Breast Lectures (pathology, cancer etc) Flashcards
what are the 2 main subtypes of breast cancer?
invasive
non-invasive
what are the types of invasive breast cancer?
ductal carcinoma (80%)
lobular carcinoma (10%)
others (like papillary or tubular)
what are the types of non-invasive breast cancer?
DCIS (ductal carcinoma in situ)
LCIS (lobular carcinoma in situ)
Risk factors for breast cancer
Gender
age
previous breast cancer
menstrual history (early menarche/ late menopause)
hormone treatment (HRT)
age at first pregnancy
FH
personal history
genetic factors
alcohol/ high BM
Radiotherapy
what genes make women more susceptible to breast cancer?
BRCA 1 (20-30%)
BRCA 2 (10-30%)
TP53 (1%)
PTEN (1%)
others
how do you diagnose breast cancer?
clinical exam
radiology (mammogram, USS, MRI)
FNA cytology
Needle core biopsy
wide local excision with adequate margins
when/ who gets screened for breast cancer in the UK?
women aged 50-71 that are registered with a GP are invited every 3 years for a mammogram
are deposits of calcium (macro calcifications) on a mammogram normal?
yes - often harmless
but a small percentage are precancerous or in cancerous tissue
what are two of the most important mammographic indicators of breast cancer?
masses
macro calcifications (indicates early cancer)
what will the histology report of an FNA of cancerous breast tissue likely involve?
invasive or non invasive?
histological types (ductal or lobular)
grade
size
margins
lymph nodes
oestrogen/progesterone receptors
spread of breast cancer:
3 types
local (skin, pectoral muscles)
lymphatic (axillary and internal mammary nodes)
blood (bones, lungs, liver, brain)
how do you manage breast cancer?
depends on the staging:
surgery (mastectomy, breast conserving surgery)
radiotherapy
antihormonal therapy
chemotherapy
Paget’s disease of the nipple is caused by what?
intraepithelial spread of an intraductal carcinoma
Paget’s disease of the nipple symptoms
(limited to the nipple or can extend to the areola)
pain or itching
scaling redness
mistaken for eczema
ulceration
crusting
serous or bloody discharge
male pathology of the breast is most commonly
gynaecomastia
microscopic examination of thin layer of cells on a slide is obtained by what 3 methods?
FNA
direct smear from nipple discharge
scrape of nipple with scalpel
how do you ‘cure’ a cyst?
aspiration
all breast cases with clinical OR radiological OR cytological suspicion - need to be what?
core biopsied
if the breast cancer patient was symptomatic - what symptoms might they have?
lump
mastalgia (unilateral pain)
nipple discharged (blood stained)
nipple changes (pagets disease, retraction)
change in the size or shape of the breast
lymph-oedema
dimpling of the breast skin
two types of surgical procedure in breast cancer
mastectomy
breast conservation surgery
what do you do is the sentinel lymph node biopsy comes back as positive for a tumour?
you remove ALL of them surgically
or give radio to all axillary nodes
factors that increase the chances or reoccurrence
lymph node involvement
tumour grade
tumour size
steroid receptor status
HER2 status
two drugs that can be taken as hormonal therapy to prevent reoccurrence of breast cancer:
(hormone therapy is ER positive - aims to block stimulation of cell growth by oestrogen)
tamoxifen (blocks on ER receptor)
aromatase inhibitor (inhibits ER synthesis)
Zoladex
inhibits FSH and LH
3 drugs used as chemotherapy in breast cancer:
CMF combinations
anthracycline combinations
taxane combinations
3 key factors that increase the risk of disease recurrence
tumour grade
tumour size
lymph node involvement
who gets invited for a breast cancer screen?
women aged 50-70 every 3 years (that are registered with a GP)
