Breast Cancer Flashcards
What is the most common carcinoma in women by incidence (excluding skin)?
breast
breast cancer is the Xth most common cause of cancer mortality in women
2nd
Name six risk factors for breast cancer
- Female gender
- Age
- Early menarche/late menopause
- Obesity
- Atypical hyperplasia
- First-degree relative (mother, sister, daughter) with breast cancer
what do you call a malignant proliferation of cells in ducts with no invasion of the basement membrane?
ductal carcinoma in situ
how is DCIS usually detected?
calcification on mammography; DCIS does not produce a mass
mammographic calcifications can also be associated with benign conditions such as
fibrocystic changes (especially sclerosing adenoma) and fat necrosis
how do you know whether mammographic calcifications are benign or malignant?
biopsy
histologic subtypes of DCIS are based on
architecture
what is the subtype of DCIS that is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
comedo
what do you call DCIS that extends up the ducts to involve the skin of the nipple
pager’s disease of the breast
Paget disease of the breast presents as
nipple ulceration and erythema
paget disease of the breast is almost always associated with an underlying
carcinoma
what do you call an invasive breast carcinoma that classically forms duct-like structures?
invasive ductal carcinoma
what is the most common type of invasive carcinoma in the breast, accounting for >80% of cases
invasive ductal carcinoma
how does invasive ductal carcinoma usually present
mass on physical exam or mammography
clinically (PE) detected breast masses are usually at least what size
2 cm
mammographically detected breast masses are usually at least what size
1 cm
advanced breast tumors may result in
dimpling of the skin or retraction of the nipple
biopsy of invasive ductal carcinoma usually shows duct-like structures in a
desmoplasic stroma
subtype of invasive ductal carcinoma that is characterized by well-differentiated tubules that lack myopeithelial cells?
tubular carcinoma
subtype of invasive ductal carcinoma that is characterized by carcinoma with abundant extracellular mucin (tumor cells floating in a mucus pool)?
mucinous carcinoma
what is the typical population of the mucinous subtype of invasive ductal carcinoma?
older women (average age is 70)
subtype of invasive ductal carcinoma that is characterized by large, high-grade cells growing in sheets with associated with lymphocytes and plasma cells
medullary carcinoma
grows as a well-circumscribed mass that can mimic fibroadenoma on mammography; increased incidence in BRCA1 carriers
medullary carcinoma (invasive ductal)
subtype of invasive ductal carcinoma that is characterized by carcinoma in dermal lymphatics
inflammatory carcinoma
presents as an inflamed, swollen breast (tumor cells block drainage of lymphatics) with no discrete mass; can be mistaken for acute mastitis
inflammatory carcinoma (invasive ductal)
which subtype of invasive ductal carcinoma has the worst prognosis?
inflammatory
malignant proliferation of cells in lobules with no invasion of the basement membrane
LCIS
how is LCIS discovered?
incidentally on biopsy (!) - it doesn’t produce a mass or calcifications
histology of LCIS
dyscohesive cells lacking E-cadherin adhesion protein
LCIS is characterized by dyscohesive cells lacking WHAT?
E-cadherin adhesion protein
Besides being undetectable except by incidental biopsy, what other features of LCIS make it scary?
usually multifocal and bilateral
how do you treat LCIS?
tamoxifen (to reduce the risk of subsequent carcinoma) and close followup
LCIS risk of progression to invasive carcinoma?
low
invasive carcinoma that characteristically grows in a single-file pattern; cells may exhibit signet-ring morphology
invasive lobular carcinoma
why is there no duct formation in invasive lobular carcinoma?
lack of E-caherin
what is the most important factor in breast cancer prognosis?
metastasis, but most patients present before metastasis occurs
what is the most useful prognostic factor in breast cancer?
spread to axillary lymph nodes; sentinel lymph node biospy is used to assess axillary lymph nodes
what do you call factors that predict response to treatment
predictive factors
what are the most important predictive factors
estrogen receptor (ER), progesterone receptor (PR). Her2/neu amplification (overexpression) status
Presence of ER and PR is associated with response to
antiestrogenic agents (eg tamoxifen)
ER and PR are located where?
in the nucleus
HER2/neu amplification with response to
trastuxumab (Herceptin)
what is trastuxumab?
a designer antibody directed against the HER2 receptor
What is HER2/neu?
a growth factor receipt present on the cell surface
what do you call a tumor that is negative for ER, PR, and HER2/neu
triple negative tuomr
what is the prognosis of triple negative tumors?
poor
what population has increased risk of developing rip negative carcinomas?
African American women
Hereditary breast cancer represents what percentage of breast cancer cases?
10%
what are three clinical factors that suggest hereditary breast cancer?
- multiple first-degree relatives with breast cancer
- tumor at an early age (premenopausal)
- multiple tumors in a single patient
what are the two most important single gene mutations associated with hereditary breast cancer?
BRCA1 and BRAC2
Mutation associated with breast and ovarian carcinomas
BRCA1
Mutation associated with breast carcinoma in males
BRCA2
women with a genetic predisposition to breast cancer may choose to undergo WHAT to reduce the risk of developing carcinoma
bilateral mastectomy
why does a small risk for breast cancer remain after bilateral mastectomy?
breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall
