Flashcards in Malignant Breast Disease Deck (82):
What is the second most common cancer in women behind lung cancer?
Carcinoma of the breast
What is the estimate of how many women will develop breast cancer during a life time?
1 in 14 women
How many new cases of breast cancer are diagnosed each year?
At least 180,000
How many women die of breast cancer each year?
46,000 (20% of all cancer deaths in women)
What is the cause of Carcinoma of the breast?
Unknown cause, but several important risk factors exist
What does the most important risk factor for Carcinoma of the breast point to?
Hormonal and genetic etiologies, which may act concomitantly, which may be paired with additional unidentified carcinogenic environmental substances or with some viruses
What are the eight (8) greatest risk factors for Carcinoma of the breast?
Sex, age, race, genetics, hormonal factors, presence of other cancers, Premalignant fibrocytic changes and Multiple Intraductal Papillomatosis, Other causes
What does sex have to do with Carcinoma of the breast?
Females are affected 100 time more often than males
What does age have to do with Carcinoma of the breast?
Very rare before puberty and quite unusual in young women. Incidence rises slowly after age 35 and peaks in postmenopausal women of about 60 years of age
What does race have to do with Carcinoma of the breast?
Uncommon in Japanese and Chinese. Most common in Caucasians and especially Jews
What does genetics have to do with Carcinoma of the breast?
Occurs more common in some families. If mother has, then all daughters have an increased risk. Same is true for sisters of breast cancer patient. Familial history increases risk for relative by 5-10 fold or higher in some families
What do hormonal factors have to do with Carcinoma of the breast?
Women who are exposed to estrogens for prolonged periods tend to develop breast cancer more often than those who are not. More common in women who have an early menarche and late menopause. Therefore are under the influence of ovarian sex hormones for a prolonged period of time.
T/F Nulliparious women are at a greater risk for breast cancer than those who have multiple children.
What is the most probable reason why multiparous women are at a lower risk for breast cancer than nulliparous women?
Pregnancy interrupts the cyclic secretion of ovarian estrogens
What kind of hormonal receptors do breast cancer cells have a lot of?
Estrogen receptors. Synthetic antiestrogens slow down cancer growth.
What does the presence of other cancers have to do with Carcinoma of the breast?
Increased incidence if cancer is present in other breast, as well as those that have ovarian or endometrial cancer. Perhaps b/c these tumors are hormonally induced, occurring in women in whom there is hyperestrinism
What does the presence of Premalignant fibrocytic changes and Multiple Intraductal Papillomatosis have to do with Carcinoma of the breast?
With atypical epithelial hyperplasia, along with multiple intraductal papillomas can progress to invasive carcinoma over a period of several years if cysts/papillomas are not removed.
What other causes raise the risk of Carcinoma of the breast?
Obesity, high fat diets, moderate alcohol consumption cal all increase the risk
What is the origin of most malignant breast tumors?
Epithelial origin and are therefore carcinomas (sarcomas would be of mesoderm or mesenchymal origin)
Where do most breast carcinomas occur?
45% occur in upper outer quadrant. ~25% of breast cancers are central, underneath the areola
What are the two classifications of breast cancers?
Noninvasive VS invasive, here we are talking about invasive cancers.
What percentage of carcinomas are non-invasive intraductal carcinomas?
20-30% lack the ability to invade thru the basement membrane and therefore no distant spread.
How do non-invasive intraductal carcinomas spread?
Thru the ductal system and still produce extensive lesions involving a large area of the breast.
T/F non-invasive intraductal carcinomas is thought to be a precursor to invasive carcinoma
What is the old term for non-invasive intraductal carcinomas?
What is a lobular carcinoma in-situ?
Cancerous proliferation in one or more terminal ducts andor ductules (acini).
Where is lobular carcinoma in-situ seen?
In breasts removed for fibrocystic change and is also seen in the vicinity of invasive carcinoma or can be admixed with foci of intraductal carcinoma
T/F lobular carcinoma in-situ is frequently multifocal and bilateral
What is lobular carcinoma in-situ a marker of?
Invasive ductal or lobular carcinoma
How frequent is invasive ductal carcinoma?
More than 2/3 of invasive carcinomas
What is an invasive ductal carcinoma?
An adenocarcinoma that is accompanied by a very strong "Desmoplastic" reaction where the tumor cells infiltrating the tissue are surrounded by dense CT that is produced by the host in response to the tumor
What is the appearance of an invasive ductal carcinoma tumor on sectioning?
Firm and gritty
What is the cause of puckering of the skin and retraction of the nipple, which are typical signs of a malignant breast lesion in invasive ductal carcinoma?
The dense CT of invasive ductal carcinoma pulls on the adjacent tissue
What is the quality of invasive ductal carcinoma on palpation?
Firm and do not have sharp margins as they infiltrate into the surrounding tissues
What is the histological appearance of invasive ductal carcinoma?
There are malignant duct lining cells in cords, solid nests, and tubules invading the surrounding stroma
What is the frequency of invasive lobular carcinoma?
5-10% of all breast cancers
Where does invasive lobular carcinoma arise?
From terminal ductules of the acini
T/F invasive lobular carcinoma tends to be bilateral far more frequently than invasive ductal cancers
Does invasive lobular carcinoma tend to be multicentric or monocentric?
What is the consistency of the invasive lobular carcinoma tumors?
