Lecture 13- Breast cancer Flashcards

Question

Fibroadenomas

Answer 1

* Present with a mass, usually mobile, or mammographic abnormality * ‘Breast mouse’ – mobile and elusive * Can be multiple and bilateral * Can grow very large and replace most of the breast * Macroscopically - well circumscribed, rubbery, greyish/white * Histology - composed of a mixture of stromal and epithelial elements * Can mimic carcinoma clinically and mammographically * Localised hyperplasia rather than true neoplasm

Answer 2

* Glandular and stromal elements

Answer 3

* Enlargement of male breast * Unilateral or bilateral * Often seen at puberty and in the elderly * Can mimic male breast cancer especially if unilateral * No increased risk of cancer

Answer 4

Caused by relative **decrease in androgen** (testosterone) effect or **increase in oestrogen effect**

Answer 5

* Occurs in most **neonates** secondary to circulating maternal and placental oestrogens and progesterone * **Transient gynaecomastia** affects more than half of boys in puberty as oestrogen production peaks earlier than that of testosterone * **Klinefelter’s syndrome** * **Oestrogen excess** - cirrhosis of the liver (when oestrogen not metabolised effectively) * **Gonadotrophin excess** - functioning testicular tumour, e.g., Leydig and Sertoli cell tumours, testicular germ cell tumours * **Drug-related** – spironolactone, chlorpromazine, digitalis, cimetidine, alcohol, marijuana, heroin , anabolic steroids

Answer 6

adenocarcinomas * **Most common in the upper outer quadrant (50%)** * Other malignant tumours are very rare e.g. primary sarcomas such as angiosarcoma

Answer 7

*Major risk factors are related to hormone exposure* * Gender * Uninterrupted menses * Early menarche (\< 11 years) * Late menopause * Reproductive history - parity and age at first full term pregnancy * Breast-feeding * Obesity and high fat diet * Exogenous oestrogens – HRT slightly increases risk (1.2-1.7 times), long term users of COCP possibly have an increased risk * Breast density * Geographic influence * Higher incidence in US and Europe * Possible explanations include diet, physical activity, breast-feeding, environmental factors, alcohol consumption * Atypical changes on previous biopsy (4-5 times) * Previous breast cancer (10 times) * Radiation * Increased risk with previous exposure to therapeutic radiation (especially in childhood or adolescence), e.g. mantle radiation for Hodgkin’s lymphoma * Genetics

Answer 8

* BRCA1 (BReast CAncer associated gene 1) or BRCA2 * Both tumour suppressor genes – their proteins repair damaged DNA * 0.1% of population has BRCA1 germline mutations * Lifetime breast cancer risk for female carriers is 60- 85% * Median age at diagnosis is approximately 20 years earlier than sporadic cases * Carriers may undergo prophylactic mastectomies * Another gene involved in hereditary breast cancer is P53 (Li-Fraumeni syndrome)

Answer 9

Another gene involved in hereditary breast cancer is p53

Answer 10

* Cells can extend to nipple skin without crossing BM = Paget’s disease * Unilateral red and crusting nipple * Eczematous or inflammatory conditions of the nipple should be regarded as suspicious and biopsy performed to exclude Paget’s disease * Requires further investigation

Answer 11

1. in situ 2. invasive 3. ductal 4. lobular

Answer 12

* Neoplastic population of cells limited to ducts and lobules **by basement membrane (BM**), myoepithelial cells are preserved * Does not invade into vessels and therefore cannot metastasise or kill the patient

Answer 13

* Non-obligate precursor of invasive carcinoma * Presentation * Mammographic calcifications (clusters or linear and rbanching and can be seen as a mass) * Can spread through ducts and lobules and be very extensive * Histologically often shows central necrosis with calcification

Answer 14

* Neoplastic cells have invaded **beyond BM** into stroma * Can invade into vessels and can therefore metastasize to lymph nodes and other sites * Usually presents as a mass or as mammographic abnormality * By the time a cancer is palpable more than half of the patients will have axillary lymph node metastases * Peau d’orange – involvment of lymphatic drainage of skin

