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CSIM 1: Pathology Strand > CSIM 1.7 Breast Cancer Case 39 Continued > Flashcards

CSIM 1.7 Breast Cancer Case 39 Continued Flashcards

1
Q

Until what age is breast development similar in both sexes?

A

Puberty

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2
Q

What do female breasts develop in response to at puberty?

A

Pituitary and ovarian hormones

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3
Q

What happens to the breast after menopause?

A

Atrophy and involution

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4
Q

What does glandular tissue of the breast develop from?

A

Modified apocrine sweat glands along ‘milk lines’

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5
Q

How many glandular breast lobes are in each breast? What connects to these?

A

15-20

Terminal duct (–> lactiferous duct)

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6
Q

What lies between breast lobules?

A

Interlobular adipose connective tissue

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7
Q

Describe the histology of a normal breast lobule

A

One single cell layer of secretory epithelium

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8
Q

Describe the histology of a normal terminal duct

A

Two layers of cells:
• Inner cell layer
• Basal cell layer

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9
Q

What are the different types of breast disease?

A
  • Benign breast disease
    • Pre-malignant atypical ductal hyperplasia
MALIGNANT:
  •  Non-invasive carcinomas:
          - Ductal carcinoma in situ
          - Lobular carcinoma in situ
  •  Invasive carcinomas
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10
Q

What are the forms of benign breast disease?

A
  • Solitary cyst
    • Fibrocystic disease
    • Papilloma
    • Sclerosing lesions
    • Radial scars
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11
Q

In what proportion of women is benign breast disease seen in?

A

80%

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12
Q

What is the significance of benign breast disease?

A
  • Can be associated with pain

* Associated with an increased risk of getting cancer

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13
Q

How are localisation excision biopsies guided?

A

With a guidewire & CT imaging

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14
Q

What are the types of biopsy used for retrieval of breast tissue?

A
  • Mammotome - Vacuum assisted biopsy
    • Core biopsy
    • Localisation excision biopsy
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15
Q

What is atypical ductal hyperplasia?

What does this often cause?

A

Pre-malignant: somewhere between benign and non-invasive malignant

Neoplastic proliferation of the ductal epithelial cells, so that some of the cells cross the lumen and divide it into 2 spaces - does not fulfil the criteria of a non-invasive cancer

Complex sclerosing lesions

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16
Q

What is the recommendation after identification and why?

A

A wider excision, because this tissue is associated with a moderate risk of developing (generalised bilateral risk) breast cancer

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17
Q

What is the commonest cause of death in women aged 35-55?

A

Breast cancer

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18
Q

What proportion of women will develop breast cancer?

A

1 in 9

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19
Q

What proportion of all cancers in women are made up of breast cancer cases?

A

30%

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20
Q

What are the risk factors for breast cancer?

A
  • Female
    • Age
    • Long time between menarche and menopause
    • Obesity
    • Atypical ductal hyperplasia
    • Family history
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21
Q

Outline the multistep process/progression leading to carcinoma in breast tissue

A

1) Normal cells
2) Proliferative cells
3) Atypical hyperplasia
4) Carcinoma in situ
5) Invasive carcinoma

1 & 2 = Benign
3 = Pre-malignant
4 & 5 = Malignant

22
Q

Describe how non-invasive carcinomas spread within their compartment

A

Spreads within the lobule and ductile system, underneath the basement membrane.

23
Q

What happens if you do not treat a non-invasive carcinoma?

A

It may rupture the basement membrane and become invasive

24
Q

Why is there an increased risk of malignancy when atypical hyperplasia is present?

A

Each step in the multistep process requires random/chance genetic changes. There are fewer steps remaining to reach a malignancy once the atypical hyperplasia is reached.

25
Q

Which genes are associated with breast cancer when certain alleles are present or when damaged?

A
  • BRCA 1
    • BRCA 2
    • p53
26
Q

Which cancer genetic predisposition is associated with the p53 gene?

