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D2 Fall > Gen Path Exam 4 - Breast Pathology > Flashcards

Gen Path Exam 4 - Breast Pathology Flashcards

1
Q

Non-essential for survival; major function is nutritional support of infant

A

Breast

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2
Q

Undergoes marked changes through life:

Expansion after menarche
Remodeling during adulthood (during/after pregnancy)
Involution and regression

A

Breast

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3
Q

What are the 6 symptoms of breast disease?

A

Pain
Inflammation
Nipple discharge
Lumpiness
Papable masses
Gynecomastia

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4
Q

Which symptom of breast disease?

Common to menses; when localized, usually due to ruptured cyst or trauma to adipose (fat necrosis)

A

Pain

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5
Q

Which symptom of breast disease?

Almost all painful masses are benign; 10% of cancers cause pain

A

Pain

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6
Q

Which symptom of breast disease?

Edema and erythema

A

Inflammation

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7
Q

Which symptom of breast disease?

Rare; caused by infection during lactation, breast feeding; exception is inflammatory breast carcinoma

A

Inflammation

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8
Q

Which symptom of breast disease?

Normal when small amount and bilateral

A

Nipple discharge

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9
Q

Which symptom of breast disease?

Common benign lesion = papilloma arising in large ducts below nipple

A

Nipple discharge

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10
Q

Which symptom of breast disease?

Spontaneous, unilateral, bloody discharge is concern for malignancy

A

Nipple discharge

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11
Q

Which symptom of breast disease?

Diffuse nodularity

A

Lumpiness

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12
Q

Which symptom of breast disease?

Normal glandular tissue

A

Lumpiness

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13
Q

Which symptom of breast disease?

Imaging used to detect discrete mass

A

Lumpiness

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14
Q

Which symptom of breast disease?

Arise from stromal or epithelial cell proliferations

A

Papable masses

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15
Q

Which symptom of breast disease?

Detected when 2-3 cm in size

A

Papable masses

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16
Q

Which symptom of breast disease?

95% are benign

A

Papable masses

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17
Q

Which symptom of breast disease?

Malignancies have irregular borders, but some are circumscribed, so all require evaluation!

A

Palpable masses

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18
Q

Which symptom of breast disease?

Breast enlargement in males

A

Gynecomastia

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19
Q

Which symptom of breast disease?

Only common breast symptom in males

A

Gynecomastia

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20
Q

Which symptom of breast disease?

Imbalance btwn estrogens and androgens causes an increase in stroma and epithelial cells

A

Gynecomastia

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21
Q

Most symptomatic breast lesions are ________

A

benign

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22
Q

What % of women with breast cancer have symptoms?

A

45%

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23
Q

With increasing age, symptoms are associated with increased likelihood of __________

A

malignancy

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24
Q

Which disease?

Usually incidental mammographic finding

A

Benign epithelial lesion

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25
Q

Which disease?

Most common benign epithelial lesion; no increased risk of breast cancer

A

Nonproliferative disease

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26
Q

Which disease?

Brown/blue cysts and increased fibrous stroma

A

Nonproliferative disease

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27
Q

Which disease?

May have microcalcifications with possible palpable nodularity

A

Nonproliferative disease

28
Q

Which disease?

Epithelial growth with small risk of cancer formation

A

Proliferative disease

29
Q

What is the most common cancer in women?

A

Breast cancer

30
Q

What is the lifetime risk of developing breast cancer? How many die from breast cancer

A

1/8 risk in getting breast cancer
25% die

31
Q

What are the risk factors of breast cancer?

A

Age (risk increases after 30, plateaus at menopase)
Gender
Family history
Genetic variations (higher in western world)
Race/ethnicity (highest rate in European descent)
Reproductive history
Ionizing radiation (during breast development)

32
Q

What parts of reproductive history increase estrogen stimulation and cause an increased risk for breast cancer?

A

Early age of 1st period
Older age at 1st pregnancy
Nulliparity
Absence of breastfeeding
Obesity or hormone replacement therapy

33
Q

Do mammograms increase risk of breast cancer?

