Flashcards in Pathology of the Breast Deck (46)
What are 8 major risk factors for sporadic breast cancer?
Sex = female.
Age > 50.
Family Hx of breast cancer.
Fibrocystic changes (some of them).
Prior breast or Gyn cancer.
Radiation (e.g. lymphoma Tx).
2 major divisions of carcinoma by location?
Carcinoma in situ (CIS)
2 forms of carcinoma in situ (CIS)? Which is more commonly diagnosed?
Ductal CIS (DCIS) - more commonly diagnosed.
Lobular CIS (LCIS).
Note we're not really sure of LCIS incidence/prevalence because it's harder to diagnose.
Can DCIS progress to invasive carcinoma?
How curable is DCIS?
Yes, but not all of it does.
DCIS is "always" curable when treated.
How is DCIS usually picked up?
Focal cluster of calcifications on mammogram.
What's the histology term for what DCIS-associated calcifications look like?
Calcified necrosis / dystrophic calcification.
Why is DCIS even called carcinoma if it's not invasive?
Histologically, the cells have malignant-looking features: Large cells, high N:C ratio, open chromatin, nucleoli, increased mitoses.
(also the ducts can look ugly: cribriform, comedo-necrosis, etc.)
What do you do when you see DCIS? Why?
"Treat it." - apparently this usually involves lumpectomy +/- radiation +/- tamoxifen (not in lecture).
We don't currently know which DCIS will progress and which ones won't.
How is LCIS usually picked up?
As an incidental finding on a biopsy done for other reasons.
What are the histological features of LCIS?
Lack of cohesion, and mucin-filled "signet-ring" cells.
What do you do when you find LCIS?
Usually watch and wait +/- anti-estrogen (such as tamoxifen).
What's a common clinical presentation for invasive carcinoma on mammogram?
10 year survival for all invasive breast cancer?
What are the 2 ways invasive breast cancer spreads to distant sites?
What are 2 location-based categories of invasive carcinoma of the breast?
Ductal and lobular. They're categorized for the associated CIS, which will always be there.
What is Paget Disease of the Nipple?
Crusting and ulceration of nipple (due to squamous metaplasia of duct cells there).
Indicative of invasive carcinoma or CIS.
What structures are being invaded in inflammatory breast carcinoma?
It's really virulent.
Histologic buzzwords for invasive lobular carcinoma?
What are the 4 keys tasks of a pathologist with regard to breast cancer?
Identify predictive markers
Get molecular profile
What's the shorthand notation for breast cancer stage?
T: Tumor size (Tis - T3)
N: Lymph nodes (N0 - N3)
M: Metastasis (M0, M1, Mx)
Stage: 0 - IV
What are 3 markers always tested for in invasive breast cancer?
Estrogen receptor (ER)
Progesterone receptor (PR)
How positive do tumors have to be for ER, PR, HER2/neu in order to merit specific treatment?
If they're at all positive, specific treatment is indicate.
What drug is used for HER2/neu positive cancers?
What's one molecular profiling assay that's commonly used? What is its utility?
For node-negative tumors with low-risk profile, can treat with just lumpectomy + tamoxifen instead of using chemo.
What type of breast carcinoma do men get?
Ductal. Male breast tissue does not have lobules.
What's 1 predisposing factor for breast cancer in males?
Klinefelter syndrome (XXY).
How does staging, prognosis, and treatment differ between male and female breast cancer?
4 clinical manifestations of fibrocystic breast changes?
Cyclic pain / tenderness.
Mass or calcifications.
What are the 2 major categories of fibrocystic changes?
Proliferative and non-proliferative.