Module 3: Breast: Cancer Flashcards
(42 cards)
Now moving onto breast cancer. What are the pre-disposing factors?
Female Increased Age BRCA 1 and 2 Her2Neu p53 Obesity (due to increased estrogen) Early Menarche Late Menopause Family History Race/Ethnicity ERT Granulosa Theca ovarian tumor (due to increased estrogen)
What is the most important pre-disposing factor in elderly women?
Age
What is the most important pre-disposing factor in middle aged women?
Family history and then nulluparity
Why are breast carcinoma lumps hard and fixed?
Fixed to underlying skin and pectoralis major
- -extremely desmoplastic (fibrotic)
- -non tender
What is the most common location for breast carcinoma?
Upper outer quadrant
What is the origin of all types of breast cancer?
Terminal Duct Lobular Unit (TDLU)
Breast carcinoma is spread through lymphatics, what is the order?
Axillary , Supraclavicular and Internal Mammary (thoracic)
Once breast carcinoma has infiltrated the lymphatics, what is a key symptom? what are other symptoms?
Peau d'orange: due to lymph edema or lymph obstruction nipple retraction (Ductal carcinoma -- desmoplasia -- fibrosis of cooper's ligaments) Bloody nipple discharge
What is the most accurate test for all breast cancers?
Biopsy
Eventually from the lymphatics there will be metastasis from to the blood, then where?
Lung Liver Brain Bone --most common cancer in lung
In regards to prognosis what are indicators of a poor prognosis?
- Greater than 2cm bad prognosis
- Lymph node spread and Peau d orange
- Invasion
- Her2New (EGFR) positive bad = extremely aggressive and herceptin is used to treat but does not cross blood brain barrier
- Cathepsin D: (enzyme destroys basement membrane) is bad because allows invasion and metastasis
- Aneuploidy is always bad
In regards to good prognosis what are indicators of a good prognosis?
- ER/PR positive: can treat with tamoxifen
- -tamoxifen increases chances of endometrial carcinoma
Now moving onto the types of breast cancer. There are two types Ductal and Lobular. Give some general features
Non-Infiltrating (Carcinoma in Situ) --Ductal Carcioma in Situ (DCIS) ***comedo (high grade) ** Non-comedo (Solid, cribiform, papillary, micropapillary) **Paget's Disease --Lobular Carcinoma In Situ (LCIS) Infiltrating Carcinoma -Ductal (no special type): 80% --Lobular: 10% --Tubular/Cribiform: 6% --Mucinous, medullary, papillary, metaplastic: 4-5%
First discussion will be on Lobular Carcinoma in Situ, which again is a non-infiltrating carcinoma. What is the origin and general features?
Origin: Terminal Duct Lobular Unit
Predisposing factors are the same for breast cancer
Asymptomatic most commonly: incidental finding without a mass
Usually unilateral but can be bilateral
Dyscohesive lacking E-cadherin
What is the histology for lobular carcinoma in Situ (slide 6 to the left)?
Atypical terminal duct lobular unit in an entire lobule
***atypical proliferation of inner cuboidal epithelial cells (response to estrogen)
Overall architecture of lobule is preserved
Ducts all still have single layer of outer myoepithelial cells (hence why its In-situ)
Now moving onto invasive lobular carcinoma, what are the general histological features?
Slide 7c:
- -No intact lobule architecture
- **due to loss of outer myoepithelial cells
- **therefore invasion into the stroma
- -invades interlobular first
What is the presentation for a patient with invasive lobular carcinoma?
No distinct mass
Usually unilateral and can be bilateral
–poorly outlined and indurated
TDLU origin with E-cadherin mutation
There are three types of invasive lobular carcinoma seen on biopsy, each card will go through one.
- Indian File Cells: intralobular invaded first then interlobular – malignant cells in the stroma
- –single file of tumor cells, round and uniform (Seen in slide 6)
What is the second type of invasive lobular carcinoma?
- Bull’s Eye Pattern: tumor cells around normal acini and ducts
What is the third type of invasive lobular carcinoma?
- Signet Ring Histology
- -Mucin within cytoplasm
- -PAS positive with metastasis to ovaries (Krukenberg)
- -E-cadherin mutation
Moving onto Ductal Carcinoma first we will discuss ductal carcinoma in situ (which again in non infiltrating). What are some features?
Slide 6b (right):
Obstruction of lactiferous duct: with intact single outer myoepithelial layer
**Origin: terminal duct lobular unit (TDLU)
More common calcification and no mass not yet cancer
Proliferation of Inner cuboidal epithelial cells
What is seen on mammogram in a patient with ductal carcinoma in situ?
Large amounts of calcification and necrosis
–asymptomatic found on mammogram; no mass
There are two types of ductal carcinoma in-situ. The first is Comedo, what are some features?
Comedo (intraduct tumor):
- -high grade cells with necrotic center and dystrophic calcification
- *less often ER,PR positive, Her2Neu positive
- *Necrotic Center= cells inspissated materials (toothpaste secretions from the nipple)
- -no mass because not yet invasive
The second type of ductal carcinoma in situ is Paget’s Diease. What are some features?
Type of DCIS almost always associated with underlying intraductal carcinoma
