Breast cancer Flashcards
What percentage of cases of breast cancer happens in males?
1%
What proportion of women will develop breast cancer in their lifetime?
1 in 12
What increases the risk of male breast cancer?
Klinefelter’s
Male to female transexuals
Men treated with oestrogen for prostate cancer
What is the most common type of breast cancer?
Name some other types
Adenocarcinoma (95%)
Primary sarcoma eg angiosarcoma
Where is breast cancer most common?
Upper outer quadrant (about 50% occur here)
Hormonal risk factors for breast cancer?
Gender Uninterrupted menses Early menarche (
Other risk factors for breast cancer?
Geographic - higher in US and Europe
Atypical changes on previous biopsy
Previous breast cancer
Therapeutic radiation exposure especially in childhood/adolescence eg Hodgkin’s lymphoma
Genetics - mutations to BRCA1 and BRCA2 genes
What do the BRCA1 and 2 genes normally do?
Tumour suppressor gene - their proteins repair damaged DNA
Lifetime risk for female carriers of BRCA1/2 gene?
60-85%
Classifications of breast carcinoma?
In situ or invasive
Ductal or lobular
For in situ carcinoma, what limits the spread of neoplastic populations of cells? Where is the spread limited to?
Limited to ducts and lobules
Limited by basement membrane so that myoepithelial cells are spared
Does not invade into vessels so cannot metastasise
How does ductal carcinoma in situ (DCIS) often present?
Mammographic calcifications (clusters or linear branching)
Sometimes as a mass
How does DCIS appear histologically?
Central necrosis with calcification
What can DCIS be a pre-cursor be a precursor to?
Invasive carcinoma (but not always)
Where can DCIS spread to?
Through ducts and lobules, can be very extensive
What is Paget’s disease of the nipple?
When DCIS cells extend to nipple skin without crossing the basement membrane
Get unilateral red and crusting nipple
What is invasive carcinoma?
When DCIS has invaded beyond the membrane
Can invade into vessels and therefore metastasise to lymph nodes
How does invasive carcinoma usually present?
As a mass or mammographic abnormality
-by the time a mass is palpable, more than half will have axillary lymph node metastases
What is peau d’orange?
When lymphatic drainage of skin is involved
Types of invasive carcinoma?
Invasive ductal carcinoma, no special type (IDC NST)
-70-80%
Invasive lobular carcinoma
-5-15%
Tubular (good prognosis), mucinous (good prognosis, older women)
Histological appearance of IDC NST?
Well-differentiated type - tubules lined by atypical cells
Poorly differentiated type - sheets of pleomorphic cells
Histological appearance of invasive lobular carcinoma?
Infiltrating cells in a single file, cells lack cohesion
Prognosis of IDC NST and invasive lobular carcinoma?
35-50% 10 year survival
Patterns of metastasis of breast cancer?
Lymph nodes via lymphatics, usually in ipsilateral axilla
Distant mets via blood vessels - bones, lungs, liver, brain
Which cancer can spread to odd sites?
Invasive lobular carcinoma (peritoneum, retroperitoneum, leptomeninges, GI, ovaries, uterus)
Factors determining prognosis in breast cancer?
In situ disease or invasive Histologic subtype - IDC NST has poor prognosis Tumour grade Tumour stage Gene expression profile
How are breast tumours staged?
Tumour size
Locally advanced disease - invading into skin or skeletal muscle
Lymph node mets
Distant mets
How to diagnose breast cancer?
Triple approach
- clinical - history, family history, examination
- radiographic - mammogram and ultrasound
- pathology - fine needle aspiration cytology and core biopsy
Therapeutic approach to local and regional breast cancer?
Breast surgery
-mastectomy or breast conserving surgery
Axillary surgery
-extent depending on whether there are nodes involved
Post-op radiotherapy to chest and axilla
Systemic control of breast cancer?
Chemo
Hormonal treatment
-tamoxifen if high amount of oestrogen receptors found on assessment
Herceptin treatment
-depends on amount of HER2 receptors found on assessment
