invasive breast carcinoma

Question 1

incidence of carcinoma

Answer 1

1/8 women
40k deaths
2400 male presentations

Question 2

risk factors for carcinoma

Answer 2

first degree relatives with breast cancer
increased length of repro life
nulliparity or primagravidas > 35 yo
obesity
exogenous estrogens
previous breast or endometrial carcinoma

Question 3

mammography areas of concern

Answer 3

irregular radiodensities and microcalcifications

Question 4

familial versions

Answer 4

5-10% of cases
BRCA 1/2 and p53 (li-fraumeni)
younger pts and bilateral tumors

Question 5

stats for CIS

Answer 5

Ductal CIS = 80%

lobular CIS =20%

Question 6

stats for invasive carcinoma

Answer 6

ductal = 80%
lobular 10%
tubular/cribriform carcinoma 6%
medullary carcinoma 2%
colloid carcinoma 2%

Question 7

describe high grade DCIS

Answer 7

comedonecrosis

therapy: lumpectomy + radiation

Question 8

describe low grade DCIS

Answer 8

low grade nuclei, cribriform, solid or papillary pattern

Question 9

paget’s disease of breast

Answer 9

DCIS that has spread to the nipple skin

ulcerated, fissured and oozing nipple, like eczema, usually an underlying mass

Question 10

histology and prognosis for paget’s breast disease

Answer 10

malignant ductal cells invading the epidermis

prognosis depends on stage

Question 11

clinical and histology of LCIS

Answer 11

premenopausal, multifocal and bilateral lesions

expansion and filling of the acini with uniform bland cells

Question 12

course of LCIS

Answer 12

30% progress to invasive over a 24 YEAR period ergo it is a marker, NOT a precursor

Question 13

exception to the marker rule for LCIS

Answer 13

if it contains pleomorphic nuclei, signet ring cells, or if the ducts are involved with central necrosis

Question 14

treatment of LCIS

Answer 14

close follow up, tamoxifen, some people want bilateral mastectomy

Question 15

invasive ductal carcinoma

Answer 15

most common type of malignancy
stony hard, irregular, fixed, skin dimpling lump
scirrhous carcinoma (scar like)
infiltrating malignant ductal cells, with variable gland formation

Question 16

invasive lobular carcinoma

Answer 16

10%, more likely to be bilateral or multicentric
clinically similar to ductal, but mets are more likely to be in the peritoneum
could be rubbery or stony
infiltrating individual low grade malignant cells, often aligned in a single file

Question 17

spread of invasive carcinomas (in general)

Answer 17

axillary lymph nodes, internal mammary lymph nodes, lungs bone and liver

Question 18

prognosis of carcinoma depends on…

Answer 18

stage!
size < 2cm good
no lymph nodes = 70-80% survival
1-3 + = 35-40%
>10 + = 10-15% 

other factors 
ER-PR (tamoxifen)
DNA ploidy
Her2
p53
proliferation rate
histologic grade

Question 19

what is Ki-67?

Answer 19

proliferation marker

Question 20

what are the four molecular subtypes?

Answer 20

Luminal A
Luminal B
Triple negative
Her2

Question 21

describe Luminal A vs. Luminal B

Answer 21

ER &/v PR +
Her 2 -
low Ki67

ER &/v PR +
Her2 +/-
high Ki67

A is better than B prognosis wise
A=40%
B=20%

Question 22

describe triple negative

Answer 22

all three negative, and ck5/6 + &/v EGFR +
worse prognosis
15-20%

Question 23

Her2?

Answer 23

ER-, PR-, Her2+
worst prognosis
10-15%