Breast cancer Flashcards
Nottingham histological grading index
Score 1-3 each for pleiomorphism, atypia and tubule/acinar/glandular formation
Grade 1: 3-5 (93% 10ysr)
Grade 2: 6-7
Grade 3: 8-9 (70% 10ysr)
Invasive lobular carcinoma
5-15% all breast cancers
Rows of discohesive, moderately-sized cells with little cytoplasm and round nuclei
Usually Grade 2, ER/PR+, HER2-, aberrant e-cadherin
High risk of bilateral breast cancers
Hormone responsive
Metastasise to GI tract and ovaries
Prognostic factors in invasive breast cancer
Nodal status, particularly isolated tumour cell clusters post-neoadjuvant chemo
Tumour size
Histological grade 1-3
Lymphovascular invasion
Oestrogen receptor
A sex steroid receptor expressed in the nucleus of a luminal breast cell
Aberrant expression results in autonomous growth and proliferation, facilitating tumorigenesis
80% invasive breast cancers ER+
Allred score
Score used to assess the frequency and intensity of reactivity of tumour nuclei in a sample (oestrogen and progesterone receptor)
Percentage of cells
1: 0
2. 1-10%
3: 10-33%
4. 33-66%
5. >66%
Intensity of staining
0: none
1: weak
2: moderate
3: strong
0-2 = ER negative
Nodal metastases
Isolated tumour cell clusters: <0.2mm, <200 cells in a section
Micrometastases: 0.2-2mm, >200 cells in a section
Macrometastases: >2mm (pN1)
Phyllodes tumour (definition, epidemiology, clinical, histo, stats on malignancy and mets, surveillance)
An uncommon fibroepithelial tumour
<1% of all breast cancers, median age 42-45, assoc with Li-Fraumeni (tp53)
Clin: smooth, firm, mobile, painless mass
Core bx: leaf-like projections of stroma covered in epithelium projecting into spaces
Histo: atypia, mitoses, margins circumscribed v infiltrative, stromal overgrowth
Malignant: 60-80% 5ys, excision with 1cm, RT
Mets: 11mo median survival, to lungs, in >5cm tumours or with malignant histo
f/u: 6 monthly until 2y, annual mammo if no mastectomy
Bi-RADS classification
- definition
- numbers + meaning, recommendation, % chance of malignancy
Developed by the American College of Radiography to standardise mammographic reporting
0: need additional imaging
1: Negative - continue routine mammogram (0% malignancy)
2: Benign - continue routine mammogram (0% malignancy)
3: Probably benign - 6 month followup or continued surveillance (>0 and <2% malignancy)
4: Suspicious - tissue diagnosis (2-95% malignancy)
5: Highly suggestive - tissue diagnosis (>95% malignancy)
6. Known bx-proven malignancy - surgical excision reuqired
Pathological scoring system for DCIS: architectural features
DCIS is classified by architectural features (growth pattern)
- Comedo (necrosis at centre +/- calcs, large cells, high mitoses. Invade.)
- Cribiform (glands without stroma, small cells, low mitoses)
- Micropapillary (tufts into lumen)
- Papillary (tufts with fibrovascular cores)
- Solid (tumour cells fill the spaces, not well defined)
Low vs high grade DCIS: describe phenotype
Use nuclear grade and the absence or presence of necrosis
Low grade: diploid, ER/PR+, low proliferation
High grade: aneuploid, ER/PR-, high number of mitoses, angiogenesis, HER2+ or tp53 mutations
Z0011
Changed the management of the axilla in patients with limited SLN involvement
1999-2004, 891 patients, cT1-T2 disease
Randomised women to ALND or no further treatment
- WLE and SLN
- 1-2 positive SLN: either ALND or no further axillary treatment
- All received post-op whole-breast RT
Outcome: overall survival
Little difference in 10y os and 10y dfs
Complications (wound infection, seroma, paraesthesia) higher in the ALND group
Who is offered NACT in breast cancer?
Inflammatory breast cancer
T3-T4 disease
Bulky or matted N2 disease
N3 disease
Patients who need further workup or management (genetic testing, pregnancy)
HER2+
TNBC
What are the benefits of NACT in breast cancer?
Downstaging the tumour to allow operation +/- BCS
Gives time to gather more information - eg genetic testing, results of which may change the operation offered
Gives time to plan breast reconstruction
To gather information on disease biology and behaviour - response to NACT can alter adjuvant therapy offered (can escalate or de-escalate)
What option for a neoadjuvant chemotherapy regimen in breast cancer?
Dose-dense doxirubicin and cyclophosphamide (IV day 1, 4 cycles of 14 days)
Then paclitaxel (IV day 1, 4 cycles of 14 days)
Then trastuzumab (IV day 1, 1 year of 14 days)
Who is offered adjuvant radiotherapy in breast cancer?
Whole breast RT following partial mastectomy + SNB
Chest wall RT following mastectomy with high risk features: LVI, chest wall involvement
Boost to tumour bed in young pts with large cancer that is hormone receptor negative
Axillary RT in T1-2, clinically negative axilla but SNB + (AMAROS)
