253b breast cancer

Question 1

Breast cancer - mortality in the past decade?

Answer 1

declining and incidence has flattened

largely due to less postmenopausal hormone use

Question 2

Breast cancer - who gets it more?

Answer 2

White > AA > other groups

Question 3

Breast cancer - risk factors

Answer 3

genetics (small group of people w/ BRCA1/2, larger group with SNPs and low penetrance)

hormonal exposure (early menarche, late menopause, nulliparity, late first pregnancy, HRT, long reproductive span)

Question 4

breast histology - where do hormones act?

Answer 4

Estrone –> ductal system

progesterone –> TDLU (where Breast cancer arises)

Question 5

Breast cancer - histo patterns with non-invasive and invasive

Answer 5

non-invasive: ductal carcinoma in situ (precursor, cancer occurs at same location, excise) and lobular carcinoma in situ (risk factor, cancer can occur anywhere in breast so removal not as important)

invasive: #1 ductal, #2 lobular, then many special types

Question 6

DCIS histo appearance (first aid)

Answer 6

Fills ductal lumen. Arises from ductal atypia. Often seen early as microcalcifications on mammography.

Early malignancy without basement membrane penetration.

Question 7

Breast Cancer - overview (first aid): who? where? receptors? prognostic indicator? location?

Answer 7

Commonly postmenopausal.

Usually arise from terminal duct lobular unit.

Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common

triple negative (ER -, PR -, and Her2/Neu -) more aggressive

Axillary lymph node involvement indicating metastasis is the single most important prognostic factor.

Most often located in upper-outer quadrant of breast.

Question 8

invasive BC - ductal (first aid)

Answer 8

Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells.

Grossly, see classic “stellate” infiltration.

Worst and most invasive. Most common (76% of all breast cancers).

Question 9

invasive BC - locular (first aid)

Answer 9

Orderly row of cells (“Indian file”).

Often bilateral with multiple lesions in the same location.

better prognosis but diagnosed later and in older women

Question 10

ER+ BC Rx

Answer 10

Tamoxifen

Question 11

HER2/neu+ BC Rx

Answer 11

Trastuzumab

Question 12

does mastectomy improve survival in BC?

Answer 12

not for the majority of cases

radiation reduces recurrence in the breast

present treatment: breast conservation surgery + radiotherapy

Question 13

triple negative BC Rx

Answer 13

chemotherapy (no hormone/endocrine drugs work)

Question 14

breast cancer prevention

Answer 14

tamoxifen for prevention in high risk women

Question 15

Breast cancer in postmenopausal women Rx? prevention?

Answer 15

Aromatase inhibitor (anastrozole) + other SERMS if useful; don’t use if osteoporotic though

aromatase inhibitors only prevent hormone receptor positive cancers though