Rubbery and poorly circumscribed (no Desmoplasia)
What is the histological appearance of invasive lobular carcinoma?
There are strands of single-file rows of malignant tumor cells dispersed thru the stroma, consisting of small round cells with little pleomorphism
What is the Targetoid pattern of arrangment?
Having solid nests and sheets arranged in concentric rings about normal ducts
What is Paget's disease of the breast?
A ductal carcinoma that forms in the nipple and areolar area, w/ usually an underlying carcinoma underneath
What does Paget's disease affect in the breast and cause to happen?
Affects the skin of the nipple, causing ulcers, fissures, discharge oozing, along w/ edema and inflammation surrounding the nipple
What is the histological appearance of Paget's disease?
There is involvement of the epidermis by malignant, large clear-staining cells (Pagets cells), from the underlying cancer present beneath the nipple that is palpable in about 60% of cases
How does breast cancer tend to metastasize?
Thru the lymphatics
Why is it expected that most metastases are found in the axillary area?
B/c most lymph ducts drain into the axillary lymph nodes
Carcinoma of the breast can be a focal lesion, where can it extend?
In all directions and may become adherent to the deep fascia of the chest wall and become fixed in position
Where can medially of centrally located tumors spread?
Into the internal mammary lymph nodes
Where are distant metastases common?
In the lungs, liver, bones, brain, and adrenals
How is 80-90% of cases of breast carcinomas detected?
By self-examination, palpation in the clinician's office, or by Mammography
What is the size of carcinoma of the breast?
Can be any size, frequently measuring 1 cm to several cm in diameter.
What is carcinoma of the breast occasionally associated with?
Enlarged axillary lymph nodes
In carcinoma of the breast, what does extension of the skin cause?
Retraction and dimpling, and at the same time lymphatics may be obstructed by tumor, causing blockage of skin drainage, causing lymphedema and thickening of the skin
What is peau d'orange?
Orange peel appearance of skin affected by carcinoma of the breast
When would retraction of the nipple develop in carcinoma of the breast?
When the tumor involves the main excretory duct
What must a complete physical exam of females include?
Palpation of the breast in all instances. Any suspicious masses or nodules should undergo a breast biopsy
What is mammography?
Low-density radiographs that allow detailed examination of the breast
What is the advantage of mammography?
Tumor masses can be detected in early stages of development, even before they have reached the size that can be palpated
What is the smallest tumor size that can be detected via mammography?
.5 cm - appear as increased density and frequently calcifications are also detected
How is a breast biopsy performed?
Using a fine needle aspiration technique with local anesthesia
What is the accuracy rate of a cytopathologist examining a fine needle aspiration (FNA) breast biopsy?
What is the downfall of using FNA for a breast biopsy?
Occasionally, the sample may be too small to establish a definitive diagnosis, and the procedure must be repeated
What has to be done if a cytopathologist cannot establish a diagnosis using FNA?
A larger specimen removed by surgical biopsy (under general anesthesia) should be submitted
If a cytologic examination reveals cancer, how is the diagnosis confirmed?
by surgical biopsy
What is the treatment for breast cancer?
Surgical resection of the primary tumor and any metastases, as well as chemotherapy
When would radiation therapy be used for someone with breast cancer?
For pts with advanced cancer
How can tumors that are composed of cells that express estrogen be treated?
With synthetic antiestrogens (Tamoxifen)
What is lumpectomy?
The most conservative surgical procedure - limited to resection of the tumor with surrounding fat tissue
What is mastectomy?
Removal of entire breast, which is associated with axillary lymph node resection
What is the prognosis of breast cancer dependent on?
Depends on the stage of the disease
What is the basis for staging of breast cancer?
Performed on the basis of gross appearance of the tumor and the extent of it's spread to local lymph nodes and distant organ metastases
How fast can a breast carcinoma tumor progress to cause death?
As rapidly as w/in 1-2 years, depending mostly upon the lymph node status of the primary
What is stage I of cancer? What is the percentage of a 5 year survival rate?
Relatively small, localized tumors (less than 2.5 cm in diameter) w/o any distant metastases.
80% 5 year survival rate after surgical removal
What is stage II of cancer? What is the percentage of a 5 year survival rate?
Tumors measure more than 2.5 cm, but less than 5 cm. May have lymph node metastasis but no evidence of distant metastasis. 65% five year survival rate
What is stage III of cancer? What is the percentage of a 5 year survival rate?
Tumors measure more than 5 cm w/ or w/o regional lymph node spread, but w/o distant spread. 40% five year survival rate
What is stage IV of cancer? What is the percentage of a 5 year survival rate?
Tumors may be of any size and may or may not be associated with local lymph node metastasis, but are associated with distant metastasis. 10% five year survival rate
Besides staging, what other factors need to be taken into consideration for accurate prognosis?
Histologic subtype, Histologic grading, Estrogen and Progesterone receptors
How does the histologic subtype affect the prognosis of carcinoma of the breast?
Several variants have a better prognosis, but most breast cancers are invasive ductal carcinomas
How does the histologic grading affect the prognosis of carcinoma of the breast?
tumor that are more anaplastic and show a more rapid growth rate have a worse prognosis than slow-growing, well-differentiated tumors
How do estrogen/progesterone receptors affect the prognosis of carcinoma of the breast?
Are expressed on some tumors but not on others. If a tumor is receptor positive, then it will respond to antiestrogens and removal of ovaries