Breast Cancers Flashcards
(53 cards)
1
Q
Low risk factors for Breast Cancer?
A
- Female Gender
- Menarche by age 11
- No live births before 35
- Post menopausal hormone replacement
- Race: Non-hispanic white females
- Age (increasing)
2
Q
Moderate risk factors for Breast Cancer?
A
- Personal Hx of breast cancer
- Biopsy proven precancerous lesion
- Hx of breast cancer in 1st degree relative
- Dense breasts
3
Q
High risk factors for Breast Cancer?
A
- Hx of chest radiation btwn ages 10-30
- BRCA gene mutation
- Li-Fraumeni syndrome
- Cowden syndrome
- BRCA gene mutation, Li-Fraumeni syndrome or Cowden syndrome in 1st degree relative
4
Q
BRCA gene mutations
A
- Most common hereditary cause of breast cancer
- Tumor suppressor genes on the long arm of chromosome 17
5
Q
______ gene increases the risk of developing male breast cancer
A
BRCA2
6
Q
_____ gene mutation increases the risk of developing breast cancer (80%) and ovarian cancer, usually serous type (50%)
A
BRCA1
7
Q
BRCA gene breast cancer - Presentation?
A
Young woman with a high-grade (poorly differentiated) breast cancer
8
Q
Breast Cancer Screening methods
A
- Monthly self breast exam.
- Annual breast exam by healthcare professional.
- Annual mammogram starting at age 40.
- MRI for high-risk patients
9
Q
In-situ Breast carcinomas – types?
A
- Ductal carcinoma in-situ
- Lobular carcinoma in-situ
- Paget’s disease
10
Q
Dx?
- Almost always detected by mammogram
- Usually presents as micro calcifications
- Represents up to 30% of breast cancers
A
Ductal Carcinoma In-Situ (DCIS)
11
Q
Lobular Carcinoma in-situ – Tx?
A
Anti-Estrogen
12
Q
Dx?
- Always an incidental finding
- More common in PREmenopausal women
- Not associated with calcifications
A
Lobular Carcinoma in-Situ (LCIS)
13
Q
Dx?
- A form of in-situ carcinoma, where tumor cells grow within the epidermis of the nipple and/or areola.
- Present 1-4% of breast carcinoma.
- Almost always associated with underlying high-grade DCIS or invasive carcinoma
A
Paget’s Disease
14
Q
Dx?
Presents as an eczematous, red, crusted nipple lesion.
A
Paget’s Disease
15
Q
How does Paget’s Disease present?
A
Presents as an eczematous, red, crusted nipple lesion
16
Q
DCIS - Almost always detected by ______
A
mammogram
17
Q
DCIS - Usually presents as ______
A
microcalcifications
18
Q
DCIS - how is it characterized prognostically?
A
- Comedo (grossly, if you squeeze the cut surface of the lesion, the necrotic material is pushed out like comedons) or Non-Comedo
- Low, Intermediate, or High Grade — based on degree of nuclear atypic
19
Q
Intraductal proliferation with punched out spaces “cookie cutters” – this sub-type of DCIS is referred to as ______ type.
A
DCIS: Cribriform type
20
Q
What sub-type of DCIS is described below?
The duct is completely filled with a monotonous population of cells; also note associated microcalcification.
A
DCIS: Solid type
21
Q
How does invasive breast cancer present clinically?
A
- Presents as a mass, either palpable or mammographically detected
- Central tumors may cause retraction of the nipple
22
Q
________ is a high grade carcinoma by default.
A
Inflammatory carcinoma
23
Q
Inflammatory Carcinoma - characteristics?
A
- Carcinoma that presents with swollen erythematous breast.
- Invasion of the dermal lymphatics blocks drainage leading to lymphedema, swelling and thickening of skin
- Tethering of the skin of the breast to the Cooper ligaments mimics an orange peel “peau d’orange”
24
Q
Dx?
Carcinoma that presents with swollen erythematous breast
A
Inflammatory Carcinoma
25
What causes Inflammatory Carcinoma to mimic an orange peel ("peau d'orange")?
Tethering of the skin of the breast to the Cooper ligaments
26
What causes Inflammatory Carcinoma to present w/ lymphedema & swelling?
