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MBBS II ERS > L33 - PATHOLOGY OF BREAST CANCER > Flashcards

L33 - PATHOLOGY OF BREAST CANCER Flashcards

1
Q

List typical clinical presentations of breast cancer? (6)

A

1) lump or thickening in breast
2) change in size or shape of a breast
3) nipple retraction
4) bloody nipple discharge
5) A rash on a nipple or surrounding area
6) Dimpling of the skin, skin appears inflamed

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2
Q

Pathogenesis of Paget’s disease of the breast?

A

Underlying intraductal or invasive carcinoma

> > Invasion of epidermis by Paget’s cells

> > erosion of the nipple and areola

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3
Q

Morphology of Paget’s cells?

A

large, round to oval, clear cytoplasm (clear halo) and eccentric, hyperchromic nuclei

contain mucin.

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4
Q

Clinical presentation of Paget’s disease?

A

Nipple and areola: red and weeping, occasionally dry, scaly and psoriatic

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5
Q

What causes puckering of skin with red, warm, peau d’orange appearance on breasts?

A

Inflammatory breast cancer

> > blockage of lymph vessels in the skin by cancer cells

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6
Q

List 2 non-invasive breast carcinoma

A
  1. Ductal carcinoma-in-situ (DCIS): High grade comedo or Non-comedo Low grade
  2. Lobular carcinoma in-situ (LCIS)
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7
Q

List Invasive breast carcinoma.

A
  1. Invasive carcinoma of no special type (NST)
  2. Special subtypes :
    - Invasive lobular carcinoma
    - Tubular carcinoma
    - Mucinous carcinoma
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8
Q

Define the anatomical location of Ductal Carcinoma-in-situ of breasts? Ddx location with LCIS?

A

confined within the ductal basement membranes

50% are centrally situated, palpable mass

LCIS = Medial + Lateral Upper quadrants

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9
Q

Compare the effectiveness of mammography in finding DCIS and LCIS?

A

DCIS = detectable due to microcalcification and confined involvement

LCIS = easily missed due to no calcification and multicentric involvement

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10
Q

Compare the prognosis of high grade and low grade DCIS of breast? How to ddx the two?

A

High = large pleomorphic cells and central comedo necrosis

High grade = 50% evolve into invasive carcinoma within 5 years

Non-comedo low grade = 30% will develop invasive carcinoma within the next 10-15 years.

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11
Q

Describe the extent of involvement of Lobular carcinoma-in-situ?

A

Multicentric, sometimes bilateral

concentrated within 5 cm of the nipple
@ OUTER + INNER UPPER QUADRANT

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12
Q

Prognosis and progression of Lobular carcinoma in situ of the breast?

A

10 times higher risk of invasive carcinoma: can be ductal or lobular

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13
Q

What is the most common type of breast carcinoma?

A

INVASIVE BREAST CARCINOMA OF NO SPECIAL TYPE (NST):

70% of invasive breast cancers

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14
Q

Gross morphology and clinical presentation of Invasive breast carcinoma of no special type (NST)?

A

FEELS LIKE CRAB!!!!!!!

poorly defined, hard, yellow-grey mass with radiating fibrous trabeculae

Touch = gritty feel and chalky streaks

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15
Q

Pathohistology of Invasive lobular carcinoma of breast?

A

SINGLE CELL INFILTRATION

in single file (INDIAN FILING)

or

arranged as concentric rings around a duct (TARGET-LIKE LESION) of small to medium-sized tumour cells

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16
Q

Extent of involvement of Invasive lobular carcinoma of breast?

A

multifocal and bilateral

poorly circumscribed mass

DCIS = Central 
LCIS = Medial + Upper lateral quadrant
17
Q

Histological feature of Tubular carcinoma of breast? Prognosis?

A

open tubules lined by single layer of cells

excellent prognosis in the pure form
Distant metatastasis are unlikely

18
Q

Histological feature of Mucinous carcinoma of breast?

