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Clinical Trials > Chapter 55 Breast Cancer Tis > Flashcards

Chapter 55 Breast Cancer Tis Flashcards

1
Q

Non invasive carcinoma of breast(Stage Tis) includes

A

Paget’s disease of nipple Lobular carcinoma in situ Ductal carcinoma in situ

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2
Q

Characteristics of LCIS

A

Multicentric breast involvement Loose, discohesive epithelial cells large in size, variable in shape, normal cytoplasm to nucleus ratio Overlap of histologic morphology

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3
Q

LCIS Percentage of multicentric distribution in mastectomy specimens? Bilateral involvement of breast? Percentage representation of noninvasive cancer?

A

90% 35-59% <15%

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4
Q

LCIS usually which harmone positive?

A

ER+

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5
Q

LCIS Average age of diagnosis?

A

45 years Premenopausal at diagnosis

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6
Q

What are clinical or mammographic characteristics of LCIS?

A

No clinical or mammographic indicators It is often detected as an incidental biopsy findings

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7
Q

LCIS is considered a marker of increased risk for subsequent development of

A

Ductal carcinoma Bilateral breast Direct precursor lesion to invasive lobular carcinoma is unresolved (NSABP B-17 trial for reference)

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8
Q

Role of MRI as a useful screening tool to detect development of invasive disease in LCIS

A

3.8-4.5% breast cancer detection rate (NCCN 2009 reference)

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9
Q

What is the widely accepted management of breast with mixed LCIS,DCIS or Invasive carcinoma?

A

Manage breast according to dominant malignant histology

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10
Q

LCIS as a sole histologic diagnosis, what is most widely accepted clinical practice?

A

Close observation and mammographic surveillance

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11
Q

Role of RT in management of LCIS?

A

NO ROLE

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12
Q

High risk patient for bilateral prophylactic mastectomy?

A

Young age Diffuse high grade lesion Significant family history

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13
Q

Less radical prophylactic approach in high risk LCIS patients?

A

Tamoxifen has shown reduction of invasive carcinoma by 56%

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14
Q

Presentation/ characteristics of Paget’s disease of nipple

A

Crusting and eczematous changes of nipple-areola complex Itching and burning of nipple and areole Presence of Paget’s cells located throughout epidermis

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15
Q

Describe Paget’s cells

A

Large Hyperchromatic Round to oval nuclei with abundant amphophilic to clear cytoplasm Mitosis commonly seen Cells found in cluster or individually in basal layers

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16
Q

Percentage of underlying malignancy in Paget’s disease

A

>95?

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17
Q

Motility factor released by epidermal keratinocytes that results in chemotaxis of Paget’s cells that migrate to overlying nipple epidermis.

A

Heregulin-alpha

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18
Q

Differential diagnosis of Paget’s disease

A

Superficial spreading melanoma Pagetoid SCC in situ Clear cells of toker

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19
Q

Percentage of palpable mass at diagnosis in Paget’s disease

A

50% Of which >90% cases invasive carcinoma

20
Q

What percentage and histology in presentation of non palpable mass in Paget’s disease

A

66-86% DCIS

21
Q

Mammographic findings in Paget’s disease of nipple

A

Palpable mass Normal mammograms reported in as many as 50%

22
Q

Management of Paget’s disease

A

Local treatment, systemic and regional node disease should be based on associated disease

23
Q

EORTC 10873 study for Paget’s disease of nipple

A

Complete excision with tumor free surgical margin and whole breast RT Median follow up 6.4 years Majority are DCIS without palpable mass 5 years local recurrence rate 5.2%

24
Q

Risk factor for DCIS

A

Family history Delayed age of first live birth and nulliparity History of benign breast biopsy Alcohol

25
Q

Percentage of new cases of DCIS present with mammogram

A

95%

26
Q

Findings of mammographic abnormalities in DCIS

A

Microcalcifications most typical

27
Q

DCIS Linear and segmental calcifications? Linear and branching calcifications? Fine and granular calcifications?

A

DCIS in 80% of cases High grade DCIS and necrosis Low grade DCIS

28
Q

Role of MRI in DCIS

A

Highest sensitivity particularly High-grade DCIS Extent of DCIS involvement aiding treatment planning

29
Q

Nipple discharge and negative mammogram. How to distinguish underlying DCIS vs Papilloma?

A

Galactography

30
Q

5 subtypes of DCIS

A

Comedo Solid Cribiform Micropapillary Papillary Less common Apocrine Neuroendocrine Signet ring cystic hypersecretory carcinoma Clinging DCIS

31
Q

DCIS Working Party of the EORTC Features that convey prognostic significance

A

Nuclear grade Presence of necrosis Polarization Architectural patterns Margin status Lesion size Extent of microcalcification Correlation between specimen x-ray and mammographic findings

32
Q

Faverly et al DCIS growth pattern within ductal free and lmplication for surgical excision

A

Unicentric Multicentric(2 distinct areas separated by >4cm) Continuous Discontinuous or Multifocal(2 or more areas separated by <4cm)

33
Q

What genetic abnormality in DCIS demonstrate synchronous invasive breast cancer

A

Loss of heterozygosity

34
Q

Which subtype of DCIS share loss of heterozygosity with synchronous invasive lesion

A

77% nocomedo 80% comedo

35
Q

Molecular markers in DCIS All High grade Low grade

A

ER 70% high grade 25% low grade 90% HER 50% P53 25%

36
Q

Occult micro invasive breast cancer are most common in

A

DCIS >2.5cm in diameter Present with palpable masses or nipple discharge High grade DCIS or Comedonecrosis

37
Q

DCIS is not a single disease

A

DCIS encompass diverse group of lesion that differ in regards to clinical presentation, mammographic features, extent and distribution with breast, histologic characteristics, biologic markers

38
Q

Factors identified in local failure risks in DCIS

A

Symptomatic presentation Lesion size Histopathologic subtype Nuclear/cytologic grade Central necrosis Margin status Patient age

39
Q

LRR and CSMR in mastectomy for DCIS

A

LRR 96-100% CSMR <=4%

40
Q

What could be cause of local treatment failure after mastectomy for DCIS

A

Unrecognized invasive carcinoma Incomplete removal of breast tissue with subsequent formation of new primary

41
Q

Role of PORT following mastectomy or skin sparing mastectomy in DCIS

A

High grade with pathologic margin <1mm

42
Q

Name trials in DCIS Lumpectomy vs Lumpectomy+RT

A

NSABP B-17 EORTC 10853 UK/ANZ SweDCIS

43
Q
A

A

44
Q
A

A

45
Q
A

Clinical Trials (8 decks)

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