CSIM 1.7 Breast Cancer Case 39 Continued Flashcards
Until what age is breast development similar in both sexes?
Puberty
What do female breasts develop in response to at puberty?
Pituitary and ovarian hormones
What happens to the breast after menopause?
Atrophy and involution
What does glandular tissue of the breast develop from?
Modified apocrine sweat glands along ‘milk lines’
How many glandular breast lobes are in each breast? What connects to these?
15-20
Terminal duct (–> lactiferous duct)
What lies between breast lobules?
Interlobular adipose connective tissue
Describe the histology of a normal breast lobule
One single cell layer of secretory epithelium
Describe the histology of a normal terminal duct
Two layers of cells:
• Inner cell layer
• Basal cell layer
What are the different types of breast disease?
- Benign breast disease
- Pre-malignant atypical ductal hyperplasia
MALIGNANT:
• Non-invasive carcinomas:
- Ductal carcinoma in situ
- Lobular carcinoma in situ
• Invasive carcinomas
What are the forms of benign breast disease?
- Solitary cyst
- Fibrocystic disease
- Papilloma
- Sclerosing lesions
- Radial scars
In what proportion of women is benign breast disease seen in?
80%
What is the significance of benign breast disease?
- Can be associated with pain
* Associated with an increased risk of getting cancer
How are localisation excision biopsies guided?
With a guidewire & CT imaging
What are the types of biopsy used for retrieval of breast tissue?
- Mammotome - Vacuum assisted biopsy
- Core biopsy
- Localisation excision biopsy
What is atypical ductal hyperplasia?
What does this often cause?
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
What is the recommendation after identification and why?
A wider excision, because this tissue is associated with a moderate risk of developing (generalised bilateral risk) breast cancer
What is the commonest cause of death in women aged 35-55?
Breast cancer
What proportion of women will develop breast cancer?
1 in 9
What proportion of all cancers in women are made up of breast cancer cases?
30%
What are the risk factors for breast cancer?
- Female
- Age
- Long time between menarche and menopause
- Obesity
- Atypical ductal hyperplasia
- Family history
Outline the multistep process/progression leading to carcinoma in breast tissue
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
Describe how non-invasive carcinomas spread within their compartment
Spreads within the lobule and ductile system, underneath the basement membrane.
What happens if you do not treat a non-invasive carcinoma?
It may rupture the basement membrane and become invasive
Why is there an increased risk of malignancy when atypical hyperplasia is present?
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.