Invasion of the dermal lymphatics blocks drainage leading to lymphedema, swelling and thickening of skin
27
Invasive Lobular Carcinoma:
a) Usually ____ Grade
b) Usually focal or multifocal?
c) Prognosis similar to ____ of same grade and stage
a) Low
b) Multifocal
c) IDC
28
What are the most characteristic histologic features of invasive lobular carcinoma?
- Infiltration of tumor cells in single files
| - They are commonly arranged circumferentially around benign residual ducts in a “targetoid” fashion (arrow)
29
Dx?
| Small, low grade tumor composed entirely of small tubules, with pointed ends “tear-drop shape”
Tubular Carcinoma
30
Tubular Carcinoma - Prognosis? Risk of metastases?
- Low risk of metastases
| - Excellent prognosis
31
T or F?
| In Tubular Carcinoma, the tubules are lined by a single layer of bland tumor cells with hardly any mitotic activity.
True
32
Dx?
| Composed entirely of aggregates of tumor cells floating in pools of mucin.
Mucinous (Colloid) Carcinoma
33
Mucinous (Colloid) Carcinoma:
a) ____- Grade tumor
b) Demographic?
c) Prognosis?
a) Low-grade tumor
b) Elderly women
c) Good prognosis
(Composed entirely of aggregates of tumor cells floating in pools of mucin)
34
Medullary CA:
a) Gross appearance?
b) Histology?
c) Genetics?
a) Sharply-circumscribed, soft fleshy tumor
b) Malignant cells admixed with intense lymphocytic infiltration.
c) More common in BRCA1 carriers
35
________ typically has a well-circumscribed pushing (as opposed to infiltrating) border and syncytial sheets of tumor cells in a stroma rich in lymphocytes and plasma cells.
Medullary carcinoma
36
Dx?
| Adenocarcinoma but not forming glands!
Metaplastic CA
| Metaplastic component may be squamous, spindle cells, fibroblasts, bone, cartilage, etc…
37
Metaplastic CA:
| ______ outcome than other types
Worse
38
What are the Modified Bloom-Richardson Criteria for tumor prognosis?
1. % of tubule formation
2. Degree of nuclear atypic
3. # of mitotic figures in 10HPF
Low grade = More tubules, less nuclear atypia, fewer MF
The higher the grade, the worse the prognosis
39
How is tumor "Stage" determined?
TNM
T = Tumor Size.
N = lymph Node metastases
M = distant Metastases
Rule #1: Inflammatory carcinoma is considered T4
Rule #2: Distant metastases is stage IV
40
For TNM staging, inflammatory carcinoma is considered ____.
T4
41
The most important prognostic factor for Breast cancer?
Axillary Lymph Node metastases
42
Molecular Classification - 3 classifications & prognosis of each?
1. Luminal-type Carcinomas express Estrogen and have the BEST prognosis.
2. Her2-type cancers do not express ER or PR but show Her2-gene amplification. They have a BAD prognosis
3. Basal-like breast cancer are negative for all 3 markers & have the WORST prognosis
(more common in African-American women)
43
What are “Triple Negative” breast cancers?
Basal-like breast cancers, which are negative for all 3 markers (ER, PR, & HER-2).
Of the 3 molecular classifications, these have the WORST prognosis.
43
What are “Triple Negative” breast cancers?
Basal-like breast cancers, which are negative for all 3 markers (ER, PR, & HER-2).
Of the 3 molecular classifications, these have the WORST prognosis.
44
Pathologic features of Luminal-type-A breast cancers?
- WD IDC
- Lobular cA
- Tubular CA
- Mucinous CA
45
Pathologic features of Luminal-type-B breast cancers?
- MD IDC
| - Lobular CA
46
Pathologic features of Basal-like breast cancers?
- Poorly-differentiated IDC
- BRCA1- assoc
- African-American women
47
Pathologic features of Basal-like breast cancers?
- Poorly-differentiated IDC
- BRCA1- assoc
- African-American women
48
Luminal Type A breast cancer -- Tx?
Tamoxifen
49
Luminal Type B breast cancer -- Tx?
Tamoxifen
50
Basal-like breast cancer -- Tx?
Chemotherapy
51
Basal-like breast cancer -- Tx?
Chemotherapy
52
Trastuzumab - MOA?
Monoclonal antibody to HER-2 receptors
| - binds receptor on tumor cells to induce an antigen-antibody-reaction leading to cytotoxicity of tumor cells.
