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Oncology > 01b: Breast Cancer > Flashcards

01b: Breast Cancer Flashcards

1
Q

By far the most common tumor of the breast arises from which tissues?

A

Ductal (predominantly) and lobular epithelium (adenocarcinomas)

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2
Q

Very common cause of “breast lumps” that fall under non-proliferative breast disease. Does this increase risk of malignancy?

A

Fibrocystic change

No (not unless associated with atypical hyperplasia)

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3
Q

List the tissue changes in fibrocystic disease of breast.

A
  1. metaplasia
  2. stromal fibrosis and calcification
  3. cyst formation
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4
Q

Proliferative breast disease without atypia usually causes (palpable/non-palpable) masses with (X) relative risk of developing breast cancer.

A

Non-palpable (detected by mammogram);

X = 1.5-2x

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5
Q

T/F: Proliferative breast disease with atypia fulfill criteria for carcinoma.

A

False - almost, but fall short

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6
Q

List the two types of proliferative breast disease with atypia.

A
  1. ADH (atypical ductal hyperplasia)

2. ALH (atypical lobular hyperplasia)

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7
Q

Proliferative breast disease with atypia associated with (X) relative risk of developing breast cancer.

A

X = 4-5

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8
Q

Most common benign tumor found in breast. Which tissue components are found in this lesion?

A

Fibroadenoma;

Epithelial (ductal) and mesenchymal

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9
Q

Fibroadenomas occur primarily in (older/younger) women, are hormonally (responsive/unresponsive), and (increase/decrease) in size with menopause.

A

Younger (under 30);
Responsive
Decrease/regress

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10
Q

T/F: Fibroadenomas generally confer no increased risk for cancer.

A

True (unless accompanied by more complex epithelial proliferation)

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11
Q

Carcinomas of breast are divided into which two main types? Star the most common.

A

Carcinomas arising from:

  1. ductal epithelium* (75%)
  2. lobular epithelium
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12
Q

Intraductal carcinoma is (invasive/non-invasive) and associated with (good/bad) prognosis.

A

Non-invasive (Carcinoma-in-situ)

Good (if adequately excised)

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13
Q

Intraductal carcinoma now accounts for a (lower/higher) % of breast carcinoma cases, since the use of mammogram screening.

A

Higher (up to 30% as opposed to 5% in the past); this is good - detecting before invasion

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14
Q

(By far) the most common breast carcinoma, arising from (ductal/lobular) epithelium:

A

Ductal;

Invasive ductal carcinoma NST (no special type)

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15
Q

Describe the texture of the typical masses found in Invasive ductal carcinoma (NST). What gives them this texture?

A

Firm, gritty;

Prominent background fibrosis and calcification

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16
Q

Invasive ductal carcinoma (NST): by the time the carcinoma is palpable, (X)% of patients will have metastasis to axillary lymph nodes.

A

X = 50

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17
Q

Well-differentiated breast carcinomas tend to be estrogen R (pos/neg) and progesterone R (pos/neg) and HER2 (pos/neg).

A

Pos, Pos, neg

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18
Q

Medullary carcinoma is a (ductal/lobular) disease of the breast that’s more commonly seen with (X) mutation. What’s the general prognosis?

A

Ductal
X = BRCA1 (13% of carcinomas in these patients; only 1% of breast carcinomas overall)

Better prognosis than typical ductal NST

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19
Q

(X) subtype of ductal breast carcinomas tends to occur in older women. It’s characterized by excessive (Y) production, forming (soft/hard) masses.

A

X = Colloid (mucinous) carcinoma

Y = mucin
Soft (gelatinous)

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20
Q

T/F: Colloid (mucinous) carcinoma has worst prognosis than typical ductal carcinoma NST.

A

False - better

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21
Q

Paget’s disease of the nipple is seen in (X)% of breast cancers. (Benign/malignant) cells extend from underlying (X) to nipple epidermis.

