Breast Tumors

Question 1

Epidemiology of breast cancer

Answer 1

• most common malignant tumor in women
• third cause of death from cancer in women
• lifetime risk: 1/8
• mortality has decreased due to screening

Question 2

Etiology of breast cancer

Answer 2

• malignant transformation of epithelial cells lining the duct or lobules
• 10% hereditary
• 90% sporadic
• lifestyle
• iatrogenic
• irradiation
• estrogen hormones: early first menses, late menopause
• contraceptives
• preventative factors: early childbirth, physical exercise

Question 3

Histology of breast cancer

Answer 3

in situ cancers:
- lobular carcinoma in situ
- ductal carcinoma in situ
- Paget’s disease

invasive cancers
- invasive ductal carcinoma
- invasive lobular carcinoma
- papillary, tubular, mucinous, medullary

lymph node metastasis: axillary, supraclavicular, parasternal

hemo metastasis: liver, lung, bone, brain

Question 4

Symptoms of breast cancer

Answer 4

• asymptomatic in early stages
• palpable mass
• fixation
• mastitis
• dimple

Question 5

Diagnosis of breast cancer

Answer 5

• mammography and lymph node US
• FNAB/core biopsy
• chest X-ray/CT
• abdominal US/CT
• PET/CT

Lab tests:
- immunohistochemistry: estrogen, progesterone
- fluoroscent in situ hybridization: HER2
- tumor markers: CA13-3, CA27-29

Question 6

Radiotherapy for breast cancer

Answer 6

Early stages (0-II): postop.
1. after breast conserving surgery
2. after mastectomy
3. region lymph nodes

Local advanced stage (III):
1. neoadjuvant CT
2. resectable: postop. RT
3. nonresectable: preop. or definite
4. palliative

LCIS: after breast conserving surgery, RT is not indicated

DCIS: after breast conserving surgery, whole breast RT; after mastectomy, RT not indicated

APBI (accelerated partial breast irradiation):
- interstitial brachytherapy
- intensity moderated radiotherapy

Question 7

Surgical therapy for breast cancer

Answer 7

• breast conserving surgery: quadrantectomy, wide excision
• mastectomy
• axillary lymph node dissection

Question 8

Pharmacological therapy for breast cancer

Answer 8

early stages: adjuvant
local advanced stage: neoadjuvant/palliative

hormone therapy:
- premenopausal: tamoxifen
- postmenopausal: aromatase inhibitor

chemotherapy: anthracycline, taxane, 5-FU, cyclophosphamide, platine based

targeted therapy: HER2 + herceptin

metastatic:
- triple neg: platine based
- olaparib (PARP inhibition)
- everolimus (mTOR inhibition)
- palbociclib (CDK4/6 inhibition)