Cancerous Pathology Flashcards
What is an in-situ carcinoma?
- Malignancy that hasn’t breached the basement membrane
- Usually seen as pre-malignant
- Rarely symptomatic at presentation
Where do all breast carcinomas originate?
- Terminal duct lobular unit
Name the two main types of in-situ breast carcinomas.
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
What is ductal carcinoma in situ (DCIS)?
Malignancy of the ductal tissue of the breast, contained within the basement membrane.
What proportion of DCIS will become invasive?
20-30%
How is DCIS detected?
Screening, then confirmed by biopsy
What does DCIS look like on mammogram?
Microcalcifications, either localised or widespread
How is localised DCIS treated?
Wide Local Excision
How is widespread/multifocal DCIS treated?
Complete mastectomy
What ages is mammogram screening available to?
Women 50-70yo every three years
What is lobular carcinoma in situ (LCIS)?
Malignancy of secretory lobules contained within the basement membrane
Which of DCIS or LCIS has greater risk of invasive disease?
LCIS
When is LCIS usually diagnosed?
Pre-menopause
How is LCIS usually diagnosed?
Incidental finding on biopsy for another reason. LCIS is usually asymptomatic
How is low-grade LCIS usually treated?
Monitoring
What are the two main types of invasive carcinoma?
- Invasive ductal carcinoma (~80%)
- Invasive lobular carcinoma (10%)
What are the five subtypes of invasive ductal carcinoma?
- Tubular
- Cribriform
- Papillary
- Mucinous/Colloid
- Medullary
Which three invasive ductal carcinomas carry the best prognosis?
- Tubular
- Cribriform
- Papillary
Best differentiated forms
In what age group is invasive lobular carcinoma more common?
Older women
What are the non-modifiable risk factors of a breast cancer?
- 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)
What are the modifiable risk factors of a breast cancer?
- Unopposed oestrogen (early menarche, late menopause, nulliparous women, first pregnancy after 30)
- Medications (oral oestrogen, HRT)
- Obesity, alcohol and smoking
What happens to your risk of breast cancer if you have one or two first degree relatives?
1- doubles
2- 4-6x
What features of a presentation may indicate cancer?
- Asymmetry
- Hard, matted, nodular lumps
- Nipple discharge and retraction
- ‘Peau d’orange’ (skin dimpling)
- Mastalgia
- Axilla lump
What is the most important factor in breast cancer prognosis?
Nodal status