A

X = 1-2
Malignant

X = ducts

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22
Q

T/F: Presence of Paget’s worsens prognosis of underlying carcinoma because cells must cross BM to reach nipple epithelium.

A

False - don’t cross BM; doesnt alter prognosis

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23
Q

Breast cancer from lobular epithelium: cells are (larger/smaller), (more/less) likely to be palpable. Tendency to be (uni/multi)-centric and (X)% are bilateral.

A

Smaller; less

Multi;
X = 5-10

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24
Q

Lobular carcinoma in situ: (X)% of patients develop invasive carcinoma that’s (lobular/ductal) in (same/contralat) breast over period of 20 y.

A

X = 30
Etiher/both;
Either same or contralateral breast

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25
Q

Invasive lobular carcinoma: why are as many as (X)% of cases easily missed?

A

X = 25

Negligible stromal reaction

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26
Q

(X) breast carcinomas have different metastasis pattern compared to others. They metastasize to (lungs/GI/ovaries) as opposed to (lungs/GI/ovaries).

A

X = Invasive lobular

GI, ovaries/uterus (peritoneum, retroperit, meninges);

Lungs/pleura

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27
Q

Ductal carcinoma of breast: which subtype(s) rarely metastasize?

A

Medullary, colloid, tubular

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28
Q

T/F: EGFR is a poor prognostic factor in breast cancer.

A

True

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29
Q

Scarff-Bloom-Richardson Grading System: which 3 characteristics taken into account in breast cancer grading?

A
  1. Tubular formation
  2. Nuclear pleomorphism
  3. Mitosis
30
Q

T/F: Many ovarian neoplasms cannot be detected early.

A

True - so they’re responsible for almost half of the deaths from cancer of the female genital tract

31
Q

Most, 80%, of ovarian neoplasms are (benign/malignant) and occur in (young/old) patients.

A

Benign;
Young (20-45 years old)

Malignancy more common in older women

32
Q

Primary tumors of the ovary arise from one of which ovarian components?

A
  1. Surface epithelium
  2. Germ cells
  3. Stroma of ovary
33
Q

Ovarian neoplasms: on gross exam, the risk of malignancy increases as a function of…

A

The amount of discernible SOLID epithelial growth (ex: papillary projections, necrotic/friable regions)

34
Q

(X)% of all ovarian tumors are of the serous type. Most, (Y)%, of these are (benign/malignant).

A 
X = 30
Y = 75

Benign or borderline malignant

35
Q

(X) account for approximately (Y)% of all ovarian cancers and are the most common malignant ovarian tumors.

A

X = Serous cystadenocarcinomas

Y = 40

36
Q

Ovarian cystadenocarcinomas are lined by (X) cells and are filled with (Y).

A 
X = tall, columnar, ciliated epithelial
Y = serous fluid
37
Q

T/F: Papillary cystadenoma (presence of papillary projections on serous ovarian tumor) is sign of malignancy.

A

False - benign

38
Q

Borderline malignant ovarian tumors: nuclear atypia is (present/absent) and papillary projections differ in which ways from benign tumor?

A

Present;

Increase in number/complexity of papillary projections with more solid tumor mass

39
Q

Ovarian tumors: key difference between borderline malignant and malignant tumors.

A

Malignant will show destructive infiltration into stroma

40
Q

(X) are concentric calcifications that characterize (Y) (breast/ovarian) tumors, although they are not specific.

A

X = psammoma bodies

Y = serous
Ovarian

41
Q

The 5-year survival rate for borderline and malignant tumors confined to the ovaries is, respectively, (X)% and (Y)%.

A 
X = 100
Y = 70
42
Q

5-year survival rate for borderline and malignant tumors involving the peritoneum is about (X)% and (Y)%, respectively.

A 
X = 90
Y = 25
43
Q

T/F: Unlike serous ovarian tumors, majority of mucinous tumors are malignant.

A

False - 80% are benign/borderline

44
Q

T/F: Mucinous ovarian tumors occur most often in middle adult life.

