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Women's Health > Malignant Lesions > Flashcards

Malignant Lesions Flashcards

1
Q

How many women will get breast cancer?

A

1 in 8 women living to 85

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2
Q

What percentage of breast lumps are cancerous?

A

20%

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3
Q

What percentage of breast cancer is genetically linked?

A

16-25%

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4
Q

In what region of the breast does cancer most often develop?

A

UOQ

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5
Q

When is there an increased risk of lymph node involvement?

A

lesion over 1 cm

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6
Q

What factors affect the outcome of breast cancer?

A

size, multicentricity, lymph node involvement, mets

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7
Q

What are risk factors for developing breast cancer?

A
  • advanced age
  • personal or family history
  • benign proliferative disease with atypia
  • early onset of menstruation, late menopause
  • late age of 1st pregnancy
  • nulliparity
  • radiation exposure
  • estrogen use
  • post menopausal obesity
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8
Q

What percentage of breast malignancies are invasive and noninvasive?

A

80% invasive, 20% non

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9
Q

What types of malignancies are invasive?

A

invasive ductal carcinoma
- tubular
- medullary
- colloid
- papillary

invasive lobular carcinoma

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10
Q

What types of cancer are noninvasive?

A
  • ductal carcinoma in situ (DCIS)
  • lobular carcinoma in situ (LCIS)
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11
Q

How does invasive cancer spread? What is it AKA?

A
  • tumor cells grow past basement membrane layer of duct wall into surrounding breast tissue
  • gain access to lymphatics and blood vessels
  • AKA infiltrating
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12
Q

What is noninvasive cancer? What is it AKA?

A
  • tumor cells are confined to duct in site of origin
  • low risk of mets
  • AKA in situ, staying in place
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13
Q

What are the major histological categories of breast malignancies?

A
  • ductal epithelial origin
  • lobular origin
  • stromal tissue origin
  • metastatic disease to breast
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14
Q

What is Mondor’s disease?

A
  • aids in early detection
  • thrombophlebitis of superficial veins in breast & anterior thorax
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15
Q

What is the clinical presentation of Mondor’s disease?

A
  • pain
  • palpable
  • red, subcutaneous cords
  • fibrous bands
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16
Q

What is the most common noninvasive breast cancer?

A

ductal carcinoma in situ AKA intraductal carcinoma

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17
Q

What is the earliest detectable form of breast cancer? What percentage of detected malignancies does it make up?

A

DCIS, 20-40%

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18
Q

What is the etiology of DCIS?

A

malignant transformation of epithelial cells lining duct without extension past duct wall

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19
Q

Where does DCIS typically arise?

A

in TDLU near lobule junction

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20
Q

What are clinical signs of DCIS?

A
  • asymptomatic, vis on screening
  • variable palp mass
  • serous/bloody nipple discharge
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21
Q

What are the grades of DCIS and what are the characteristics of them?

A

Low nuclear grade/ non-comedo
- well differentiated
- atypical ductal hyperplasia = precursor
-better prognosis

Intermediate grade

High nuclear grade/comedo
- poorly differentiated
- more aggressive & progresses to invasive
- large neoplastic cells fill duct
- duct distention with plug like necrotic material that has calcs

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22
Q

What is Paget’s disease of the nipple?

A
  • uncommon form of DCIS
  • involves epidermal layer of the nipple
  • tumor cells spread along a subareolar duct, extend to nipple/areola
  • progresses to invasive
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23
Q

What is the clinical presentation of Paget’s disease of the nipple?

A
  • erythema
  • ulceration
  • eczema crusting
  • nipple discharge
  • itching
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24
Q

What is lobular carcinoma in situ AKA? Who does it affect MC?

A

AKA lobular neoplasia, perimenopausal women 45-55

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25
Q

What is LCIS?

A
  • marker for increased risk of future development of IDC/ILC
  • not considered true cancer
  • usually multicentric and bilateral
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26
Q

What is the etiology of LCIS? What are the symptoms?

A
  • originates in epithelium of acini, doesn’t extend past basement membrane
  • no palp mass or physical symptoms
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27
Q

What does LCIS look like on US and mamm?

A
  • not usually detected through imaging
  • diagnosed microscopically during biopsy
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28
Q

What is papillary carcinoma?

