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Flashcards in Malignant breast cancer Deck (35)
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1

Lifetime probability of women developing cancer? Breast cancer?

1/3

1/8 for breast ~ 30%

2

Note the increase incidence in breast cancer in 1980, whats happening?

Introduction of mammographic screening
- catching smaller bc and at early age

*decrease in mortality is due to hormone tx and herceptin - actually does help

3

Men are most likely to get dx with which cancer and die from which?

Top 3 dx of cancer:
1. prostate cancer
2. Lung and bronchus
3. Colon rectum

More likely to die of:
1. lung+bronchus cancer
2. Prostate
3. Colon + rectum

4

Risk factors for breast cancer

1. hereditary breast cancer
- BRCA1, BRCA2
(both are TSG)
- CHEK2
- Syndromes
For hereditary - risk is very very high if no prophylaxis is taken
2. Sporadic
- most are due to hormonal (post-menopausal)

5

Which one is at a higher risk for ovarian cancer, BRCA1 or 2?

BRCA1 is more than 2

6

Syndromes that are additional causes of breast cancer and their associated gene mutation

1. Li fraumeni syndrome: mut in p53
- HER2 +
2. Cowden syndrome: mut in PTEN gen
3.Peutz-Jeghers syndrome: mut in STK11/LKB1

*in 2/3 of inherited breast cancer, the cause is unknown

7

Risk factors associatedvand Race associated with breast cancer


6. Prior biopsies: why did she need it in the first place?
7. Race: Caucasion>AA>Asian>Latina
8. Exogenous E exposure
9. Radiation exposure: to tx other malignancy
10. Cancer of opposite breast

8

Most likely cancer to met to breast

lymphoproliferative

9

Cancers originating from skin

carcinomas

10

Does DCIS have associated risk of invasive carcinoma?

Yes - surgical excision is often curative

11

Most sig risk factor for recurrence of DCIS?

1. Positive surgical margins
2. Histological grade
3. Extent of breast involvement (size)

12

Low grade DCIS express

High grade DCIS express?

Progesterone/estrogen receptor

HER2/Neu

13

What malignant breast cancer presents as rash on the nipple?

Pagets disease
often confused with eczema
- very likely that breast represents invasive carcinoma

14

Pagets disease of the nipple often resembles what cancer?

melanoma

15

Does LCIS typically form a mass or calcification?

No: discovered incidentally
- often multicentric and bilateral
- both breasts are at risk of invasive carcinoma (DCIS is just in ips breast)

16

Signs of locally advanced invasive carcinoma

1. Fixation to the underlying chest wall

17

Invasive carcinoma in women are more likely to be where in the breast?

Upper outer quadrant
(but can be anywhere)
- first spread to axillar LN

18

Most breast carcinoma falls in what category?

Invasive ductal carcinoma (NOS)

*2nd most common histologic type is invasive lobular carcinoma

19

Expression of tubular carcinoma

E/PR +
Her2/Neu -

Small, tubular, excellent prognosis
- almost all express hormone receptors and
do NOT overexpress Her2/neu

*poorly differentiated tumors also tend to overexpress HER2/neu more frequently

20

Mucinous carcinoma

1. well circumscribed mass in older age group
2. Favorable prog
3. Usually expresss H receptors and no Her2/Neu
4. More freq in patients with BRCA1 mut

21

Triple (-) prognosis

very poor
- not very much we can treat them with

22

3 main features of medullar carcinom

1. Indistinct cell border (aka syncytial growth)
2. Prominent lymphoplasmacytic infiltrate at peripher
3. Pushing borders

23

Metaplastic carcinoma

Usually ER/PR neg

24

Most important sarcoma in the breast? How does it develop?

angiosarcoma

1. Spontaneously
2. Treatment associated (following radiation therapy)
2. Chronic edema of the limb (stewart-Treves syndrome)

*if woman has been treated for breast cancer, keep an eye out for angiosarcoma in first 5 yrs following

25

Phyllodes tumor

Mixed tumor derived from stroma and epithelium
- leaflike projections
- differ from fibroadenomas by:
1. Mitotic rate
2. Overgrowth of hypercellular stromal component
3. Infiltrative borders

26

Prognostic factors of breast cancer

1. Lymph node metastasis!
- most imp factor
2. Tumor size
- second most imp factor
3. Presence of invasion
4. Distant metastases
5. Locally advanced disease
6. Inflammatory carcinoma

*dont confuse with risk factors
(Fam hx, exposures)

27

Expression of E and P receptors have what prognosis?

Good - more likely to respond to hormonally based therapy

28

Her2/Neu overexpression has what prognosis?

poor prognosis
- Trastuzumab, herceptin, work better if it is being overexpressed

29

Tubular, mucinous, medullary carcinoma have what prognosis?

better prognosis than invasive ductal carcinoma

30

Which is more risky for males, BRCA1 or 2 mut?

BRCA2 mut

men also present at higher stage - but prognosis is same to women.