A

islands of tumour cells floating in large lakes of mucin

19
Q

Clinical presentation of mucinous carcinoma of breast? Prognosis?

A

slow growing** circumscribed mass

bulky, soft**, gelatinous material

excellent prognosis in the pure form

20
Q

2 main modes of breast cancer spread?

A

Lymphatic and Haematogenous

21
Q

Define the 2 paths of breast cancer spread along lymph nodes.

A

Lateral tumours&raquo_space; Level I to III Axillary nodes (at outer, upper quadrant)&raquo_space; Supraclavicular LN

Medial and deep carcinoma&raquo_space; Internal mammary chain (medial quadrant)

22
Q

Which organs are most susceptible to breast cancer spread? Triple negative tumours?

A

Haematogenous spread:

  • Bone most common
  • Lung
  • Liver
  • Ovary and adrenals
  • Brain

VISCERAL METASTASIS is common for TRIPLE NEGATIVE tumours: negative for estrogen receptors, progesterone receptors, and excess HER2 protein

23
Q

Define Sentinel lymph nodes and it’s clinical implications in breast CA?

A

first lymph node(s) to which cancer cells are most likely to spread from a primary tumor

Negative finding:

  • breast CA not able to spread to nearby LN or organ
  • Indication for LN removal as prevention
24
Q

List 7 prognostic factors for breast carcinoma?

A
  • Size
  • Histological type and grade
  • Presence of DCIS
  • Margins of excision
  • Lymph node status
  • Vascular invasion
  • Hormone receptor and HER2 status
25
Q

List types of breast cancer with excellent prognosis?

A

Mucinous carcinoma

Tubular carcinoma

26
Q

List types of breast cancer with poor prognosis?

A

Invasive carcinoma of no special type (NST)

Pleomorphic invasive lobular carcinoma

High grade comedo DCIS

LCIS

27
Q

Define the criteria for histological grading of invasive carcinoma?

A

assessed on
– tubule formation
– nuclear grade
– mitotic rate

Grade I > 80% survival in 16 years
Grade II < 60% survival in 16 years
Grade III < 50% survival in 16 years

28
Q

Classification of DCIS?

A

Assess:
- Margin, size, pathological subtype

Classify into Low, intermediate and High nuclear grade DCIS

29
Q

How is prognosis of breast CA linked to lymph nodes?

A

Prognosis related to the overall number of nodes involved and the level of nodal involvement

30
Q

Which genetic marker indicates use of Herceptin and Doxorubicin-based chemotherapy in breast CA?

A

HER2 Oncogene expression

31
Q

2 lab dx tests to confirm HER2 status?

A

Immunohistochemical assay

Fluorescent in-situ hybridization (FISH)

32
Q

Define the size of breast cancer for in each TNM stage?

A

pTis = DCIS (including Paget’s disease)

pT1:
pT1a < or = 5 mm
pT1b 5 - 10 mm
pT1c 10 - 20 mm

pT2 = tumour 20 - 50 mm

pT3 = tumour > 50 mm

pT4 = tumour with direct extension to skin or chest wall

33
Q

List different approaches to classify tumours.

A
  • Traditional pathologic prognostic and predictive features
  • Clinical outcome (prognostic)
  • Response to therapy (predictive)
  • Gene expression profiling
34
Q

Define the major breast cancer subtypes based on gene profiling?

A

Classify by traditional immunomarkers ER, PR and HER2

  • Luminal A/B
  • HER2
  • Basal-like
35
Q

Compare the treatment options indicated by Luminal, HER2 and Basal-like breast CA?

A

Luminal = Endocrine treatment

HER 2 = Herceptin, Anthracycline based chemo

Basal- like = Platinum, PARP inhibitors

36
Q

Which major breast cancer subtypes based on gene profiling accounts for the most breast cancers?

A

Luminal = 70%

HER2 and Basal-like = 15% each

MBBS II ERS (37 decks)

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