A
  • slow growing, good prognosis
  • usually noninvasive but can become invasive
  • invasive: well circumscribed, show only focal areas of invasion
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29
Q

Who does papillary carcinoma typically occur in?

A

older women

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30
Q

What is the etiology of papillary carcinoma?

A
  • central duct lesion: can arise from preexisting papilloma
  • peripheral duct lesion: arises within TDLU from area of hyperplasia/papillomatosis
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31
Q

What are the clinical signs of papillary carcinoma?

A
  • bloody nipple discharge: earliest sign
  • palp mass, large can bulge skin
  • skin dimpling, ulceration, nipple retraction
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32
Q

What is intracystic papillary carcinoma?

A
  • form of DCIS, papillary carcinoma growing in a duct
  • can become invasive & extend out of duct
  • can cause obstruction & cyst formation
  • blood filled cavity if there is infarction or torsion of stalk
  • nipple discharge common
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33
Q

What is the MC breast cancer? What percentage of cancers does it make up?

A

invasive ductal carcinoma, 80%

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34
Q

What type of cancer has the worst prognosis of all breast cancers?

A

IDC

35
Q

What is the etiology of IDC?

A

tumor cells grow past duct wall and invade surrounding fat/connective/stromal tissues

36
Q

What are the S&S of IDC?

A
  • firm, fixed, painless palp mass
  • bloody nipple discharge
  • skin or nipple retraction
37
Q

What are benign masses that mimic IDC?

A
  • fat necrosis
  • radial scar
  • sclerosing adenosis
  • scar
  • fibrosclerosis
  • fibrous mastopathy
  • granular cell tumor
38
Q

What is the second MC invasive breast malignancy?

A

invasive lobular carcinoma

39
Q

What is ILC?

A
  • multicentric and bilateral
  • coexists with LCIS
  • poor prognosis
40
Q

What percentage of people with ILC develop a second primary in the same or opposite breast within 20 years?

A

30-50%

41
Q

What is the most frequently missed invasive breast cancer by physical exam or mammo?

A

ILC

42
Q

Why is ILC commonly missed?

A
  • doesn’t produce significant clinical findings until advanced stages
  • diffusely infiltrative growth pattern
43
Q

What is the etiology of ILC?

A
  • Indian file pattern: small tumor cells infiltrate surrounding stroma in single file rows
  • targetoid pattern: circumferential infiltration can occur around ducts and lobules
44
Q

What are clinical signs of ILC?

A
  • asymptomatic
  • ill-defined firm mass
  • area of asymmetric thickening
  • multiple small areas of nodularity
45
Q

What is the mean age of ILC?

A

45-65 yo

46
Q

How often does ILC display microcalcs?

A

10%

47
Q

What is tubular carcinoma associated with?

A

LCIS and family hx

48
Q

What is tubular carcinoma?

A
  • uncommon form of IDC
  • multicentric and bilateral
  • good prognosis, low risk of mets
  • small and slow
  • desmoplasia
49
Q

What are the clinical signs of tubular carcinoma?

A
  • small, fixed, hard palp mass
  • skin dimpling
50
Q

What is the mamm appearance of tubular carcinoma?

A
  • small spiculated radiodense mass
  • calcs
  • satellite lesions
51
Q

What is medullary carcinoma?

A
  • subtype of IDC
  • highly cellular with high grade atypia, causes enhancement
  • low risk of mets, good prognosis
52
Q

What percentage of breast cancers in women under 35 does medullary carcinoma account for? What percentage of all breast cancers?

A

11% under 35, <5% of all

53
Q

What are clinical signs of medullary carcinoma?

A
  • smooth, round, lobulated
  • mobile, nontender, mildly compressible
  • 2-3 cm
  • periphery of breast
54
Q

What is colloid mucinous carcinoma?

A
  • subtype of IDC
  • slow growing
  • low risk of mets, good prognosis
55
Q

Who does colloid mucinous carcinoma typically occur in?

A

older women

56
Q

What are the two variants of colloid mucinous carcinoma?

A

pure: well circumscribed, lobulated, soft and gelatinous
mixed: less mucin, larger, more infiltrative

57
Q

What is the etiology of colloid mucinous carcinoma?

A

cluster of uniform cells floating in large pools of extracellular mucin, small uniform cells with mild-moderate atypia

58
Q

What is the clinical presentation of colloid mucinous carcinoma?

