe DCIS

Answer 1

DCIS = ductal carcinoma in situ

• proliferation of ATYPICAL cells within a duct;
• hasn’t broken through the basement membrane
• precursor to cancer

Question 2

Describe LCIS

Answer 2

LCIS = lobular carcinoma in situ

• NOT cancer!!
• but does increase risk of cancer.
• doesn’t show up on mammogram.
• proliferation within the lobules.

Question 3

5 major risk factors for breast cancer

Answer 3

• intraductal papilloma (bleeding nipple)
• atypical hyperplasia (basically a precursor to DCIS)
• LCIS - lobular carcinoma in situ
• first birth later in life, or no kids. (unopposed estrogen effects)
• obesity

Question 4

3 options for breast cancer risk reduction in high risk patients.

Answer 4

• prophylactic mastectomy
• yearly screening (MRI and mammogram), along with breast exams every 6 mo.
• Tamoxifen is sometimes given for DCIS lesions to prevent cancer.

Question 5

mammogram is positive for calcifications. next step?

Answer 5

do multiple “core biopsies”

Question 6

What is one thing that differentiates between LCIS and DCIS in pathology? (they can be difficult to tell apart)

Answer 6

LCIS has loss of E-cadherin staining

L=Loss of E-cadherin staining**

Question 7

Management of LCIS

Answer 7

• excise it!!
• she now has a ~40% lifetime chance of cancer, so she should have a rigorous surveillance schedule
• prophylactic mastectomy typically not done (60% chance of NOT getting cancer)

Question 8

Management of DCIS

Answer 8

• excise it!

- anti-estrogen therapy if DCIS is estrogen sensitive.

Question 9

44yo woman with an abnormal mammogram and 2 cm mass palpable in right breast. What should you do on physical exam?

Answer 9

• lymph nodes in head/neck,
• examine spine (bony metastasis),
• ask about bone/joint pains,
• neuro exam for neurologic symptoms

Question 10

Features to look for on ultrasound for breast cancer

Answer 10

• partially hypoechoic (darker), partially isoechoic (heterogeneous - bad sign)
• irregular borders.
• cancer is often taller than it is wide on ultrasound, but not always

Question 11

Difference b/t mastectomy and lumpectomy in terms of

• recurrence rate
• survival

Answer 11

survival the same!!

-recurrence rate higher

Question 12

What % lifetime risk for breast cancer must a person have for insurance to cover screening?

Answer 12

20% or above.