Lecture 14 Breast Cancer Flashcards
What is ductal carcinoma in situ (DCIS)?
1) proliferation of cells in ducts
2) NOT invasive into basement membrane
3) there is normally single layer of epithelial cells but there is overgrowth of cells in DCIS
4) definition: atypical overgrowth within ductal cells
How do you treat ductal carcinoma in situ?
1) core biopsy is recommended and calcifications are targeted
2) take out several tissue samples
3) maybe tamoxifen
4) determine if estrogen receptor positive and want to give anti-estrogen meds
What is Lobular Carcinoma in Situ (LCIS)?
1) Loss of E-cadherin differentiates DCIS and LCIS!
2) LCIS NOT CANCER!
3) proliferation of atypical cells in lobule
How to treat Lobular Carcinoma in Situ?
1) if you find it on biopsy, remove it! simply because you might have missed something else
2) maybe give tamoxifen cuz elevated risk of breast cancer
What diseases increase risk for breast cancer?
1) Intraductal Papilloma-benign, most common bloody nipple discharge precursor to DCIS
2) Atypical Ductal Hyperplasia-precursor to DCIS and remove
3) Lobular Carcinoma in Situ
What are some genes that increase breast cancer risk?
1) BRCA 1 and 2-80% increased risk of breast cancer
2) p53 and p10 (Coudin Syndrome)-increase breast cancer risk
What are some lifestyle shiz that increase breast cancer risk?
1) smoking
2) estrogen
3) fattness
4) excess alcohol
5) duration from menarche to time of first prego
6) older age at first prig or younger age at menarche
7) low exercise
8) nullparity
9) bilateral breast cancer
How do you manage LCIS and DCIS?
1) excise LCIS/DCIS
2) If estrogen sensitive, estrogen therapy=Tamoxifen and Raloxifine
3) high risk for breast cancer=more than 20% risk
4) yearly mammogram and yearly MRI if 40% risk and offer double mastectomy (25 yr old with LCIS)
If you feel a small lump do you want to do mastectomy or lumpectomy with radiation?
1) woman has choice if small mass
2) NO DIFFERENCE IN SURVIVAL WHEN COMPARE MASTECTOMY TO LUMPECTOMY with radiation or lumpectomy alone
3) however lumpectomy has HIGHER RECURRENCE RATES compared mastectomy
Woman presents with risk factors of:
1) late age at childbirth
2) strong family history of breast cancer
What are her options?
1) NO LCIS
2) screen for breast cancer
3) can offer bilateral prophylactic mastectomy, tamoxifen, genetic counselor (mom have BRCA?)
4) genetic testing-BRCA1/2 vs multigene panel, impacts fam bam
Summary Slide 1
1) DCIS is precursor for cancer
2) LCIS is marker for cancer risk-NOT PRECURSOR FOR BREAST CANCER!
3) partial mastectomy and mastectomy are surgical options for breast cancer
4) adjuvant therapies depend on tumor and patient factors
Summary Slide 2
1) patients at high risk for breast cancer should undergo accelerated screening and offered prevention
2) genetic testing can help ID patients at risk for cancer and guide screening and prevention
