3: Breast Pathology II

Question 1

Tumours of which organs commonly spread to the breast?

Answer 1

Lungs

Ovaries

Kidneys

Skin (melanoma)

Smooth muscle (commonly uterus)

Question 2

Which malignant skin tumour can spread to the breast?

Answer 2

Malignant melanoma

Question 3

Breast cancer commonly spreads to which structures?

Answer 3

Ovaries

Peritoneum

Bones

Question 4

Which cells are neoplastic in breast carcinomas?

Answer 4

Epithelial cells

Question 5

In which specific part of the breast are most carcinomas found?

Answer 5

Lobules

functional units

Question 6

Apart from the lobules, where else can breast carcinomas arise?

Answer 6

Ducts

Question 7

What is meant by an in situ carcinoma?

Answer 7

Hasn’t breached basement membrane

So not invasive (yet)

Question 8

What are the two specific types of lobular neoplasia?

Answer 8

Atypical lobular hyperplasia (<50% of lobule involved)

Lobular carcinoma in situ (>50% involved)

Invasive carcinoma after that

Question 9

Lobular neoplasms tend to have oestrogen receptors.

What does this mean?

Answer 9

They grow in response to oestrogen

e.g menstrual cycle, OCP, HRT

Question 10

20% of lobular neoplasms removed by core biopsy are hiding a more ___ lesion.

Answer 10

advanced

so the recurrence rate is really high

Question 11

How are lobular neoplasms managed?

Answer 11

Excision

Question 12

What happens to the centre of high grade ductal neoplasms (DCIS)?

Answer 12

Comedo necrosis

because growth outpaces blood supply

Question 13

High grade ductal carcinomas can spread to involve what breast structures?

Answer 13

Lobules

Nipple

Question 14

What is a cancer of the nipple which is highly associated with DCIS?

Answer 14

Paget’s disease of breast

Question 15

What does Paget’s disease of breast look like?

Answer 15

Indrawn nipple

Painful swelling

Eczema around affected area

Question 16

Which breast cancer is Paget’s disease most associated with?

Answer 16

DCIS

Question 17

Is Paget’s disease invasive?

Answer 17

No

Still a carcinoma in-situ, bound by the basement membrane, but is likely to invade if not cut out

Question 18

How is DCIS managed?

Answer 18

Surgical excision +/- radiotherapy, chemo, hormones, Herceptin

depends on the makeup of the tumour

Question 19

Which proteins are commonly found in epithelial tumours and can be stained?

Answer 19

Cytokeratins

Question 20

Both lobular and ductal neoplasms have the potential to become which tumours?

Answer 20

Invasive carcinomas

Question 21

Which structure is breached in invasive carcinomas?

Answer 21

Basement membrane

Question 22

What is the most common cancer affecting females?

Answer 22

Breast cancer

Question 23

What is the most common cancer affecting males?

Answer 23

Prostate cancer

Question 24

The incidence of breast cancer (increases / decreases) with age.

Answer 24

increases with age

thus screening

Question 25

**(Increased / Decreased)** age is a risk factor for **breast cancer.**

Answer 25

**Increased age** is a risk factor for breast cancer

Question 26

**Genetic mutations** in which genes are risk factors for **breast cancer?**

Answer 26

**BRCA1 / 2** **TP53** (Li Fraumeni syndrome)

Question 27

When **menstrual abnormalities** predispose you to breast cancer?

Answer 27

**Early menarche** **Late menopause**

Question 28

**Multiparity** is a risk factor for breast cancer - true or false?

Answer 28

**False**

Question 29

**Nullparity** is a risk factor for breast cancer - true or false?

Answer 29

**True**

Question 30

Which **lifestyle factors** increase a person's risk of developing breast cancer?

Answer 30

**Obesity** **Alcohol consumption**

Question 31

Which genetic mutations are best known for causing breast cancer?

Answer 31

**BRCA1 / BRCA2**

Question 32

Which **local structures** can breast cancer spread to?

Answer 32

**Breast stroma** **Skin** **Anterior chest wall muscles**

Question 33

Which **lymph nodes** does breast cancer commonly spread to?

Answer 33

**Axillary nodes** (numbered 1 -3 inferior to superior) **laterally** **Internal mammary (thoracic) nodes medially** Both of these drain to the **supraclavicular nodes** (which is why you check here in a breast exam)

Question 34

What are **sentinel nodes**?

Answer 34

**The first lymph nodes which would drain a suspected tumour**

Question 35

What is a **sentinel node biopsy?**

Answer 35

**Excision of the first nodes would drain a tumour to see if they're positive for cancer**

Question 36

Which type of carcinoma in situ most commonly gives rise to **invasive breast cancer?**

Answer 36

**DCIS**

Question 37

What is the difference between the a) stage b) grade of a tumour?

Answer 37

**a) Stage = spread** **b) Grade = degree of differentiation**

Question 38

The **more** differentiated a tumour is, the **(better / worse)** its prognosis.

Answer 38

**worse** because the tumour cells highly metaplastic - not like their parent cells

Question 39

The more ___ receptors an invasive carcinoma has, the better its prognosis.

Answer 39

**hormone receptors** because it can be targeted by drugs

Question 40

**Malignant breast tumours** possessing **oestrogen receptors** are susceptible to which treatments?

Answer 40

**Oophorectomy** **Tamoxifen**

Question 41

**Malignant breast tumours** possessing **progesterone receptors** are vulnerable to which treatments?

Answer 41

**Oophorectomy** **Tamoxifen** I think it's just the same as oestrogen receptors

Question 42

Apart from oestrogen and progesterone, what is another type of hormone receptor which is found in breast cancer?

Answer 42

**HER2**

Question 43

Which monoclonal antibody is derived from mice and can be used to target **HER2 receptors** in breast cancers?

Answer 43

**Trastuzamab** / **Herceptin** which can't be given to pregnant women

Question 44

**Malignant breast tumours** possessing **HER2 receptors** are vulnerable to which treatment?

Answer 44

**Trastuzamab / Herceptin**

Question 45

What is meant by the term **triple negative** when referring to **breast cancer?**

Answer 45

**Tumour cells don't have oestrogen, progesterone or HER2 receptors** Rendering it harder to treat

Question 46

Which gene mutations tend to cause **triple negative breast cancers?**

Answer 46

**BRCA1 / 2**

Question 47

Which organs are a common site of breast cancer metastasis because they produce oestogen?

Answer 47

**Ovaries**

Question 48

What are the treatment options for invasive carcinomas?

Answer 48

**Surgery** **Hormone therapy** **Radiotherapy** **Chemotherapy** inc. trastuzamab