Breast

Question 1

Most common ____ of female cancer Second highest ____ rate

Answer 1

Incidence Mortality

Question 2

___x more common in women than men Incident _____ with age 80% new cases in women >50 due to ______

Answer 2

100x rises screening (1988)

Question 3

anatomy

Answer 3

Question 4

Alveolar Structure

lobules - multiple s______ units

epithelial cells - be c______ or columnar

myoepithelial cells - situated between the e______ cells and b_______ membrane.

Answer 4

lobules - multiple secretory units

epithelial cells may be cuboidal or columnar

myoepithelial cells are situated between the epithelial clls and basement membrane.

Question 5

Ducts

Myoepithelial cells

Answer 5

lined with layer of epithelial cells

contractile, sensitive to oxytocin

Question 6

Mammary Gland Development

Answer 6

BIRTH - almost entirely ducts, few alveoli

BIRTH-PUBERTY - branching of ducts

PUBERTY:

oestrogen - branching of ducts and alveolar development

cyclic oestrogen/progesterone - additional duct/lobule + deposition of adipose and connective tissue

Question 7

During Pregnancy

Answer 7

• lobules enlarge
• less intralobular tissue
• alveoli enlarge
• cuboidal epithelial cells

Question 8

Lactation

Answer 8

• decrease oestrogen & progesterone
• increase prolactin, oxytocin
• copious milk secretion

Question 9

DURING Lactation

Answer 9

• mammary tissue almost entirely alveoli distended with milk
• intralobular tissue consists only of thin septa
• epithelial flattened

Question 10

NON NEOPLASTIC breast conditions

Inflammatory (3)

Non-Neoplastic (1)

Benign Neoplasms (1)

Answer 10

Inflamatory

• acute mastitis and abscess
• fat necrosis
• silicone mastitis

Non-Neoplastic

• cysts

Benign Neoplasms

• fibroadenoma

Question 11

Malignant Neoplasms (BREAST CANCER) Risks

Answer 11

• relatives with breast cancer
• length of reproductive age
• age of first pregnancy
• ethnicity
• BRCA 1+2
• alcohol
• previous cancer (bar cervical)

Question 12

TDLU?

Answer 12

TUBULAR DUCTAL LOBULAR UNIT

Question 13

Non-Invasive Carcinomas - DCIS

Answer 13

DUCTAL CARINCOMA IN SITU

• terminal ducts enlarge - proliferation of tumour cells
• spread throughout duct system
• NOT palpable
• becomes invasive if untreated (30%)

Question 14

Non-Invasive Carcinoma - LCIS

Answer 14

LOBULAR CARCINOMA IN SITU

• NOT palpable
• mammograms not useful in detection
• coincidental finding in biopsies
• 30% chance of becoming invasive within 20 yrs
• 50% likely to arise in other breast

Question 15

INVASIVE CARCINOMAS

Answer 15

• invasive ductal carcinoma (worst prognosis)
• invasive lobular carincoma (worst prog)
• medullary carcinoma (interm. prog)
• colloid carcinoma
• tubular carcinoma (favourable prog)

Question 16

DIAGNOSIS OF BREAST CANCER

Answer 16

Self-examination

• regular
• post menstruation
• upper outer quadrant

Mammography

• palpable masses
• detects smaller lesions

Biopsy

• definitive diagnosis
• grading/staging

Question 17

GRADING OF BREAST CANCER

Answer 17

1. Grade 1 (low grade) - appear normal, small tubules
2. Grade 2 (moderate grade) - cellular characteristics
3. Grade 3 (high grade) - abnormal appearance, aggresive spread

Question 18

STAGING OF BREAST CANCER

Answer 18

TNM SYSTEM

• tumour
• node
• metastases

Question 19

STAGING - tumour size

Answer 19

1. Stage 1 - no evidence of regional spread
2. Stage 2 - regional involvement
3. Stage 3 - any size, region but not distant spread, skin involvement
4. Stage 4 - any size, distant spread

Question 20

IHC

Answer 20

• primary/secondary tumours
• lymph nodes
• suspected metastases

Tumour markers

• steroid receptors
• HER2 - chemo response