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Reproductive and Sexual Health > Breast Pathology (malignant) > Flashcards

Breast Pathology (malignant) Flashcards

1
Q

What is an angiosarcoma and what is the most common cause?

A

malignant tumour of the blood vessels most commonly associated with x-ray treatment (previous radiotherapy)

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2
Q

What are the mets associated with breast?

A

carcinomas (ovarian, bronchial, clear cell), melanoma and leimyosarcoma

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3
Q

What is a breast carcinoma?

A

this is a malignant lesion of the breast glandular tissue - specifically the terminal duct lobular unit (TCLU). This makes it an adenocarcinoma

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4
Q

What are the ductal precursors to breast carcinoma?

A

epithelial hyperplasia of usual type, columnar cell change, atypical ductal hyperplasia and ductal carcinoma in situ (DCIS)

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5
Q

What are the lobular precursors to breast carcinoma?

A

atypical lobular hyperplasia and lobular carcinoma insitu

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6
Q

How do you differentiate between atypical lobular hyperplasia and lobular carcinoma in situ?

A

<50% of the lobule involves in ALH >50% of the lobule involves in LCIS

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7
Q

What are the changes observed in the precursors to lobular carcinoma?

A

small-medium sized nuclei

solid proliferation

intracytoplasmic vacuoles

ER positive

E-cadherin -ve

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8
Q

What is the presentation of lobular in-situ neoplasia?

A

frequently multifocal and bilateral

not palpable, not visible and usually an incidental finding on mammogram (may calcify)

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9
Q

When decreases the incidence of lobular in-situ neoplasia?

A

post-menopause

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10
Q

How do you manage lobular in-situ neoplasia if found on core biopsy?

A

investigate further with vacuum biopsy/excision

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11
Q

How do you manage a lobular in-situ neoplasia found on vacuum biopsy/excision?

A

follow-up and clinical trials

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12
Q

What is DCIS?

A

this is the pre-cursor to ductal breast carcinoma. It is the cancerous growth of cells within the terminal ductule lobular unit (TDLU) without the breaching of the BM. It tends to be unicentric (affecting only one unit)

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13
Q

What is Paget’s disease of the nipple?

A

when there is DCIS tracking up a lobule to the epidermis

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14
Q

Is Pagets disease invasive?

A

no - it will not have breached the BM

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15
Q

When does a cancer become invasive?

A

when it breaches the basement membrane of the tissue

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16
Q

How should you manage DCIS?

A

surgery (if low-grade adopt a watch and wait approach to avoid overtreatment)

radiotherapy to reduce recurrence

chemoprevention trial

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17
Q

Low grade DCIS will develop into…

A

G1 ductal carcinoma

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18
Q

Intermediate grade DCIS will devlop into

A

G2 ductal carcinoma

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19
Q

High grade DCIS will develop into

A

G3 ductal carcinoma

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20
Q

What is microinvasive carcinoma?

A

when high grade DCIS invades less than 1mm beyond the BM - treat as HG DCIS

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21
Q

Describe breast cancer indicence?

A

it is the most common cancer affecting women in the UK and will likely affect 45-70 year olds. 1 in 8 will get breast cancer

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22
Q

What is the trend in mortality with breast cancer?

A

Decreasing (although incidence is increasing) due to screening techniques

23
Q

What is the breast screening program offered in the UK?

A

offered from 50-71st birthday every 3 years

24
Q

What are some risk factors for breast carcinoma?

A

older age, early menarche, increased age of first child, nulliparous, no breastfeeding, late menopause

increased endogenous and exogenous hormones (OCP, HRT)

higher BMI, decreased physical activity, high fat diet, smoking

History of previous breast disease

BRCA1 and 2 mutations

25
Q

Where will a breast carcinoma locally invade?

A

skin, nipple, muscle, intercostals, stroma of breast

26
Q

Where will a breast cancer drain to lymphatically?

A

regional draining lymph nodes

Axillary nodes drain the lateral part of breast (75%)

Parasternal (internal thoracic nodes) drains the medial border of breast (20%)

posterior intercostal (5%)

27
Q

What makes up the axillary nodes (5)?

A

Apical

central

lateral

posterior

pectoral

(all drain to the apical nodes)

28
Q

Where will breast cancer spread haematologically?

A

brain, bone, liver, lung, abdomen, vscera, genital tracts

29
Q

What is a sentinel node?

A

This is the node to which the cancer drains first. It can be biopsied to determine the risk of mets and prognosis

30
Q

what proportion of cancers are ductal or lobular?

A

70% ductal

10% lobular

31
Q

If a cancer is ‘well differentiated’ what does this mean?

A

low grade carcinoma with a good prognosis

32
Q

How are breast carcinomas graded?

A

tubular differentiation

nucleus pleomorphism

mitotic activity

3-5 = grade 1

6, 7 = grade 2

8, 9 = grade 3

33
Q

Describe a ‘basal-like’ carcinoma?

A

triple negative

34
Q

Describe luminal A and B carcinomas

A

A = ER positive and low proliferation

B = ER positive and high proliferation

35
Q

If a cancer is ER positive what does this mean?

A

Means that the cancer will be responsive to anti-oestrogen treatment e.g. oophorectomy, tamoxifen, anti-GnRH, aromatase inhibitors

36
Q

What is HER2?

A

Human Epidermal growth factor Receptor 2

37
Q

If a cancer is HER2 receptive what does this mean?

A

responsive to trastuzamab treatment

38
Q

What is trastuzamab?

A

This is a humanised mouse monoclonal antibody treatment that specifically targets the HER2 receptor

39
Q

What is the likelihood of having breast cancer if BRCA1/2 positive?

A

45-64% lifetime risk

40
Q

What percentage of cancers are triple negative?

A

13.6%

41
Q

How is cancer prognosis calculated?

A

using the PREDICT tool online as takes into account the histopathology, HER2, ER status, clinical picture, and mode of detection

42
Q

What does the nottingham prognostic index take into account?

A

only histopathology

43
Q

How is breast cancer treated?

A
  1. breast conserving surgery (with radiotherapy)
  2. modified mastectomy (leaves the muscle, takes breast, skin and lymph nodes)
44
Q

What is breast conserving surgery?

A

wide local excision with clear margins (hopefully) +/- oncoplastic reconstruction

45
Q

When is radiotherapy indicated in BCS?

A

is the tumour was > 5cm, margins are not clear or >3 nodes involved

46
Q

How long does radiation need to be given for in BCS?

A

5 days a week for 3-6 weeks post surgery

47
Q

What is a modified total mastectomy?

A

removal of the entire breast, lymph nodes and associated skin but muscles are left to improve healing outcomes

48
Q

What is a side effect of axillary lymph node extraction?

A

lymphoedema of the arm

49
Q

What are autologous and prosthetic implants?

A

A = from own patients tissue

B= artificial tissue

50
Q

When can reconstruction be done?

A

immediately or delayed

51
Q

Does non-skin spraing total mastectomy have a good aesthetic outcome when reconstructing?

A

no - will have a large scar and abnormalities in the colour/texture of the breast.

Skin-sparing surgeries have the better outcomes aesthetically

52
Q

Give the two main targetted treatment regimes for breast carcinoma?

A

ER positive = tamoxifen

HER2 positive = trastuzamab

53
Q

What is comedo carcinoma?

A

this is a type of ductal carcinoma in situ that is associated with central necrosis of the breast.

54
Q

Can the mirena coil be given as contraceptive to patients with breast carcinoma?

A

no!!

Reproductive and Sexual Health (27 decks)

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