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REGUB > 30. Breast Cancer > Flashcards

30. Breast Cancer Flashcards

1
Q

What factors protect against breast cancer?

A

Breast feeding
Having children at a young age
Vegetables
Omega 3

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2
Q

What are the hereditary causes of breast cancer?

A 
BRCA 1 (chromosome 17)
BRCA 2 (chromosome 13)
Li Fraumeni (p53)
Cowden's syndrome (PTEN)
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3
Q

What other cancers are associated with BRCA 1?

A

Ovarian
GI
Prostate

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4
Q

What type of breast cancer is associated with BRCA 1?

A

Medullary; not visible on mammogram

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5
Q

What other cancers are associated with BRCA 2?

A

Male breast cancer
GI
Prostate

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6
Q

Which cells do ER+ breast cancers arise in?

A

Luminal epithelium cells

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7
Q

What factors increase the risk that a cancer will become invasive?

A

Clear margins
Size
Age
Grade of DCIS

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8
Q

What are the non-invasive forms of breast cancer?

A

Ductal Carcinoma in situ

Lobular Carcinoma in situ

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9
Q

What can be seen on mammogram in DCIS?

A

Micro-calcifications

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10
Q

What are the different forms of DCIS architecture?

A 
Comedo
Solid
Cribiform
Papillary
Micropapillary
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11
Q

Which form of DCIS is associated with central necrosis and a poor prognosis?

A

Comedo

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12
Q

What is the management of DCIS?

A

Wide local excision +/- radiotherapy
Mastectomy if small breast and large tumour
Tamoxifen

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13
Q

What is Paget’s disease?

A

DCIS extends up ducts to nipple without crossing the BM
Erythematous crusty lesion at nipple
Malignant cells in nipple discharge or biopsy

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14
Q

How is LCIS detected?

A

Incidentally: no mass lesion or calcifications present

Often bilateral, multifocal and seen in younger women

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15
Q

Which invasive cancers can LCIS progress to?

A

Invasive lobular or ductal

DCIS only ductal

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16
Q

What is the most common invasive carcinoma of the breast?

A

Invasive ductal carcinoma

‘no special type’

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17
Q

What are the ‘special type’ invasive carcinomas?

A 
Lobular
Mucinous
Medullary
Tubular
Papillary
18
Q

Does special type or no special type invasive carcinoma have a better prognosis?

A

Special type

19
Q

How is invasive ductal carcinoma detected?

A

Mass on physical exam with hard, irregular border

Skin dimpling and nipple retraction

20
Q

What are the histiological features of invasive ductal carcinoma?

A

Ducts formed, fibrous stroma

Most are ER+, PR+, HER2 -

21
Q

What IHC stains are positive and negative in tubular and lobular carcinomas?

A

ER+

Her2-

22
Q

What is the appearance of invasive lobular carcinoma?

A

Cells are in single file: ‘Indian filing’ due to loss of E-cadherin

23
Q

What is the appearance of invasive medullary carcinoma?

A

Circumscribed
Large cells
Lymphocytic infiltrate

24
Q

What stains are positive in medullary carcinoma and what is the genetic association?

A

Triple negative

BRCA1

25
Q

What is inflammatory breast cancer?

A

Any type of cancer that infiltrates dermal lymphatics
Red and swollen breast
Poor prognosis

26
Q

What is the local spread of breast cancer?

A

Surrounding breast
Chest wall
skin: peau d’orange

27
Q

What is the lymphatic spread of breast cancer?

A

Axillary
Internal mammary
Supraclavicular

28
Q

What is the vascular spread of breast cancer?

A

Bone,
lung
liver
brain

29
Q

What is the trans-coelomic spread of breast cancer?

A

Pleural cavities causing pleural effusion

30
Q

What grading system is used for breast cancer?

A

Scarff Bloom Richardson

31
Q

What factors is the Scarff Bloom Richardson system based on?

A

% of tubule formation
Mitosis
Nuclear pleomorphism

32
Q

What are the prognostic indicators in breast cancer?

A 
Invasive vs in situ
Stage, grade
Invasion
Subtype
Adequacy of excision
Angiogenesis
33
Q

What are predictive factors?

A

Predict response to treatment
Expression of hormone receptors
Expression of Her2
Triple negative= poor prognosis

34
Q

What are the side effects of Tamoxifen?

A

Increased risk of DVT and endometrial carcinoma

35
Q

What is the treatment for breast cancer?

A

Surgery
Sentinel node biopsy
Radiotherapy
Hormonal. herceptin, chemo, inhibit angiogenesis

36
Q

What are the risk factors for male breast cancer?

A

Older age

BRCA2 or Klinefelter syndrome

37
Q

What subtype does male breast cancer behave like?

A

Invasive ductal carcinoma

38
Q

What is the most common stromal tumour of the breast?

A

Fibroadenoma

39
Q

What age group is seen with fibroadenomas vs phyllodes tumour?

A

Fibroadenoma: between puberty to 30

Older in phyllodes

40
Q

What are the features of fibroadenomas?

A

Solitary, well defined, freely moveable lump
size can fluctuate with menstrual cycle, regress after menopause
Benign

41
Q

What are the features of a Phyllodes tumour?

A

Like a giant fibroadenoma
‘Leaf like’ clefts on histology
Can be benign or malignant

REGUB (31 decks)

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