Breast Cancer Flashcards
In DCIS you have a malignant proliferation of cells in the duct. Explain the most high yield DCIS pattern
Comedocarcinoma: Centre usually dies due to lack of oxygen
Get dystrophic calcification
What are the risk factors for breast cancer
OH BEAT
Obesity: adipose convert androstnedione –> estrone
Hyperplasia Atypical - usually XS oestrogen
BRCA1+2 mutation-sister mum daughter first relative
Eestrogen exposure
Age = postmenopausal + African
Total no. of menstrual cycles - early menarche/late menopause
What is the DDX of dystrophic calcification detecting on mammogram
Fat necrosis
Sclerosing adenosis
DCIS
Need to biopsy!!
What is Paget disease of breast?
Presentation?
DCIS that extends up the duct and involves the nipple skin
Padded cells = large cells @ epidermis with clear HAAAAAALLLOOOOOO
Nipple ulceration + erythema
Invasive ductal carcinoma what do the malignant cells do?
What kind of structures to the malignant cells form in IDC?
How is it usually detected?
Invade basement membrane and connective-tissue
Form duct-like structures
Detected by
physical exam 2 cm /// mammography 1 cm
As the cancer progresses what can happen to the skin and nipple?
What do you see on biopsy in invasive Ductal carcinoma
Skin dimpling + nipple retraction
firm fibrous rockhard mass +
Sharp margins +
small glandular duct like cells
in a desmoplastic stroma - stellate infiltration
Subtypes of invasive ductal carcinoma
Tubular Medullary Mucinous = good prognosis
Inflammatory = Poor prognosis
Explain histologically what we see in
tubular, mucinous, inflammatory, medullary carcinoma
Tubular –
No myoepithelial cells
Desmoplastic stroma
Mucinous –
Malignant cells floating in pools of mucus
Medullary = well circumscribed ~ fibroadenoma
BRCA1 mutation – >
high-grade malignant cell
+
inflammatory cells e.g. lymphocytes + plasma cells
Inflammatory carcinoma –
Cancer + dermal lymphatics. Skin resembles orange peel
A recently pregnant feeding woman comes in with a swollen and erythematous breast. What’s the DDX?
After antibiotics the information does not resolve. What does the biopsy show?
Acute mastitis / Paget/ inflammatory carcinoma IDC
Inflammatory carcinoma IDC biopsy =
Cancer @ dermal lymphatics –> blocked drainage
– > swollen + erythematous
What is lobular carcinoma in situ
Malignant proliferation of cells without BM invasion
How does lobular carcinoma in situ present?
What do you see on histology for LCIS?
No mass/classification – discovered incidentally on biopsy
Dyscohesive cells lack E-cadherin
Multifocal + bilateral
How do you treat LCIS
Tamoxifen – anti-oestrogen agent = reduce risk of LCIS invading
What’s the difference in terms of histology between DCIS and LCIS
DCIS = make duct like structures
LCIS =
dispersed in single file because of ⬇️E-cadherins -> can’t make ducts so end up invading singly
Out of the T N M staging which factor is the most important?
Which lymph-node do you biopsy?
Metastasis – if cancer outside breast + @axillary – >Poor prognosis
Explain sentinel lymph node biopsy
In fact breast with blue day/radioactive substance
– >
Go to lymph-nodes – >
Allowed out to assess first line of lymph-node drained by breast – >
Once marked remove the lymph-node
If negative assume ones behind are also negative
If positive remove other lymph-nodes ASAP