A

Li-Fraumeni syndrome

27
Q

What age range of women are invited to the NHS breast screening programme?

A

50-70

28
Q

What does the NHS breast screening programme involve?

A

Mammogram every 3 years

29
Q

What is searched for in mammograms?

A
  • Densities

* Calcifications

30
Q

If there is an anomaly, where is the woman sent?

A

One stop clinic

31
Q

What is performed at a one stop clinic?

A

A triple assessment of:
• Clinical examination
• Radiology (mammography, US, MRI)
• Pathology (the three biopsies)

This information is used to form a diagnosis

32
Q

What are the clinical features of breast cancer?

A
  • Pain
    • Palpable mass
    • Nipple discharge
    • Nipple retraction
    • Peau d’orange & erythema
    • Axillary lymphadenopathy
33
Q

What are the two types of non-invasive carcinoma?

A
  • Ductal carcinoma in situ

* Lobular carcinoma in situ

34
Q

What does ductal carcinoma in situ look like?

A

Massively proliferated cells so that the lumen(s) are minimal. These are classed based on their diameter (e.g. 15mm)

Nuclear neomorphism is present

35
Q

What proportion of INVASIVE carcinomas are made up of infiltrating ductal and infiltrating lobular carcinomas?

A

• 75% infiltrating ductal
• 10% infiltrating lobular
( • 15% other)

36
Q

How are tumours graded?

A

Grades 1-3 which grade the amount the tumour cell has differentiated, depending on:

  • Tubule formation:
  • Nuclear pleomorphism
  • Mitoses

1 = most similar to normal cells, best prognosis

3 = more aggressive, poor prognosis

37
Q

How is cancer staging deduced?

A

The extent of cancer spread based on TNM (tumour, nodes, metastasis):

Primary tumour extent:
• T1 = 100mm
Presence and extent of lymph node metastasis:
• N0 = Nodes negative
• N1 = Axillary nodes mobile metastases
• N2 = Axillary nodes fixed metastases
• N3 = Supraclavicular nodes or oedema
Presence of distant metastasis
• M0 = Not present
• M1 = Present

38
Q

What local areas can breast metastases spread?

A

Skin & muscle

39
Q

What distant areas can breast metastases spread to?

A
  • Lymph nodes
    • Lungs
    • Liver
    • Bone
    • Brain
    • Adrenal glands
40
Q

Which lymph nodes can breast metastases spread to?

A
  • Axillary
    • Supraclavicular
    • Internal mammary
41
Q

What are the treatment options for breast malignancy?

A
  • Surgery
    • Radiotherapy
    • Chemotherapy
    • Hormone therapy
    • Herceptin
42
Q

What oncogenes does the treatment received by a patient depend on?

A

Presence of:
• ERBB2 / HER-2
• Oestrogen receptors
• Progesterone receptors

43
Q

How does ERBB2/HER-2 alteration lead to carcinogenesis?

A

Gene is over-amplifies and the membrane-related protein is overexpressed

44
Q

What is the impact of ERBB2/HER-2 on prognosis?

A

Poorer prognosis

45
Q

What is trastuzumab the trade name for and what does this treat?

What is this used in conjunction with as a standard treatment?

A

Herceptin - an antibody used to treat women whose cancers have HER-2 molecular alteration present

Chemotherapy used with it.

46
Q

What is cancer called if it has none of the three oncogene alterations? What is the typical characteristic of this?

A

Triple-negative breast cancer

Associated with BRCA1 and is more aggressive and resistant to treatment due to lack of a target for therapies

47
Q

Which type of malignancies most commonly are caused by BRCA2-associated breast cancers?

A

Predominantly high-grade invasive carcinomas

48
Q

What is the overall

risk for male breast carcinoma?

A

0.11%

gynecomastia is not a risk factor

49
Q

Why do men present at later stages than women?

A

There is no breast cancer screening programme for males

50
Q

How is male breast cancer treated?

A
  • Mastectomy

* Axillary node dissection

CSIM 1: Pathology Strand (30 decks)

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