Breast cancer lectures Flashcards
__ + cyclophosphamide are given as adjuvant therapy for breast cancer
Adriamycin and Cyclophosphamide followed by taxol (Adriamycin is Doxorubicin)
**another option is taxotere + cyclophosphamide (but seems like no matter what, you use cyclophosphamide)
**if the pt is Her2+, the regimen will also contain perceptin (trastuzumab) for a year**
What is the mechanism of action of tamoxifen?
Besides what you’ve learned from previous lectures, name 3 side effects of tamoxifen
Selective estrogen receptor modulators (i.e. tamoxifen) bind to the estrogen receptor and become antagonists in some tissues or agonists in other tissues (e.g. they have an antagonist effect in the breast, but an agonist effect in the endometrium)
**
other side effects of tamoxifen:
Blood clots
Endometrial cancer
Cataracts
Describe the mechanism of action of aromatase inhibitors
Which 3 drugs are in the class of aromatase inhibitors?
Aromatase inhibitors block conversion of androgens to estrogens
Drugs in this class: letrozole, anastrozole, exemestane
What are the side effects of aromatase inhibitors?
Aches
Hot flashes
Vaginal dryness
Osteopenia
How do you treat ER+ metastatic breast cancer?
Hormone therapy + CDK4/6 inhibitor
**know that CDK4/6 inhibitors: cause cell cycle arrest**
How would you treat metastatic Her2+ cancer?
Dual Her2 therapy (Trastuzumab and Pertuzumab)
Antibody drug conjugate (Trastuzumab with emtansine chemotherapy/ Kadcyla)
Oral tyrosine kinase inhibitor – Lapatinib, neratinib
___ is a bacterial infection of the breast commonly occuring during lactation due to cracks and fissures in the nipples that make room for S. aureus infection
Acute mastitis is a bacterial infection of the breast commonly occuring during lactation due to cracks and fissures in the nipples that make room for S. aureus infection
What inflammatory breast condition manifests as a warm, erythematous breast with purulent nipple discharge?
How do you Rx this condition?
Acute mastitis (mostly due to S. aureus)
Rx: continued drainage (still continue breastfeeding) + antibiotics (dicloxacillin)
What inflammatory breast condition presents as a painless mass or calcification in the breast resulting from necrosis of breast fat from trauma (or enzymatic breakdown)?
Fat necrosis
**can calcify and can lead to skin retraction**
**Biopsy: necrotic fat w/ calcifications + giant cells**
2 common stromal tumors are ___ and ___
Fibroadenoma
Phyllodes tumor
___ is the most common benign breast tumor which typically presents as a mobile mass in pre-menopausal women
Fibroadenoma is the most common benign breast tumor which typically presents as a mobile mass in pre-menopausal women
(also well circumscribed, which is characteristic of benign lesions)
Which benign breast tumor results from proliferation of intralobular stroma and is estrogen sensitive (grows during menstruation + pregaz but shrinks after menopause)?
Fibroadenoma
A ___ tumor is a fibroadenoma-like tumor characterized by stromal overgrowth
A phyllodes tumor is a fibroadenoma-like tumor characterized by stromal overgrowth
Unlike fibroadenoma, a phyllodes tumor occurs in __ patients and can be ___ (benign/malignant)
Unlike fibroadenoma, a phyllodes tumor occurs in post-menopausal patients and can be malignant
What is the pathology below and how can you tell?
Phyllodes tumor
**note that it forms leaf-like projections and the stroma have mitotic figures**
Which benign breast condition is characterized by “lumpy” breasts, blue-domed cysts and fibrosis occuring in pre-menopausal women?
Non-proliferative fibrocystic changes
**condition occurs with fluid-filled cysts, fibrosis from cyst rupture and apocrine metaplasia**
Name the conditions that fall under “proliferative breast disease without atypia”
Epithelial hyperplasia (mild, moderate, severe)
Sclerosing adenosis
Intraductal papillomas
Gynecomastia
Which non-atypia proliferative breast diseases will increase risk of cancer by up to 2x?
