Breast Cancer

Question 1

Which system do the breasts fall under?

Answer 1

Reproductive system

Question 2

T/F: Breast cancer occurs in females and males.

Answer 2

True. It can occur in men, but this is very rare

Question 3

Etiology of BC?

Answer 3

Mutations of oncogenes (genes that regulate self-proliferation)

Question 4

Risk factors of BC?

Answer 4

• Familial risk
• 5-10% is inherited (75% have mutated BRCA1 gene on Ch17 and BRCA 2 gene on Ch13 and remaining 25% have inherited BC but it does not involve these mutated genes)
• increased age
• hormonal factors [1. women who receive hormone replacement therapy after menopause. 2. women who go into menopause late. 3. early menarche 4. Nulliparity d/t no break in the menstrual cycle]

Question 5

What are breast cancer gene 1 and 2?

Answer 5

Tumor supressor “stop” genes. With the function altered, growth suppression is limited and malignant cells proliferate rapidly.

Question 6

Which quadrant are the majority of breast cancers found?

Answer 6

upper outer quadrant

Question 7

Tail of sequence?

Answer 7

an extension of the breast tissue that extends into the axilla

Question 8

Where is the first place mets typically occur?

Answer 8

axillary lymph nodes

Question 9

Breasts are divided into 4 quadrants. List the percentage of BC found in the following quadrants:

1. Upper OUTER quadrant
2. Upper INNER quadrant
3. Lower OUTER quadrant
4. Lower INNER quadrant
5. Areolar

Answer 9

1. 50%
2. 15%
3. 11%
4. 6%
5. 18%

Question 10

In situ?

Answer 10

Referring to the tumor being in place -> AKA in situation, the tumour remains where it originates and will likely not metastasize

Question 11

Name the 7 types of breast cancer and 1 disease.

Answer 11

1. Ductal carcinoma in situ
2. Infiltrating Ductal carcinoma
3. Infiltrating Lobular Carcinoma
4. Medullary carcinoma
5. Colloid Carcinoma
6. Tubular carcinoma
7. Inflammatory carcinoma
8. Paget’s disease

Question 12

Ductal carcinoma in situ?

Answer 12

~20% of all breast cancer; intraductal -> non-invasive; Stage 0 (you have a tumour but it is int he early stage and is non-invasive- it is also referred to as pre-cancerous because it has not yet advanced to the more aggressive form)

Question 13

Infiltrating ductal carcinoma?

Answer 13

Most common (~75%); ductal carcinoma in situ may lead to this however, infiltrating ductal can carcinoma can also form on its own; ductal origin [tumour arises from the duct system and invaded the surrounding tissue]; solid, irregular mass; infiltrating referring to invasive.

Question 14

Infiltrating lobular carcinoma?

Answer 14

10-15% of breast cancers; tumours arise from lobular epithelium; area of ill-defined thickening in the breast; multi-centric and may be bilateral

Question 15

Medullary carcinoma?

Answer 15

~5% of breast cancers; well-defined edge, very similar to common invasive ductal carcinoma and is treated as such

Question 16

Colloid cancer?

Answer 16

• Rare; Aka mucinous carcinoma -> Cancer cells produce mucus; decreased metastases and better prognosis

Question 17

Tubular Cancer?

Answer 17

~2% of breast cancers; not likely to spread beyond the breasts -> good prognosis

Question 18

Inflammatory Carcinoma?

Answer 18

~1-3% of diagnosed breast cancer cases; cancer cells spread to the lymph node changes in the skin of the breast; edema, large breast size, erythema, “peau d’orange” [resembles an orange peel] caused by malignant cells blocking lymph channels

Question 19

Paget’s disease?

Answer 19

~1% of diagnosed breast cancer cases (more common in age 50+); scale, erythematous, pruritic lesion of the nipple

Question 20

Manifestations of breast cancer?

Answer 20

• painless mass (no pain on palpation); usually found on the upper outer quadrant; tail of spence and axillary region; as mass advances it may present with retracted nipples, discharge and edema in this area

Question 21

Diagnostics of breast cancer?

Answer 21

• mammography
• biopsy
• SLN assessment
• tumour markers -> carcinoembryonic antigen test
• measuring sex hormone receptors on the cells in the biopsy sample
• mostly detected by pt (pt feels lump and goes to doctor for further investigation)

Question 22

What is a disadvantage of a mammography?

Answer 22

false positives (may undergo unnecessary dx tests and tx) and false negatives (tumour is missed)

Question 23

SLN assessment?

Answer 23

Sentinel lymph node assessment; first lymph node that is affected which is usually the axillary lymph nodes. Assessment to see if the malignancy has spread.

Question 24

CEA?

Answer 24

carcinoembryonic antigen test -> usually produced during the development of a fetus and stop before birth, shouldn’t be present in a healthy adult. Secreted by malignant cells (more cancer cells = more CEA)

Question 25

Treatment for breast cancer?

Answer 25

• surgery, radiation, chemo
• hormone therapy if receptor numbers are high [tamoxifen; enzyme inhibitors]
• lumpectomy
• quadrantectomy
• mastesctomy

Question 26

Give an example of an anti-estrogen drug?

Answer 26

Tamoxifen