Gen Path Exam 4 - Breast Pathology Flashcards by A G

Q

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

A

Breast

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Q

Undergoes marked changes through life:

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

A

Breast

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Q

What are the 6 symptoms of breast disease?

A

Pain
Inflammation
Nipple discharge
Lumpiness
Papable masses
Gynecomastia

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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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Q

Which symptom of breast disease?

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

A

Pain

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Q

Which symptom of breast disease?

Edema and erythema

A

Inflammation

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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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Q

Which symptom of breast disease?

Normal when small amount and bilateral

A

Nipple discharge

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Q

Which symptom of breast disease?

Common benign lesion = papilloma arising in large ducts below nipple

A

Nipple discharge

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Q

Which symptom of breast disease?

Spontaneous, unilateral, bloody discharge is concern for malignancy

A

Nipple discharge

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Q

Which symptom of breast disease?

Diffuse nodularity

A

Lumpiness

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Q

Which symptom of breast disease?

Normal glandular tissue

A

Lumpiness

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Q

Which symptom of breast disease?

Imaging used to detect discrete mass

A

Lumpiness

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Q

Which symptom of breast disease?

Arise from stromal or epithelial cell proliferations

A

Papable masses

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Q

Which symptom of breast disease?

Detected when 2-3 cm in size

A

Papable masses

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Q

Which symptom of breast disease?

95% are benign

A

Papable masses

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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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Q

Which symptom of breast disease?

Breast enlargement in males

A

Gynecomastia

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Q

Which symptom of breast disease?

Only common breast symptom in males

A

Gynecomastia

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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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Q

Most symptomatic breast lesions are ________

A

benign

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Q

What % of women with breast cancer have symptoms?

A

45%

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Q

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

A

malignancy

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Q

Which disease?

Usually incidental mammographic finding

A

Benign epithelial lesion

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

Nonproliferative disease

Which disease? Brown/blue cysts and increased fibrous stroma

Nonproliferative disease

Which disease? May have microcalcifications with possible palpable nodularity

Nonproliferative disease

Which disease? Epithelial growth with small risk of cancer formation

Proliferative disease

What is the most common cancer in women?

Breast cancer

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

1/8 risk in getting breast cancer 25% die

What are the 7 risk factors of breast cancer?

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)

What 5 parts of reproductive history increase estrogen stimulation and cause an increased risk for breast cancer?

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

Do mammograms increase risk of breast cancer?

NO

What 3 things play a role in the pathogenesis of breast cancer?

Genetics Hormonal influences (excess estrogen) Enivronment

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

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

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

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

What accounts for 5-10% of breast cancers?

Germline mutations

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

DNA

50% of inherited cases have _______ mutations

BRCA1

33% of inherited cases have _______ mutations

BRCA2

Greater than 95% of malignancies are _______________

adenocarcinomas

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

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

Which disease has the following tx methods? Surgery, chemo, radiation, and tx based on tumor markers

Breast cancer

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

Endocrine/hormone therapy Targeted therapy

Which type of tx based on tumor markers in breast cancer? Blocks estrogen production in breast; reduces risk for reccurence

Endocrine/hormone therapy

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)

Endocrine/hormone therapy

Which type of tx based on tumor markers in breast cancer? If HER2 +, give Herceptin (tratuszumab)

Targeted therapy

What is breast cancer prognosis based on?

Molecular + morphologic features Stage

What's the breast cancer prognosis? Size: < 1.0 cm and no lymph node spread

Excellent prognosis

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

Sentinel lymph node

Survival of breast cancer decreases with each ____________

positive node

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

90%

Distant metastasis of breast cancer is __________ curable

rarely

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

2-3

In unscreened populations, how are most breast cancers detected?

Palpable mass by pt

What does progression of breast cancer lead to?

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

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

thickening

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

Lung Skeleton Liver Adrenals Brain

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

Mammogram

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

True

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

Mammography

Why do mammograms become more sensitive with age?

Fat replaces fibrous tissue

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

malignancy

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

Every other year (biennial)

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

Optional

What makes someone high risk for breast cancer?

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