A

True

45
Q

Benign mucinous tumors histology: lining of (X) cells with (apical/basal) mucin.

A

X = tall, non-ciliated, columnar epithelial

Apical

46
Q

Which ovarian tumors fall under “Type 1” and “Type 2”?

A

1: Mucinoid, endometrioid
2: Serous

47
Q

Type (1/2) ovarian tumors tend to be low grade, slower growing.

A

1

48
Q

Type (1/2) ovarian tumors tend to follow step-wise progression.

A

1 (benign to borderline to malignant)

49
Q

Characteristic mutations seen in Type 1 ovarian tumors.

A

PTEN and MSI (endometrioid)

k-ras, BRAF (mucinous)

50
Q

Characteristic mutations seen in Type 2 ovarian tumors.

A

BRCA1,2 and p53

51
Q

Cell type of origin in serous ovarian tumors:

A

Not known! Controversial, no defined precursor

52
Q

T/F: Tubal ligation is protective against all ovarian tumors.

A

False - not serous

53
Q

Aside from endometrioid tumors, (X) rare ovarian tumors have VERY strong association with endometriosis. They fall under the Type (1/2) category for ovarian tumors.

A

X = clear cell

Neither

54
Q

Serous ovarian tumor cells resemble (X) cells.

A

X = fallopian tube

55
Q

Cauliflower-like projections are seen in (benign/borderline/malignant) (serous/mucinous) ovarian tumors.

A

Borderline; serous

56
Q

Borderline serous ovarian tumor: which characteristic of “invasion” won’t alter/worsen the prognosis?

A
  1. Under 3 mm (microinvasion)

2. Invasion into vascular space

57
Q

The presence of (X) and whether they are invasive are
the most important indicators of outcome in serous
borderline tumors

A

X = implants (peritoneal deposits)

58
Q

Mucinous ovarian tumor cells resemble (X) cells.

A

X = cervix or GI tract (stomach/intestine)

59
Q

Serous ovarian carcinomas are graded based on (X). And mucinous based on (Y).

A 
X = nuclear morphology
Y = architecture
60
Q

(X) ovarian tumors tend to be VERY large (300 lbs) and almost always (uni/bi)-lateral.

A

X = mucinous

Unilateral

61
Q

Pseudomyxoma Peritonei is a(n) (X) tumor which is almost always metastatic from (Y).

A 
X = ovarian mass
Y = GI tract (appendix)
62
Q

(X)% of ovarian tumors are germ cell tumors. The vast majority are (benign/malignant).

A

X = 15-20

Benign, mature cystic teratomas

63
Q

(X) ovarian tumor
containing hair, teeth,
keratin/sebaceous debris

A

X = germ cell tumor (mature cystic teratoma)

64
Q

Your patient comes in with an ovarian mass containing hair. She asks you what are the chances that it is/will become malignant, and you say:

A

It’s benign (Mature Cystic Teratoma); 1% undergo malignant transformation

65
Q

Ovarian counterpart of seminoma in the testis:

A

Dysgerminoma

66
Q

T/F: Dysgerminoma has poor prognosis.

A

False - over 80% survival with proper therapy

67
Q

(X) ovarian tumors are derived from ovarian stroma, which is derived from (Y) in the developing embryo

A

X = Y = sex cord cell

68
Q

Which ovarian tumors secrete hormones? What’s the cell of origin for each tumor?

A

Sex cord cell tumors

  1. Granulosa-Theca Cell Tumors (estrogen)
  2. Sertoli-Leydig Cell Tumors (androgens)
69
Q

(X) ovarian tumor can lead to precocious puberty in young patients

A

X = Granulosa-Theca Cell (secretes estrogen)

70
Q

(X) tumor: Bilateral ovarian metastasis by mucin-secreting signet ring cells, usually of (Y) origin.

A

X = Krukenbern

Y = gastric

Oncology (10 decks)

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