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OSD_Repro > Breast Cancers > Flashcards

Breast Cancers Flashcards

1
Q

Low risk factors for Breast Cancer?

A
  • Female Gender
  • Menarche by age 11
  • No live births before 35
  • Post menopausal hormone replacement
  • Race: Non-hispanic white females
  • Age (increasing)
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2
Q

Moderate risk factors for Breast Cancer?

A
  1. Personal Hx of breast cancer
  2. Biopsy proven precancerous lesion
  3. Hx of breast cancer in 1st degree relative
  4. Dense breasts
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3
Q

High risk factors for Breast Cancer?

A
  • Hx of chest radiation btwn ages 10-30
  • BRCA gene mutation
  • Li-Fraumeni syndrome
  • Cowden syndrome
  • BRCA gene mutation, Li-Fraumeni syndrome or Cowden syndrome in 1st degree relative
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4
Q

BRCA gene mutations

A
  • Most common hereditary cause of breast cancer

- Tumor suppressor genes on the long arm of chromosome 17

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5
Q

______ gene increases the risk of developing male breast cancer

A

BRCA2

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6
Q

_____ gene mutation increases the risk of developing breast cancer (80%) and ovarian cancer, usually serous type (50%)

A

BRCA1

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7
Q

BRCA gene breast cancer - Presentation?

A

Young woman with a high-grade (poorly differentiated) breast cancer

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8
Q

Breast Cancer Screening methods

A
  • Monthly self breast exam.
  • Annual breast exam by healthcare professional.
  • Annual mammogram starting at age 40.
    • MRI for high-risk patients
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9
Q

In-situ Breast carcinomas – types?

A
  • Ductal carcinoma in-situ
  • Lobular carcinoma in-situ
  • Paget’s disease
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10
Q

Dx?

  • Almost always detected by mammogram
  • Usually presents as micro calcifications
  • Represents up to 30% of breast cancers
A

Ductal Carcinoma In-Situ (DCIS)

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11
Q

Lobular Carcinoma in-situ – Tx?

A

Anti-Estrogen

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12
Q

Dx?

  • Always an incidental finding
  • More common in PREmenopausal women
  • Not associated with calcifications
A

Lobular Carcinoma in-Situ (LCIS)

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13
Q

Dx?

  • A form of in-situ carcinoma, where tumor cells grow within the epidermis of the nipple and/or areola.
  • Present 1-4% of breast carcinoma.
  • Almost always associated with underlying high-grade DCIS or invasive carcinoma
A

Paget’s Disease

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14
Q

Dx?

Presents as an eczematous, red, crusted nipple lesion.

A

Paget’s Disease

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15
Q

How does Paget’s Disease present?

A

Presents as an eczematous, red, crusted nipple lesion

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16
Q

DCIS - Almost always detected by ______

A

mammogram

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17
Q

DCIS - Usually presents as ______

A

microcalcifications

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18
Q

DCIS - how is it characterized prognostically?

A
  1. Comedo (grossly, if you squeeze the cut surface of the lesion, the necrotic material is pushed out like comedons) or Non-Comedo
  2. Low, Intermediate, or High Grade — based on degree of nuclear atypic
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19
Q

Intraductal proliferation with punched out spaces “cookie cutters” – this sub-type of DCIS is referred to as ______ type.

A

DCIS: Cribriform type

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20
Q

What sub-type of DCIS is described below?

The duct is completely filled with a monotonous population of cells; also note associated microcalcification.

A

DCIS: Solid type

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21
Q

How does invasive breast cancer present clinically?

A
  • Presents as a mass, either palpable or mammographically detected
  • Central tumors may cause retraction of the nipple
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22
Q

________ is a high grade carcinoma by default.

A

Inflammatory carcinoma

23
Q

Inflammatory Carcinoma - characteristics?

A
  • Carcinoma that presents with swollen erythematous breast.
  • Invasion of the dermal lymphatics blocks drainage leading to lymphedema, swelling and thickening of skin
  • Tethering of the skin of the breast to the Cooper ligaments mimics an orange peel “peau d’orange”
24
Q

Dx?

Carcinoma that presents with swollen erythematous breast

A

Inflammatory Carcinoma

25
Q

What causes Inflammatory Carcinoma to mimic an orange peel (“peau d’orange”)?

A

Tethering of the skin of the breast to the Cooper ligaments

26
Q

What causes Inflammatory Carcinoma to present w/ lymphedema & swelling?

