Breast Cancer

Question 1

Clinical Presentation of Breast Cancer

Answer 1

Patients may present to be evaluated because of an abnormal finding located on a screening test, or they may present with a palpable lump or thickening, or a change in the size, shape, or appearance of the breast or nipple.

The nipple may be inverted or have bloody discharge. Sometimes, there is dimpling of the breast, most notable when raising the arms. The skin on the breast may be red, tender, or ulcerated, or take on a peau d’orange appearance, where the skin is dimpled like the appearance of an orange peel. Involved lymph nodes may be palpable, hard, irregularly shaped, and either fixed to the skin or movable.

Question 2

Invasive breast cancer falls most frequently into three main types.

Answer 2

Invasive Ductal Carcinoma

Invasive Lobular Carcinoma

Inflammatory Breast Cancer

Question 3

Invasive Ductal Carcinoma

Answer 3

Invasive ductal carcinoma (IDC), or infiltrating ductal carcinoma, is the most common type of breast cancer, accounting for 60%–80% of malignant breast cancers. IDC spreads outside of the ductal wall and into the lymph and blood vessels found in the surrounding tissues. Prognosis for those with IDC can vary considerably with cellular characteristics, such as hormone receptor status and tumor grade.

Question 4

Invasive Lobular Carcinoma

Answer 4

Invasive lobular carcinoma (ILC) is the second most common type of breast cancer, making up 10%–15% of malignant breast cancers. ILC can pose a challenge in both diagnosis and treatment. It is more difficult to detect on mammograms and is usually nonpalpable. The margins for this cancer are not as clearly defined. The use of MRI can help to visualize the margins, but in some cases, when attempting breast-conserving surgery, re-excision may be needed to obtain clean margins. These cancers are more likely to occur bilaterally and metastasize to unusual surfaces, such as the pericardium, abdomen, ovaries, stomach, and eyes.

Question 5

Inflammatory Breast Cancer

Answer 5

Inflammatory breast cancer (IBC) is the most lethal form of primary breast cancer and accounts for 1%–5% of cases. IBC is known for its rapid onset, with diffuse erythema, edema, cellulitis, and peau d’orange appearance of the skin. It is not unusual for IBC to be mistaken for mastitis or inflammation due to an insect bite or infection. IBC is found more commonly in younger women and those of African American descent.

Question 6

The following subtypes of breast cancer make up less than 10% of breast cancer cases and are known to have a more favorable prognosis. They are as follows:

Answer 6

1. Papillary
2. Tubular
3. Mucinous
4. Pure medullary carcinomas
5. Metaplastic carcinoma