Breast Cancer: Tis Flashcards
(41 cards)
Breast cancer
What are the three non-invasive histopathologic entities classified as Stage Tis?
-Paget disease of the nipple,
-lobular carcinoma in situ (LCIS) and
-ductal
carcinoma in situ (DCIS)
Breast cancer
LCIS has been reported to be multicentric in up to 10% of mastectomy speciments, with bilateral involvement in 35% to 59%.
TRUE or FALSE?
False.
multicentric in 90%
Breast cancer
LCIS cells are commonly ______ receptor positive.
Estrogen.
although overexpression of
c-erbB-2 and p53 are uncommon
Breast cancer
The loss of this adhesion molecule may explain the
growth pattern seen with LCIS.
What is this adhesion molecule?
E-cadherin
Breast cancer
LCIS represents ____ of all noninvasive breast cancer.
The majority of
women are ___menopausal at diagnosis, with an average age of __ years.
<15%
pre
45
Breast cancer
Why is LCIS not seen in males?
Because the male breast lacks lobular elements
Breast cancer
What is the most common presentation of LCIS?
As there are no clinical or mammographic
indicators that are characteristic of LCIS, it is often detected as an incidental
biopsy finding.
Breast cancer
In
excisional biopsy specimens, DCIS or invasive carcinoma are frequently
identified even when LCIS is the sole histologic entity seen on core biopsy.
TRUE or FALSE?
True.
Breast cancer
LCIS is considered a marker of increased risk for the subsequent development
of invasive (usually ductal) carcinoma that may be greatest for high-grade
or more extensive lesions.
This risk appears to be “nearly equal” for both
breasts
TRUE or FALSE?
True.
Breast cancer
In 2009, what imaging modality was recommended by the NCN to be part of the annual screening for patients with LCIS.
Breast MRI.
Breast cancer
What is the management for a breast which has an LCIS component and an invasive component?
the most widely
accepted treatment approach is to manage the breast according to the dominant
malignant histology (DCIS or invasive carcinoma) and disregard the LCIS. In
such circumstances, it is not necessary to pursue additional surgery to obtain
clear margins for LCIS
Breast cancer
What is the management for a breast which has LCIS as the sole histologic diagnosis?
obtain excision biopsy first.
pure LCIS on core biopsy sometimes reveal an invasive component.
If none, the most
widely accepted clinical practice is close observation with regular physical
examination and mammographic surveillance
Breast cancer
When do you do prohylactic bilateral mastectomy in LCIS patients?
young age, diffuse high-grade
lesion, and significant family history.
Breast cancer
What other prophylactic options can be given to patients with LCIS except mastectomy?
Tamoxifen.
Tamoxifen has
demonstrated efficacy in the prevention of invasive carcinoma and, in the
context of LCIS, has been shown to reduce risk by 56%
Breast cancer
What are the common presenting signs and symptoms of Paget disease?
burning and itching of nipple and areola.
crusting and eczematioid changes of the nipple and areola.
a palpable mass (50%) usually associated with invasive carcinoma in >90% of cases.
Breast cancer
What is the management for Paget disease?
mastectomy or breast-conserving techniques (surgery + rt)
Breast cancer
What is the most common mammographic findings in DCIS?
Microcalcifications
Linear and branching
calcifications frequently are associated with high-grade DCIS and necrosis,
whereas fine and granular calcifications are associated more commonly with
low-grade DCIS
Breast cancer
What imaging modality has the highest sensitivity to detect DCIS?
Breast MRI
particularly high-grade DCIS. MRI has
additionally been shown to better establish the extent of DCIS, thus aiding
treatment planning.
In cases that present with nipple discharge and a negative
mammogram, galactography may be helpful in determining the likelihood of
underlying DCIS versus papilloma
Breast cancer
Enumerate the 5 most common subtypes of DCIS.
- comedo
- solid
- cribriform
- micropapillary
- papillary
Breast cancer
Estrogen receptor expression rate is higher in high-grade lesions,
HER2/neu and p53 is higher in low grade lesions.
TRUE or FALSE?
False.
It’s the other way around
Breast cancer
An occult microinvasive tumor (one that does not exceed 0.1 cm in diameter)
may be seen with some cases of DCIS.
Such cases are classified as
microinvasive breast cancer and are generally treated according to the
guidelines for invasive disease.
Occult microinvasive tumors are most common in what circumstances involving DCIS?
-in patients with DCIS lesions that are >2.5 cm in diameter
-those presenting
with palpable masses or nipple discharge
-and those with high-grade DCIS or
comedonecrosis
Breast cancer
Women with DCIS in one breast are at risk for a second tumor (either invasive or in situ) in the contralateral breast; the rate at which such tumors develop is similar to that among women with primary invasive cancer at approximately 0.5% to 1% per year.
TRUE or FALSE?
True
Breast cancer
What is the recommended margin for BCS in DCIS?
2 mm (ASTRO/ASCO/SSO)
