Flashcards in Repro 11.2.2 Breast Cancer Deck (47)
How common is breast cancer?
Accounts for 20% of all malignancies in women
1 in 12 women develop breast cancer in their life
1% occurs in men
95% are adenocarcinomas (other malignant tumours of the breast are very rare
What increases mens risk of breast cancer?
Male to female transexuals
Men treated with oestrogen for prostate cancer
Where are breast cancers most common?
Upper outer quadrant (50%)
What are the risk factors for development of breast cancer?
Early menarche (<11)
Obesity and high fat diet
Exogenous oestrogens (HRT, OCP)
(All to do with hormones)
Atypical changes on previous biopsy (4-5 times)
Previous breast cancer (x10)
What factors reduce risk of breast cancer?
Reproductive history - parity and age at first full term pregnancy and amount of pregnancies
How does geography influence the risk of development of breast cancer?
Higher incidence in US and Europe. Possible explanation in diet, physical activity, breast-feeding and environmental factor
What % of breast cancers are hereditary?
What genes are most commonly implicated in breast cancer?
3% of all breast cancers and 25% of hereditary breast cancers are attributed to mutations in BRCA1 or BRCA2
Which BRCA gene is also implicated in ovarian cancer?
What are BRCA genes?
Tumour supressor genes - their proteins repair damaged DNA
What % of the population have BRCA germ line mutations?
What is the lifetime breast cancer risk for female carriers of BRCA1?
May undergo prophylactic mastectomy
When are familial breast cancers usually diagnosed in comparison to sporadic cases?
20 years earlier on average
What are the classification of breast carcinoma?
In situ or invasive
Ductal or lobular
What are carcinomas in situ?
Neoplastic population of cells limited to ducts and lobules by basement membrane, myoepithelial cells are preserved
Does not invade into vessels and therefore cannot metastasise
How do most DCIS present?
Mammographic calcifications (clusters or linear and branching) but can also present as a mass
How does DCIS appear microscopically?
Often shows central necrosis with calcification
How might DCIS spread?
Can spread through ducts and lobules and be very extensive
What is DCIS?
Ductal carcinoma in situ. Non-obligate precursor of invasive carcinoma
How can Paget's disease present in the breast?
Unilateral red crusting nipple
What might Paget's disease of the nipple be mistaken for?
Eczematous or inflammatory conditions of the nipple - should be regarded as suspicious and biopsy performed
What is the pathophysiology of Paget's disease in the nipples?
Malignant cells can infiltrate epidermis via the mammary duct epithelium. The cells proliferate leading to thickening of the affected skin
Define an invasive carcinoma.
Invaded beyond BM into stroma. Can invade into vessels and can therefore metastasise to lymph nodes and other sites
How does an invasive carcinoma present?
Usually as a mass or mammographic abnormality. By the time a cancer is palpable more than half the patients will have axillary lymph node metastases
What is peau d'orange?
Involvement of lymphatic drainage of the skin gives rise to a dimpled affect by the hair follicles as oedema swells the skin surrounding them. A clinical appearance of breast cancer
What are the most common types of invasive carcinoma of the breast?
Invasive ductal carcinoma, no special type (IDC NST) (70-80%)
Invasive lobular carcinoma (5-15%)
Tubular, mucinous etc
What is the appearance of well/poorly differentiated IDC NST?
Well-differentiated - tubules lined by atypical cells
Poorly-differentiated - sheets of pleomorphic cells
What is the 10 year survival rate for IDC NST?
What is the microscopic appearance of invasive lobular carcinoma?
Infiltrating cells in a single file
Cells lack cohesion