A
  • smooth or lobulated palp mass
  • mildly compressible and mobile
  • high % of cancers in women over 75
59
Q

What is Phyllode’s tumor?

A
  • malignant counterpart of fibroadenoma
  • uncommon, usually benign but undergoes malignant transformation
  • larger = more likely to be malignant
60
Q

What is the MC breast sarcoma?

A

Phyllode’s tumor

61
Q

Who does Phyllode’s tumor MC affect?

A

45-50 yo women

62
Q

What is the etiology of Phyllode’s tumor?

A

fibroepithelial tumor with leaflike (phyllodes) growth pattern, clefts of mucus, blood or fluid, stromal tissue turns malignant in 25% of cases

63
Q

What is the clinical presentation of Phyllode’s tumor?

A
  • rapidly enlarging, nontender, firm, moveable, palp mass
  • bulge, stretch, discolored or ulcerated skin
  • dilated superficial veins
  • solitary, unilateral
  • smoothly lobulated
64
Q

What type of rare malignancy makes up 1% of all breast cancers?

A

inflammatory carcinoma

65
Q

What is inflammatory carcinoma?

A
  • highly aggressive, invades and blocks lymphatics of the skin
  • rapid and diffuse invasion
  • poor prognosis
66
Q

What are the clinical signs of inflammatory carcinoma?

A
  • skin thickening/erythema (orange peel)
  • warm skin with dilated veins
  • retracted nipple
  • swollen, tender, hard breast
  • enlarged lymph nodes
67
Q

What is the MC lymphoma to affect the breast?

A

Non-Hodgkin’s

68
Q

What is the clinical presentation of lymphoma in the breast?

A
  • abnormally enlarged intramammary or axillary lymph nodes
  • palpable, rapidly growing masses
69
Q

What is multifocal carcinoma?

A

additional tumors within one breast quadrant or in the same ductal system as the primary tumor

70
Q

What is multicentric carcinoma?

A
  • multiple tumors in diff quadrants of the breast or tumors separated by a distance of >5cm
  • less common
  • more likely to recur, worse prognosis
  • satellite lesions are formed via ducts
  • more extensive surgery
71
Q

What modality can effectively diagnose multicentric carcinoma?

A

MRI

72
Q

What defines stage 0 and stage 1 carcinoma?

A

0: in situ
1: <2 cm, no node involvement, no mets

73
Q

What defines stage 2 carcinoma?

A
  • <2 cm: positive axillary LN, no mets
  • 2-5 cm: positive axillary LN, no mets
  • > 5 cm: negative axillary LN, no mets
74
Q

What are the characteristics of stage 3 malignancy?

A
  • > 5cm
  • local and regional spread
  • fixed tumor to pectoralis
  • fixed tumor with axillary LN
75
Q

What are the characteristics of stage 4 carcinoma?

A
  • node involvement
  • mets
  • tumor of any size with extension to skin or chest wall
76
Q

What is the MC site of nodal mets?

A

axillary LNs, 75% of lymph from breast drains into them

77
Q

Where does breast cancer commonly metastasize to?

A

regional LNs, axillary, ipsilateral internal mammary nodes, supraclavicular nodes

78
Q

What is the appearance of nodal mets on US?

A
  • enlargement
  • round/lobular shape
  • asymmetric cortical thickening
  • irregular margins
  • hypo or hetero
  • absent/compressed hilar fat
79
Q

What are common sites of hematogenous mets?

A

bone, lung, brain, liver

80
Q

Where do breast mets commonly arise from?

A
  • contralateral breast ca
  • extramammary primary
  • melanoma
  • lung
  • ovary
  • sarcoma
  • GI tract
  • hematological malignancy
81
Q

When does tumor recurrence typically happen?

A

2 or more years following therapy

82
Q

What can tumor recurrence be difficult to differentiate from? What modality can be used to determine?

A

fat necrosis or scar, contrast MRI

83
Q

What is the appearance of tumor recurrence on mamm?

A
  • enlarging scar
  • architectural distortion
  • microcalcs
  • new nodular mass in area of previously stable tumor
84
Q

What modality is more effective at diagnosing DCIS?

A

Mammography, 70-80% more sensitivity than US

Women's Health (10 decks)

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