Breast Canccer 1

Question 1

Breast cancer is most common what and second most common what?

Answer 1

Carcinoma by incidence

Cancer mortality in women

Question 2

Risk factors are mostly related to what?

Answer 2

Estrogen exposure

Question 3

How do we best characterize ductal carcinoma in situ?

Answer 3

Malignant proliferation of cells in the ducts that do not invade the basement membrane. Confined to the duct.

Question 4

How is DCIS detected?

Answer 4

As calcification on mammogram.

Question 5

What is the most common Histology subtype of DCIS and how do we characterize it on histo?

Answer 5

Comedo type.

Necrosis and calcification in the center of the duct.

Question 6

What is Paget’s disease?

Answer 6

When DCIS extends up the duct to involved the nipple

Question 7

2 ways Paget’s disease presents?

Answer 7

Nipple ulceration and redness

Question 8

So, if a patient presents with Paget’s disease of the nipple, what is always the underlying cause?

Answer 8

Underlying carcinoma

Question 9

How do we best characterize invasive ductal carcinoma?

Answer 9

Ductal carcinoma in situ invades the basement membrane of the duct

Question 10

Invasive ductal carcinoma is the most common what?

Answer 10

Invasive carcinoma of the breast

Question 11

Histo shows two things for invasive ductal carcinoma?

Answer 11

Duct like structures with desmoplastic stroma

Question 12

What are the 4 main types of invasive ductal carcinoma?

Answer 12

Tubular, mucinous, medullary, inflammatory

Question 13

2 classic histo features of tubular invasive ductal carcinoma?

Answer 13

Forms tubules and lacks myoepithelial cells

Question 14

1 classic histo feature of mucinous invasive ductal carcinoma?

Answer 14

Cancer cells are floating in mucus

Question 15

What patient population do we normall see the mucinous subtype in?

Answer 15

Older women, like over 70

Question 16

How do we best characterize the inflammatory type of invasive ductal carcinoma?

Answer 16

The cancer cells are found in the dermal lymphatics and clog them so you get inflammation of the breast. Very swollen and red

Question 17

How do we best characterize medullary type of invasive ductal carcinoma?

Answer 17

High grade malignant cells growing with lymphocytes and plasma cells.

Question 18

What is the mutation associated with medullary type invasive ductal carcinoma?

Answer 18

BRCA 1

Question 19

How do we best characterize lobular carcinoma in situ?

Answer 19

Malignant growth inside the lobule that does not invade the basement membrane

Question 20

What is an important mutation associated with lobular carcinoma in situ? What does this mutation lead to?

Answer 20

Cancer cells lack E cadhedrin so they are not connected to one another.

Question 21

How does the cancer usually present, where does it show up?

Answer 21

Multifocal and bilateral

Question 22

How do we treat lobular carcinoma in situ and why?

Answer 22

An anti estrogen like tamoxifen because it has a low risk to progress to invasive

Question 23

In what pattern do the malignant cells invade through basement membrane in invasive lobular carcinoma?

Answer 23

In a single file line. They cannot make ductules because the lack E. Cadherin.

Question 24

What is the most important factor in determining prognosis for breast cancer. However, what is the caveat here?

Answer 24

Metastasis. However, most patients who present with breast cancer do not have metastasis so the most useful indicator of prognosis is axillary lymph node involvement.

Question 25

How do docs access the axillary lymph nodes while at the same time trying to preserve the patients lymph nodes?

Answer 25

They inject radioactive die in the breast and let it drain to the lymph nodes. They take out the first layer of nodes and if they are negative they leave the other ones in so the patient can have LN for the breast to drain to.