A

Invasion of the dermal lymphatics blocks drainage leading to lymphedema, swelling and thickening of skin

27
Q

Invasive Lobular Carcinoma:

a) Usually ____ Grade
b) Usually focal or multifocal?
c) Prognosis similar to ____ of same grade and stage

A

a) Low
b) Multifocal
c) IDC

28
Q

What are the most characteristic histologic features of invasive lobular carcinoma?

A
  • Infiltration of tumor cells in single files

- They are commonly arranged circumferentially around benign residual ducts in a “targetoid” fashion (arrow)

29
Q

Dx?

Small, low grade tumor composed entirely of small tubules, with pointed ends “tear-drop shape”

A

Tubular Carcinoma

30
Q

Tubular Carcinoma - Prognosis? Risk of metastases?

A
  • Low risk of metastases

- Excellent prognosis

31
Q

T or F?

In Tubular Carcinoma, the tubules are lined by a single layer of bland tumor cells with hardly any mitotic activity.

A

True

32
Q

Dx?

Composed entirely of aggregates of tumor cells floating in pools of mucin.

A

Mucinous (Colloid) Carcinoma

33
Q

Mucinous (Colloid) Carcinoma:

a) ____- Grade tumor
b) Demographic?
c) Prognosis?

A

a) Low-grade tumor
b) Elderly women
c) Good prognosis

(Composed entirely of aggregates of tumor cells floating in pools of mucin)

34
Q

Medullary CA:

a) Gross appearance?
b) Histology?
c) Genetics?

A

a) Sharply-circumscribed, soft fleshy tumor
b) Malignant cells admixed with intense lymphocytic infiltration.
c) More common in BRCA1 carriers

35
Q

________ typically has a well-circumscribed pushing (as opposed to infiltrating) border and syncytial sheets of tumor cells in a stroma rich in lymphocytes and plasma cells.

A

Medullary carcinoma

36
Q

Dx?

Adenocarcinoma but not forming glands!

A

Metaplastic CA

Metaplastic component may be squamous, spindle cells, fibroblasts, bone, cartilage, etc…

37
Q

Metaplastic CA:

______ outcome than other types

A

Worse

38
Q

What are the Modified Bloom-Richardson Criteria for tumor prognosis?

A
  1. % of tubule formation
  2. Degree of nuclear atypic
  3. # of mitotic figures in 10HPF

Low grade = More tubules, less nuclear atypia, fewer MF

The higher the grade, the worse the prognosis

39
Q

How is tumor “Stage” determined?

A

TNM
T = Tumor Size.
N = lymph Node metastases
M = distant Metastases

Rule #1: Inflammatory carcinoma is considered T4
Rule #2: Distant metastases is stage IV

40
Q

For TNM staging, inflammatory carcinoma is considered ____.

A

T4

41
Q

The most important prognostic factor for Breast cancer?

A

Axillary Lymph Node metastases

42
Q

Molecular Classification - 3 classifications & prognosis of each?

A
  1. Luminal-type Carcinomas express Estrogen and have the BEST prognosis.
  2. Her2-type cancers do not express ER or PR but show Her2-gene amplification. They have a BAD prognosis
  3. Basal-like breast cancer are negative for all 3 markers & have the WORST prognosis
    (more common in African-American women)
43
Q

What are “Triple Negative” breast cancers?

A

Basal-like breast cancers, which are negative for all 3 markers (ER, PR, & HER-2).
Of the 3 molecular classifications, these have the WORST prognosis.

43
Q

What are “Triple Negative” breast cancers?

A

Basal-like breast cancers, which are negative for all 3 markers (ER, PR, & HER-2).
Of the 3 molecular classifications, these have the WORST prognosis.

44
Q

Pathologic features of Luminal-type-A breast cancers?

A
  • WD IDC
  • Lobular cA
  • Tubular CA
  • Mucinous CA
45
Q

Pathologic features of Luminal-type-B breast cancers?

A
  • MD IDC

- Lobular CA

46
Q

Pathologic features of Basal-like breast cancers?

A
  • Poorly-differentiated IDC
  • BRCA1- assoc
  • African-American women
47
Q

Pathologic features of Basal-like breast cancers?

A
  • Poorly-differentiated IDC
  • BRCA1- assoc
  • African-American women
48
Q

Luminal Type A breast cancer – Tx?

A

Tamoxifen

49
Q

Luminal Type B breast cancer – Tx?

A

Tamoxifen

50
Q

Basal-like breast cancer – Tx?

A

Chemotherapy

51
Q

Basal-like breast cancer – Tx?

A

Chemotherapy

52
Q

Trastuzumab - MOA?

A

Monoclonal antibody to HER-2 receptors

- binds receptor on tumor cells to induce an antigen-antibody-reaction leading to cytotoxicity of tumor cells.

OSD_Repro (15 decks)

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