GN 3.1.2 Flashcards
Why did the clinical trial of hormone replacement therapy (HRT) that included estrogen and progestin get stopped early?
Patients in the estrogen plus progestin group started showing increased invasive breast cancer risk as compared to the placebo group.
If a cancer has an M score of 1, what is it’s correlated stage?
M1 is always stage IV
What is ILC? What is the percentage of breast cancers that are ILC?
Invasive lobular carcinoma, 7%
Why is 3D mammogram preferred over 2D mammograms? Why do patients still chose 2D mammograms at times?
3D mammogram is more sensitive. Patients sometimes choose 2D because insurance doesn’t cover the extra charge at this point, but there is a big push for insurance companies to begin including 3D mammogram coverage.
What percentage of breast cancer is sporadic? Of the hereditary BC, 25% is due to high penetrance genes. Give an example of high penetrance genes.
90% of BC is sporadic. High penetrance gene - BRCA1/2
What are the three categories of TNM staging?
Primary Tumor, Regional lymph nodes, Distant metastasis (M)
Describe how hormonal exposure relates to breast cancer risk.
Increased hormonal exposure leads to an increased breast cancer risk (sex, age, family history, inherited genetic susceptiblility, early menstruation and late menopause, nulliparity, combination hormonal therapy) Decreased hormonal exposure leads to decreased breast cancer risk (early pregnancy, breast feeding, exercise, estrogen use by women with prior hysterectomy)
If a patient has a high RS score on there Oncotype Dx profile, how is the prognosis affected?
Worse prognosis/outcome….. Hey Miles, need a little help? RS stands for Recurrence Score. If you need more help than that, you should just plan on remediated GenNeo this summer.
Triple negative cancer cells have what cellular morphology common to the breast?
Basal
What is the cancer staging system that puts cancers into stages depending on their TNM stage?
AJCC
How do Immunohistochemistry (IHC) and fluorescence In Situ Hybridization (FISH) differ in their detection of Her2 overexpression?
IHC: looking at protein expression, the receptor itself FISH: fluorescently marks genomic amplification Look at image
How does mutations in BRCA1 or BRCA2 affect the risk of developing breast cancer by age 70?
With normal BRCA, the risk is 12%. With mutated BRCA2, the risk jumps to 45%. With mutated BRCA1, the risk is 55%-65%. (Note: BRCA1 mutation leads to a higher risk of breast and ovarian cancer)
What is the primary source of hormonal production for postmenopausal women?
Fatty tissue; obesity is becoming an increased risk factor of developing breast cancer.
What is DCIS and its relationship to IDC?
DCIS (ductal carcinoma of in situ) is the most-detected lesion by mammography. It is a malignancy that is contained with the duct. Despite lumpectomy, 30% will recur as IDC. 50% of women w/ DCIS will never progress to IDC.
Why do basal breast cancers have poorer outcomes than luminal A and luminal B breast cancers?
Luminal A and B have hormonal therapy targets whereas basal types lack hormonal targets
What is the difference b/t amplification and overexpression of Her2/neu?
Amplification: multiple Her2 genes (genomic amp) Overexpression: many Her2 receptors (present in 20% of breast tumors) Amplification can result in overexpression
What happened in the estrogen-only HRT clinical trial?
Estrogen reduced the overall risk of invasive breast cancer (protective)
What is the most commonly diagnosed cancer among women?
Breast Cancer
What type receptors are ER/PR?
Steriod-activated nuclear receptors
When estrogen (or progesterone) response elements bind directly to DNA, what typically occurs?
Turn on proliferative genes
When would an MRI be used rather than an Mammogram?
MRI is typically used for patients with an increased breast cancer risk (genetic predisposition or prior history of breast cancer)
What are the 5 major molecular subtypes of breast cancer?
Luminal A (ER+/PR+) Luminal B (ER+/PR+/-) ErbB2/Her2 (Her2+) Basal (Triple neg) Normal
What is the 21 gene profile that is used in expression profiling of certain types of cancers?
Oncotype Dx
How do BRCA-1 mutations affect the genomic instability of potential tumors?
BRCA1-mutant tumors have higher levels of genomic instability.
What is a female’s lifetime risk of developing breast cancer?
1 in 8
What type of receptor is Her2/neu? What family of receptors does it belong to?
Receptor tyrosine kinase, EGFR (epidermal growth factor receptor)
What are BRCA1/2 involved in?
Sensing and repairing DNA damage
What are the three receptors that are tested for in breast cancer biopsies?
Estrogen receptor (ER), Progesterone Receptor (PR), and Her2/neu
What are some of the most common locations of metastatic spread of breast cancer?
Lymph, bone, lung, liver
What is the preinvasive form of IDC?
DCIS (ductal carcinoma in situ)
What type of cancers tend to have better outcomes? Why?
Hormonal responsive cancers, better outcomes because of hormonal targeted threatments
What is IDC? What is the percentage of breast cancers are IDC?
Invasive ductal carcinoma; 76%
What are three imaging techniques that can be used for detection and diagnosis of breast cancer?
Mammogram (2D and 3D), MRI, Ulstrasound
Aside from translocating from the cytosol to the nucleus and affecting txn, what can ER/PR do?
Interact w/ proteins (Insulin GFR and EGFR/Her2) to affect downstream signaling