A

NO

34
Q

What plays a role in the pathogenesis of breast cancer?

A

Genetics
Hormonal influences (excess estrogen)
Enivronment

35
Q

Driver mutations in epithelial cells of duct/lobular system cause differential expression of…

A

Estrogen receptors (ER)
Progesterone receptors (PR)
Overexpression of HER2

36
Q

What defines the 3 major breast cancer subtypes with direct tx implications?

A

Estrogen receptors (ER)
Progesterone receptors (PR)
Overexpression of HER2

37
Q

What accounts for 5-10% of breast cancers?

A

Germline mutations

38
Q

Germline mutations are most often in ______ repair genes (BRCA1 and BRCA2)

A

DNA

39
Q

50% of inherited cases have _______ mutations

A

BRCA1

40
Q

33% of inherited cases have _______ mutations

A

BRCA2

41
Q

Greater than 95% are adenocarcinomas

A
42
Q

What are the 3 major groups for clinical classification of breast cancer?

A

ER + (HER2 - ) -> MOST COMMON
HER2 + (ER + or -)
Triple - (ER, PR, HER2 - )

43
Q

Which disease has the following tx methods?

Surgery, chemo, radiation, and tx based on tumor markers

A

Breast cancer

44
Q

What are the 2 types of tx based on tumor markers in breast cancer?

A

Endocrine/hormone therapy
Targeted therapy

45
Q

Which type of tx based on tumor markers in breast cancer?

Blocks estrogen production in breast; reduces risk for reccurence

A

Endocrine/hormone therapy

46
Q

Which type of tx based on tumor markers in breast cancer?

Medications are:
Tamoxifen (competitive inhibitor of ER)
Aromatase inhibitor (block conversion of androgens into estrogen)

A

Endocrine/hormone therapy

47
Q

Which type of tx based on tumor markers in breast cancer?

If HER2 +, give Herceptin (tratuszumab)

A

Targeted therapy

48
Q

What is breast cancer prognosis based on?

A

Molecular + morphologic features
Stage

49
Q

What’s the breast cancer prognosis?

Size: < 1.0 cm and no lymph node spread

A

Excellent prognosis

50
Q

What biopsy is highly predictive of absence of metastatic cancer in other nodes?

A

Sentinel lymph node

51
Q

Survival of breast cancer decreases with each ____________

A

positive node

52
Q

If breast cancer has not gone into axillary nodes, what is the 5 yr survival?

A

90%

53
Q

Distant metastasis of breast cancer is __________ curable

A

rarely

54
Q

At detection, average size of breast cancer lesions are _______ cm with 50% lymph node involvement

A

2-3

55
Q

In unscreened populations, how are most breast cancers detected?

A

Palpable mass by pt

56
Q

What does progression of breast cancer lead to?

A

Adherence to pectoral muscles/deep fascia
Adherence to skin -> causes dimpling of skin or nipple (looks like texture of an orange)

57
Q

In breast cancer, lymph involvement may cause lymphedema, which causes skin __________ (peau d’orange)

A

thickening

58
Q

In breast cancer, distant metastasis may occur in any organ, up to many years later. What are the preferred sites?

A

Lung
Skeleton
Liver
Adrenals
Brain

59
Q

What detects early, non-palpable, asymptomatic breast cancer before metastasis?

A

Mammogram

60
Q

T/F: Not many people have lymph node involvement upon diagnosis of breast cancer with mammogram

A

True

61
Q

What are most cancers in women > 50 years of age detected by?

A

Mammography

62
Q

Why do mammograms become more sensitive with age?

A

Fat replaces fibrous tissue

63
Q

Abnormal mammographic finding is more likely to be caused by ___________ with increasing age

A

malignancy

64
Q

For a person of average risk, how often is breast cancer screening done for women 40-74 years old?

A

Every other year (biennial)

65
Q

For a person of average risk, how often is breast cancer screening done for women 75 years or older?

A

Optional

66
Q

What makes someone high risk for breast cancer?

A

Family history of breast, ovarian, tubal, or peritoneal cancer
BRCA1 or BRCA2 mutations

D2 Fall (37 decks)

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