Epithelial hyperplasia - moderate + severe (can become ductal hyperplasia)
Sclerosing adenosis
Intraductal papillomas (multiple)
Gynecomastia
Which breast pathology is characterized by increased glands and fibrosis? (condition can also be calcified)
Sclerosing adenosis
___ results from papillary proliferation in the duct and can cause bloody nipple discharge
Intraductal papilloma
Name the 2 types of intraductal papilloma
Which one is typically solitary and subareolar, and occurs in older patients?
Which type occurs peripherally and in younger patients?
Large duct papilloma - occurs in older patients, subareolar and solitary
Multiple papillomas - occurs peripherally and in younger patients
___ is a condition characterized by male breast enlargement
Gynecomastia
2 examples of proliferative breast disease WITH atypia are___
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Does atypical ductal hyperplasia carry a risk of cancer?
Yup. 4-5x risk bilaterally
___ typically occurs as an incidental finding, can be multifocal and bilateral, and carries a cancer risk of 4-5x bilaterally
Atypical lobular hyperplasia typically occurs as an incidental finding, can be multifocal and bilateral, and carries a cancer risk of 4-5x bilaterally
___ is a malignant clonal proliferation of epithelial cells limited to ducts contained in the basement membrane. This malignancy is characterized by calcifications since it doesn’t normally produce a mass
Ductal carcinoma in situ is a malignant clonal proliferation of epithelial cells limited to ducts contained in the basement membrane. This malignancy is characterized by calcifications since it doesn’t normally produce a mass
**know that DCIS still has both a luminal layer and a myoepithelial layer, unlike invasive DC, which does not have myoepithelium**
Low grade DCIS is usually __ positive vs high grade, which is __ independent
Low grade DCIS is usually estrogen positive vs high grade, which is estrogen independent
**cancer risk increases to 8-10x ipsilaterally**
___ is high grade DCIS with central necrosis
Comedo DCIS is high grade DCIS with central necrosis
___ is DCIS that has spread to the skin of the nipple and usually involves underlying carcinoma in the breast
Paget’s disease of the nipple is DCIS that has spread to the skin of the nipple and usually involves underlying carcinoma in the breast
Which pathology is indicated below?
Paget’s disease of the nipple
___ is also an incidental finding, is multifocal and bilateral and is characterized by dyscohesive cells due to loss of E-cadherin (CDH1 mutation)
Lobular carcinoma in situ (LCIS) is also an incidental finding, is multifocal and bilateral and is characterized by discohesive cells due to loss of E-cadherin (CDH1 mutation)
(no mass or calcifications)
___ is the prototypical breast cancer that presents as a stellate mass and forms duct-like structures
Invasive ductal carcinoma is the prototypical breast cancer that presents as a stellate mass and forms duct-like structures
Invasive lobular carcinoma a bilateral, multicentric malignancy that is characterized by loss of E cadherin and ___
Invasive lobular carcinoma a bilateral, multicentric malignancy that is characterized by loss of E cadherin and formation of tumor cells in a single file
Medullary carcinomas are characterized by infiltration of what cell type?
Carriers of which cancer mutation are more likely to develop this disease?
Medullary carcinomas are characterized by infiltration of lymphocytes
More common in BRCA1 mutation carriers
Inflammatory breast carcinoma results from __
Inflammatory breast carcinoma results from tumor invasion if the lymphatics resulting in inflammation
**can mimic acute mastitis**
Describe the prognostic and predictive significance of the Estrogen Receptor
ER staining is +ve prognostic because tumors are generally less invasive and +ve predictive because they respond well to therapy (namely tamoxifen and aromatase inhibitors)
Her2 nu receptor is __ predictive and __ prognostic
Her2 nu is -ve prognostic but +ve predictive (only response Her2 therapy: trastuzumab)
FYI
