Breast Cancer Flashcards

0
Q

In DCIS you have a malignant proliferation of cells in the duct. Explain the most high yield DCIS pattern

A

Comedocarcinoma: Centre usually dies due to lack of oxygen

Get dystrophic calcification

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1
Q

What are the risk factors for breast cancer

A

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

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2
Q

What is the DDX of dystrophic calcification detecting on mammogram

A

Fat necrosis
Sclerosing adenosis
DCIS

Need to biopsy!!

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3
Q

What is Paget disease of breast?

Presentation?

A

DCIS that extends up the duct and involves the nipple skin

Padded cells = large cells @ epidermis with clear HAAAAAALLLOOOOOO

Nipple ulceration + erythema

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4
Q

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?

A

Invade basement membrane and connective-tissue

Form duct-like structures

Detected by
physical exam 2 cm /// mammography 1 cm

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5
Q

As the cancer progresses what can happen to the skin and nipple?
What do you see on biopsy in invasive Ductal carcinoma

A

Skin dimpling + nipple retraction

firm fibrous rockhard mass +
Sharp margins +
small glandular duct like cells
in a desmoplastic stroma - stellate infiltration

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6
Q

Subtypes of invasive ductal carcinoma

A

Tubular Medullary Mucinous = good prognosis

Inflammatory = Poor prognosis

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7
Q

Explain histologically what we see in

tubular, mucinous, inflammatory, medullary carcinoma

A

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

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8
Q

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?

A

Acute mastitis / Paget/ inflammatory carcinoma IDC

Inflammatory carcinoma IDC biopsy =
Cancer @ dermal lymphatics –> blocked drainage
– > swollen + erythematous

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9
Q

What is lobular carcinoma in situ

A

Malignant proliferation of cells without BM invasion

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10
Q

How does lobular carcinoma in situ present?

What do you see on histology for LCIS?

A

No mass/classification – discovered incidentally on biopsy

Dyscohesive cells lack E-cadherin
Multifocal + bilateral

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11
Q

How do you treat LCIS

A

Tamoxifen – anti-oestrogen agent = reduce risk of LCIS invading

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12
Q

What’s the difference in terms of histology between DCIS and LCIS

A

DCIS = make duct like structures

LCIS =
dispersed in single file because of ⬇️E-cadherins -> can’t make ducts so end up invading singly

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13
Q

Out of the T N M staging which factor is the most important?

Which lymph-node do you biopsy?

A

Metastasis – if cancer outside breast + @axillary – >Poor prognosis

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14
Q

Explain sentinel lymph node biopsy

A

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

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15
Q

What are the three predictive factors for breast cancer

A

Estrogen receptor
Progesterone receptor
HER2/neu amplification

16
Q

What agents can we give in order to detect the presence of these predictive factors

A

Tamoxifen anti Estrogen therapy –>
ER/PR complex @nucleus
Actual receptor + cytoplasm
Tamoxifen binds to receptor – >receptor translocate and move to nucleus

HER2/neu @ cell-surface –
bind to trastuzumab/herceptin

17
Q

Who has an increased propensity to develop triple negative carcinoma

A

African-American

18
Q

What clinical features suggest hereditary breast cancer

A

First-degree relative
Tumour @premenopausal age
Multiple tumours

19
Q

What are BRCA1 +2 associated with?

A

BRCA1 =
breast (medullary) + ovarian at fallopian tube too)

BRCA 2 =
Breast cancer @ males = rare

20
Q

How does a breast cancer in male present

A

Subareolar mass

Usually invasive ductal carcinoma as males don’t have lobules

21
Q

Risk factors for gynaecomastia and breast cancer in males

A

Testicular tumour, Old-age, puberty, Cirrhosis -> Hyperestrogenism

Klinefelter’s

Drugs e.g. some drugs create awesome knockers
Spironolactone, digoxin, cimetidine, alcohol, ketaconazole

–>

Gynaecomastia