Breast Canccer 1 Flashcards
Breast cancer is most common what and second most common what?
Carcinoma by incidence
Cancer mortality in women
Risk factors are mostly related to what?
Estrogen exposure
How do we best characterize ductal carcinoma in situ?
Malignant proliferation of cells in the ducts that do not invade the basement membrane. Confined to the duct.
How is DCIS detected?
As calcification on mammogram.
What is the most common Histology subtype of DCIS and how do we characterize it on histo?
Comedo type.
Necrosis and calcification in the center of the duct.
What is Paget’s disease?
When DCIS extends up the duct to involved the nipple
2 ways Paget’s disease presents?
Nipple ulceration and redness
So, if a patient presents with Paget’s disease of the nipple, what is always the underlying cause?
Underlying carcinoma
How do we best characterize invasive ductal carcinoma?
Ductal carcinoma in situ invades the basement membrane of the duct
Invasive ductal carcinoma is the most common what?
Invasive carcinoma of the breast
Histo shows two things for invasive ductal carcinoma?
Duct like structures with desmoplastic stroma
What are the 4 main types of invasive ductal carcinoma?
Tubular, mucinous, medullary, inflammatory
2 classic histo features of tubular invasive ductal carcinoma?
Forms tubules and lacks myoepithelial cells
1 classic histo feature of mucinous invasive ductal carcinoma?
Cancer cells are floating in mucus
What patient population do we normall see the mucinous subtype in?
Older women, like over 70
How do we best characterize the inflammatory type of invasive ductal carcinoma?
The cancer cells are found in the dermal lymphatics and clog them so you get inflammation of the breast. Very swollen and red
How do we best characterize medullary type of invasive ductal carcinoma?
High grade malignant cells growing with lymphocytes and plasma cells.
What is the mutation associated with medullary type invasive ductal carcinoma?
BRCA 1
How do we best characterize lobular carcinoma in situ?
Malignant growth inside the lobule that does not invade the basement membrane
What is an important mutation associated with lobular carcinoma in situ? What does this mutation lead to?
Cancer cells lack E cadhedrin so they are not connected to one another.
How does the cancer usually present, where does it show up?
Multifocal and bilateral
How do we treat lobular carcinoma in situ and why?
An anti estrogen like tamoxifen because it has a low risk to progress to invasive
In what pattern do the malignant cells invade through basement membrane in invasive lobular carcinoma?
In a single file line. They cannot make ductules because the lack E. Cadherin.
What is the most important factor in determining prognosis for breast cancer. However, what is the caveat here?
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.
How do docs access the axillary lymph nodes while at the same time trying to preserve the patients lymph nodes?
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.
