Breast (3) (Malignant conditions) Flashcards
Carcinoma in situ
Malignancies that are contained within the basement membrane tissue.
invasive
any type of breast cancer that has spread (invaded) into the surrounding breast tissue.
carcinoma in situ is seen as
- pre-malignant condition, typically found on imaging and are rarely symptomatic at presentation
two types of carcinoma in situ
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
ductal carcinoma in situ (DCIS)
- Most common non-invasive breast malignancy (20%)
- Malignancy of ductal tissue of the breast- contained within basement membrane
- 20-30% of cases will develop invasive disease
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Subtypes
- Comedo (microcalifcations), cribriform (multifocal), micropapillary (multifocal) and solid types, most are mixed
presentation of DCIS
- Usually asymptomatic
- Microcalcifications on mammography
investigations for DCIS
- Detected during screening
- Confirmed by biopsy
management of DCIS
- Completely wide excision, ensuring surrounding tissue of all margins have no residual disease
- Widespread or multifocal DCIS – complete mastectomy
lobular carcinoma in situ
Is a malignancy of the secretory lobules of the breast that is contained within the basement membrane.
They are much rarer than DCIS however individuals with LCIS are at greater risk of developing an invasive breast malignancy
RF for LCIS
before menopause
presentation of LCIS
asymptomatic
investigations of LCIS
- Incidental finding during biopsy of breast
management of LCIS
- Depends on extent of disease
- Low grade LCIS
- Monitoring rather than excision
- If invasive component and BRCA1 or BRCA2 positive à bilateral prophylactic mastectomy
invasive cancer can be classified into
Carcinoma most common in western world. Classification
- Invasive ductal carcinoma (80%)
- Invasive lobular carcinoma
- Other subtypes
- Medullary carcinoma
- Colloid carcinoma
RF for invasive cancer
- Female sex
- Older (doubles every 10 years until menopause)
- BRCA1 and BRCA2 mutation
- Family history
- Previous bening disease
- Obesity
- Alcohol
- Degree of exposure to oestrogen
- Early menarche
- Late menopause
- Nulliparous women
- First pregnancy after 30 years age
- Oral contraceptive or hrt
presentation of invasive cancer
- Can present symptomatically or asymptomatically via screening(particularly for ILC).
- Breast lump
- Asymmetry
- Swelling
- Abnormal nipple discharge
- Nipple retraction
- Skin changes (dimpling/peau d’orange or Pagets-like change)
- Mastalgia
- Palpable lump in axilla
investigations for invasive cancer
- Triple assessment:
- Clinical – history, family history, examination
- Radiographic imaging – mammogram (in older) and ultrasound scan (in younger)
- Pathology – core biopsy and fine needle aspiration cytology (FNAC)
- Receptor status
- Oestrogen, progesterone, human epidermal growth factor
prognosis of invasive cancer
Nodal status is the most important prognostic factor in breast cancer- size, grade and receptors status also influence prognosis
invasive ductal carcinoma
- Most common type of breast carcinoma, constituting 80% of all cases.
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Further classified into
- tubular, cribriform, papillary, mucinous (/colloid), or medullary carcinomas, all showing distinct patterns of growth*.
- Most commonly incidental finding during screening
*Tubular, cribriform and papillary subtypes are well circumscribed and show the most favourable prognoses