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Junior Surgery- Breast Care > Cancerous Pathology > Flashcards

Cancerous Pathology Flashcards

1
Q

What is an in-situ carcinoma?

A
  • Malignancy that hasn’t breached the basement membrane
  • Usually seen as pre-malignant
  • Rarely symptomatic at presentation
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2
Q

Where do all breast carcinomas originate?

A
  • Terminal duct lobular unit
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3
Q

Name the two main types of in-situ breast carcinomas.

A
  • Ductal carcinoma in situ (DCIS)

- Lobular carcinoma in situ (LCIS)

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4
Q

What is ductal carcinoma in situ (DCIS)?

A

Malignancy of the ductal tissue of the breast, contained within the basement membrane.

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5
Q

What proportion of DCIS will become invasive?

A

20-30%

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6
Q

How is DCIS detected?

A

Screening, then confirmed by biopsy

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7
Q

What does DCIS look like on mammogram?

A

Microcalcifications, either localised or widespread

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8
Q

How is localised DCIS treated?

A

Wide Local Excision

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9
Q

How is widespread/multifocal DCIS treated?

A

Complete mastectomy

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12
Q

What ages is mammogram screening available to?

A

Women 50-70yo every three years

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13
Q

What is lobular carcinoma in situ (LCIS)?

A

Malignancy of secretory lobules contained within the basement membrane

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14
Q

Which of DCIS or LCIS has greater risk of invasive disease?

A

LCIS

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15
Q

When is LCIS usually diagnosed?

A

Pre-menopause

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16
Q

How is LCIS usually diagnosed?

A

Incidental finding on biopsy for another reason. LCIS is usually asymptomatic

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17
Q

How is low-grade LCIS usually treated?

A

Monitoring

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18
Q

What are the two main types of invasive carcinoma?

A
  • Invasive ductal carcinoma (~80%)

- Invasive lobular carcinoma (10%)

19
Q

What are the five subtypes of invasive ductal carcinoma?

A
  • Tubular
  • Cribriform
  • Papillary
  • Mucinous/Colloid
  • Medullary
20
Q

Which three invasive ductal carcinomas carry the best prognosis?

A
  • Tubular
  • Cribriform
  • Papillary

Best differentiated forms

21
Q

In what age group is invasive lobular carcinoma more common?

A

Older women

22
Q

What are the non-modifiable risk factors of a breast cancer?

A
  • Age (risk doubles every decade up to the menopause)
  • Female sex
  • BRCA1/BRCA2 gene mutation
  • Family History (1st degree relative)
  • Previous benign disease
  • Geographic variation (more common in MEDCs)
23
Q

What are the modifiable risk factors of a breast cancer?

A
  • Unopposed oestrogen (early menarche, late menopause, nulliparous women, first pregnancy after 30)
  • Medications (oral oestrogen, HRT)
  • Obesity, alcohol and smoking
24
Q

What happens to your risk of breast cancer if you have one or two first degree relatives?

A

1- doubles

2- 4-6x

25
Q

What features of a presentation may indicate cancer?

A
  • Asymmetry
  • Hard, matted, nodular lumps
  • Nipple discharge and retraction
  • ‘Peau d’orange’ (skin dimpling)
  • Mastalgia
  • Axilla lump
26
Q

What is the most important factor in breast cancer prognosis?

A

Nodal status

27
Q

What is the Nottingham Prognosis Index?

A

Prognosis of breast cancer:

(Size/cm)x2 + Nodal Status + Tumour Grade

28
Q

What is the 5 year survival at <2.4, <5.4 and 5.4+?

A

<2.4 93%

<5.4 70%

5.4+ 50%

29
Q

What is Paget’s Disease of the Nipple?

A

Rough, red and ulcerated nipple

30
Q

Why is Paget’s Disease a concern?

A

97% have underlying malignancy, either in-situ or invasive

31
Q

What are the hypotheses of Paget’s Disease?

A
  • Malignant cells migrate from ducts to the nipple

- Nipple epidermis itself becomes malignant

32
Q

How does Paget’s Disease present?

A
  • Itchy/red nipple or areola
  • Flaking/thick skin
  • Painful/sensitive nipples
33
Q

What is Paget’s Disease often mistaken for?

A

Dermatitis or Eczema

Eczema usually spares the nipple, only affects areola

34
Q

How is Paget’s Disease treated?

A

Surgery- removal of the nipple and areola, and underlying malignancy in the breast.

Adjuvant therapies e.g. radio

35
Q

Which of DCIS/LCIS is more likely to metastasise to axillary nodes?

A

DCIS

36
Q

What treatment is available to women who possess the BRCA1 or BRCA2 genes?

A

Bilateral prophylactic mastectomy

37
Q

What chromosome is BRCA1 on?

A

17

38
Q

Which chromosome is BRCA2 on?

A

13

39
Q

If a cancer is HER2 positive, what drug should you add to treat it?

A

Trastuzumab

HERCEPTIN

40
Q

If a cancer is ER positive, what drug should be added to treat it?

A

Tamoxifen

41
Q

What drug should you add to a patient’s tamoxifen if post-menopause?

A

Anastrozole- aromatase inhibitor, stops androgens being converted to oestrogen

Junior Surgery- Breast Care (4 decks)

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