Breast carcinoma In situ Flashcards
(74 cards)
Etiology of breast cancer
1 in 8 women, nearlth 20% cancer deaths (2nd to lung) average age is mid 50s
Risk factors for breast carcinoma
75% are over 50
more in north america and northern europe
Highest in non-hispanic
early period adn late menopause = higher risk
first birth >35 higher risk
Family Hx and breast cancer
1st degree relative: 13% adn 87% wont get cancer
prior atypical breast biopsy or prior estrogen exposure, radtiation or carcinoma of other breast
Three main factors for breast pathogenesis
Genetics (proto-onco mutatio in Her2/Neu) (Tumor suppressor genes of BRCA1 or 2)
Hormonal
Environmental
Major risk = hormone exposure, seen in POST mentopauseal women with OVERexpression of estrogen receptor ER
Sporadic Breast Carcinoma
____ breast cancers are Hereditary
_____ are Familial
______ are Sporadic
5-10% Hereditary
15-20% Familial
70-80% are sporadic
Dx after menopause, low incidence of cancer in the family, influcenced by environmental factors, increases with age (hormones) and lifestyle (alcohol/obese)
Sporadic Breast cancer
Caused by a combination of factors: MULTI- FACTORIAL, Multiple low-penetrance genes may play a role and interact with Environmental triggers and see family ‘clustering’
Familial Breast Cancer
Main cause is a single germline gene mutation in the family, Multiple generations often affected Typically young age of breast cancer onset (<50 yrs)
Hereditary Breast Cancer
Hereditary Breast and Ovarian Cancer (HBOC)
Ashkenazi Jewish
Triple negative tumors (BRCA1)
Cowden syndrome (PTEN gene): Breast, thyroid, uterine
Li Fraumeni syndrome (TP53 gene) Breast, brain, leukemia, sarcoma
Examples of Hereditary Breast cancer with clustering
What is the 3-2-1 rule
3 family members with breast cancer REGARDLESS of age
2 family members with breast cancer, 1 dx <50 yrs
1 family member with Ovarian cancer
______is more relevant than the number of women with the disease
Age of onset of breast cancer
Ovarian cancer is an important indicator of
hereditary risk, although it is not always present.
BRCA1 and BRCA2 are associated with what cancers?
Breast, ovarian, pancreatic, prostate
What kind of genes are BRCA1 and BRCA2
they repaire ds DNA breaks; tumor suppresor gene
damage here in germline is bad news!
Pattern of inhericance for BRCA1 and BRCA2
lifetime risk of breast cancer:
associated cancer
Auto Dominant
45-85% risk of breast cancer
15-45% ovarian cancer risk
incrase prostate, male breast, pancreatic and melanoma
Key for Dx of neoplasm
is it benign or malignant, what tissue is it from, why type of cancer, did it met?
is it invasive,
Grade: how simuar to normal cells or differentiated
Stage: extent of spread
What is progression of breast disease to carcinoma
NOrmal–> Hyperplasia–> Atypical hyperplasia–> Carcinoma in situ
–> invasive cancer
Normal duct cells will have this intact and you can see it on staining, means cancer is still IN situ
intact myoepithelila layer of duct
What happens in INvasive ductal carcinoma in situ
normal duct, ductal cancer cells break through basement membrane
Ductal CArcinoma in situ (DCIS)
Mean age:
bilateral:
palpabel?
HOw do we find them?
ductal carcinoma in situ: mean age is 50-59, not often bilateral nor palpable
represents 30-40% cacrinomas found on mammograpy
See this on mammogram of 55 year old pt. No mass was noted. What is the likely dx?
Ductal carcinoma in situ
<20% palpable and found incidentally
Types of Ductal carsinoma in situ
Comedo, cribiform, micropapillary, papillary, solid, flat