Answer 15

tumour may be tethered to nipple

Answer 16

* 70-80% * Well-differentiated type – tubules lined by atypical cells * Poorly differentiated type – sheets of pleomorphic cells * 35-50% 10 year survival

Answer 17

* 5-15% * Infiltrating cells in a single file, cells lack cohesion * Similar prognosis to IDC NST

Answer 18

Other types, e.g. tubular (1-2%, excellent prognosis), mucinous (1-6%, excellent prognosis, often older women)

Answer 19

* Irregular * Condensed part which tugs other tissue in e.g. inverted nipple or breast dimple

Answer 20

* Very small and can resemble lymphocytes * Infiltrate very subtilty in the stroma * Don’t always form a palpable mass

Answer 21

* Lymph nodes via **lymphatics**– usually in the ipsilateral axilla * Distant metastases via **blood vessels** – bones (most frequent site), lungs, liver, brain

Answer 22

* In situ disease (cant really be fatal) or invasive carcinoma * Tumour stage: * Tumour size and locally advanced disease – invading into skin or skeletal muscle * Lymph Node metastases * Distant Metastases * Tumour grade * Histologic subtype – IDC NST has poorer prognosis * Molecular classification and gene expression profile

Answer 23

* Grade 3- doesn’t resemble tissue of origin- poorly differentiated the higher the grade the less differentiated

Answer 24

oestrogen receptor postive and negative

Answer 25

Her2 positive or negative

Answer 26

better prognosis

Answer 27

better prognosis (can have Herceptin)

Answer 28

poor prognosis and usually BRCA1

Answer 29

* Triple approach * **Clinical** – history, family history, examination * **Radiographic** imaging – mammogram (in older) and ultrasound scan (in younger) * **Pathology** – core biopsy and fine needle aspiration cytology (FNAC)

Answer 30

* Started in the UK in the late 1980s * Women 47–73 years * 2 view mammograms every 3 years * Aim is to detect small impalpable cancers and pre-invasive cancer (incidence of DCIS has increased from 5% of breast cancers to 25% in screened populations) * Look for asymmetric densities, parenchymal deformities, calcifications * Assess abnormalities using further imaging, core biopsy and FNAC

Answer 31

**Local and regional control** * breast surgery * axillary treatment * poster-operative radiotherapy to chest and axilla **Systemic control** * chemotherapy * hormonal treatment * herceptin

Answer 32

mastectomy or breast conserving surgery – decision depends on patient choice, size and site of tumour, number of tumours, size of breast

Answer 33

**–** extent depending on whether there are involved nodes (sentinel node sampling or axillary dissection)

Answer 34

* Reduces the risk of postoperative morbidity * Intraoperative lymphatic mapping with dye and/or radioactivity of the draining or ‘sentinel’ lymph node(s) – the one most likely to contain breast cancer metastases * If the sentinel node(s) is negative axillary dissection can be avoided – e.g. avoid lymphodema

Answer 35

if benefits thought to outweigh the risks; if given before surgery = neoadjuvant

Answer 36

e.g. tamoxifen – depending on oestrogen receptor status (approximately 80% of cancers are ER positive)

Answer 37

depending on Her2 receptor status (approximately 20% of cancers are Her2 positive) * Her2 is a member of the human epidermal growth factor receptor family * Encodes a transmembrane tyrosine kinase receptor * Herceptin = trastuzumab = humanised monoclonal antibodies against the Her2 protein

Answer 38

* Early detection – awareness of disease, importance of family history, self-examination, mammographic screening * Neoadjuvant chemotherapy – early treatment of metastatic disease * Use of newer therapies – e.g. Herceptin * Gene expression profiles * Prevention in familial cases * genetic screening, prophylactic mastectomies

Lecture 13- Breast cancer Flashcards

(66 cards)