Breast Cancer

Question 1

breast cancer

Answer 1

• most common form of reproductive cancer
• 1 in 9-10 women will develop it
• men can develop it too, but its rare

Question 2

etiology and risk

Answer 2

• mutation of oncogenes
• familial risk
• inherited forms (5-10%)
• ageing (d/t increased exposure to carcinogens; occurs later in life)
• hormonal factors (bc breasts are affected by hormones)

Question 3

origin of breast cancer

Answer 3

most found in upper outer quadrant (50%)

• then 15%, 11%, 6%
• 17-18% found in areola
• tail of spence: extension of breast tissue that extends into the axilla (close to axillary lymph nodes -> mets)

Question 4

describe inherited forms

Answer 4

• 75% have a mutated BRCA 1 gene on Chr 17 and BRCA 2 gene on Chr 13
• breast cancer gene 1 & 2 = tumor suppressor stop genes
• if fx is altered, growth suppression is limited and malignant cells proliferate rapidly

Question 5

how do hormonal factors play a part?

Answer 5

• HRT -> hormone replacement therapy for after menopause; of estrogen and progestin; exogenous supplementation may increase risk for CA
• early menarche (first period) extended estrogen exposure
• late menopause = breasts exposed to estrogen for longer periods of time
• nulliparity

Question 6

patho

Answer 6

various forms:

• in situ (tumor being in place/where it originates, will likely not mets, non-aggressive but still malignant)
• rest are invasive

Question 7

what are the different forms?

Answer 7

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/Breast Cancer
8. Paget’s Disease

Question 8

ductal carcinoma in situ

Answer 8

• 20%
• intraductal origin -> non-invasive
• stage 0 (tumor is in early stage that’s non-invasive)
  aka precancerous bc it has not yet advanced to the more aggressive form

Question 9

infiltrating ductal carcinoma

Answer 9

• 75%
• most common form
• dcis may lead to this, but it can form on its own
• ductal origin (tumor arises in duct system and invades surrounding tissues)
• solid irregular tumor
• aggressive; mets proximally (axillary lymph nodes) and distally (liver, bone, brain)

Question 10

infiltrating lobular carcinoma

Answer 10

• 10-15%
• tumor arises from lobular epithelium
• area of ill-defined thickening in breast
• multicentric, may be bilateral

Question 11

medullary carcinoma

Answer 11

• 5%

- well defined edge, similar to common invasive ductal carcinoma

Question 12

colloid carcinoma

Answer 12

• rare
• aka mucinous carcinoma -> CA cells prod mucous
• decreased mets and better prognosis

Question 13

tubular carcinoma

Answer 13

• 2%

- not likely to spread beyond breasts, good prognosis

Question 14

inflammatory breast cancer/carcinoma

Answer 14

• 1-3%
• malignant CA cells spread to lymph node channels in skin of breast
• edema, erythema, large breast size and peau d’orange caused by malignant cells blocking lymph channels

Question 15

paget’s disease

Answer 15

• 1% of all diagnosed breast CA cases (more common in age 50+)
• scaly, erythematous, pruritic lesion of the nipple

Question 16

manifestations

Answer 16

• vary by form and stage
• primary mnftn = palpable, unilateral mass in UOQ that is fixed, irregular and painless
• as mass advances, it may present with retracted nipples, discharge, and edema

Question 17

diagnosis

Answer 17

• mammography (used as a screen and dx test)
• biopsy
• SLN assessment
• serum markers - > CEA
• measuring sex hormone receptors on cells in biopsy sample
• most detected by pt.

Question 18

disadvantage of mammography

Answer 18

it can prod false positives (unnecessary dx and tx) or false negatives (tumor is missed)

Question 19

SLN

Answer 19

• sentinel lymph nodes
• 1st lymph nodes affected
• assessment is done to see if malignancy has spread

Question 20

CEA

Answer 20

• carcinoembryonic antigen
• test that measures amount of protein in the blood to determine how widespread the CA is
• normally prod, during fetal development and stops before birth
• secreted by malignant cells (more CA cells = increased CEA)

Question 21

measuring sex hormone receptors

Answer 21

estrogen and progesterone

large amount = CA is hormone-dependent

Question 22

treatment (varied)

Answer 22

• surgery, radiation, chemo

- hormone therapy if receptor numbers are high (withdraw hormone support by giving anti-estrogen or anti-progesterone)

Question 23

drugs

Answer 23

tamoxifen (synthetic non-steroidal anti-estrogen)
enzyme inhibitors (block synthesis of estrogen)

Question 24

surgery

Answer 24

• lumpectomy (remove mass and some surrounding tissue)
• quadrantectomy (remove entire quadrant where lump is)
• mastectomy (remove entire breast, not as common)
• radiation and chemo used in conjunction with sx, but bo ta big success