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LC 02 > Malignant breast cancer > Flashcards

Malignant breast cancer Flashcards

1
Q

Lifetime probability of women developing cancer? Breast cancer?

A

1/3

1/8 for breast ~ 30%

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2
Q

Note the increase incidence in breast cancer in 1980, whats happening?

A

Introduction of mammographic screening
- catching smaller bc and at early age

*decrease in mortality is due to hormone tx and herceptin - actually does help

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3
Q

Men are most likely to get dx with which cancer and die from which?

A

Top 3 dx of cancer:

  1. prostate cancer
  2. Lung and bronchus
  3. Colon rectum

More likely to die of:

  1. lung+bronchus cancer
  2. Prostate
  3. Colon + rectum
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4
Q

Risk factors for breast cancer

A
  1. hereditary breast cancer
    - BRCA1, BRCA2
    (both are TSG)
    - CHEK2
    - Syndromes
    For hereditary - risk is very very high if no prophylaxis is taken
  2. Sporadic
    - most are due to hormonal (post-menopausal)
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5
Q

Which one is at a higher risk for ovarian cancer, BRCA1 or 2?

A

BRCA1 is more than 2

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6
Q

Syndromes that are additional causes of breast cancer and their associated gene mutation

A
  1. Li fraumeni syndrome: mut in p53
    - HER2 +
  2. Cowden syndrome: mut in PTEN gen
  3. Peutz-Jeghers syndrome: mut in STK11/LKB1

*in 2/3 of inherited breast cancer, the cause is unknown

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7
Q

Risk factors associatedvand Race associated with breast cancer

A
  1. Prior biopsies: why did she need it in the first place?
  2. Race: Caucasion>AA>Asian>Latina
  3. Exogenous E exposure
  4. Radiation exposure: to tx other malignancy
  5. Cancer of opposite breast
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8
Q

Most likely cancer to met to breast

A

lymphoproliferative

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9
Q

Cancers originating from skin

A

carcinomas

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10
Q

Does DCIS have associated risk of invasive carcinoma?

A

Yes - surgical excision is often curative

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11
Q

Most sig risk factor for recurrence of DCIS?

A
  1. Positive surgical margins
  2. Histological grade
  3. Extent of breast involvement (size)
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12
Q

Low grade DCIS express

High grade DCIS express?

A

Progesterone/estrogen receptor

HER2/Neu

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13
Q

What malignant breast cancer presents as rash on the nipple?

A

Pagets disease
often confused with eczema
- very likely that breast represents invasive carcinoma

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14
Q

Pagets disease of the nipple often resembles what cancer?

A

melanoma

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15
Q

Does LCIS typically form a mass or calcification?

A

No: discovered incidentally

  • often multicentric and bilateral
  • both breasts are at risk of invasive carcinoma (DCIS is just in ips breast)
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16
Q

Signs of locally advanced invasive carcinoma

A
  1. Fixation to the underlying chest wall
17
Q

Invasive carcinoma in women are more likely to be where in the breast?

A

Upper outer quadrant
(but can be anywhere)
- first spread to axillar LN

18
Q

Most breast carcinoma falls in what category?

A

Invasive ductal carcinoma (NOS)

*2nd most common histologic type is invasive lobular carcinoma

19
Q

Expression of tubular carcinoma

A

E/PR +
Her2/Neu -

Small, tubular, excellent prognosis
- almost all express hormone receptors and
do NOT overexpress Her2/neu

*poorly differentiated tumors also tend to overexpress HER2/neu more frequently

20
Q

Mucinous carcinoma

A
  1. well circumscribed mass in older age group
  2. Favorable prog
  3. Usually expresss H receptors and no Her2/Neu
  4. More freq in patients with BRCA1 mut
21
Q

Triple (-) prognosis

A

very poor

- not very much we can treat them with

22
Q

3 main features of medullar carcinom

A
  1. Indistinct cell border (aka syncytial growth)
  2. Prominent lymphoplasmacytic infiltrate at peripher
  3. Pushing borders
23
Q

Metaplastic carcinoma

A

Usually ER/PR neg

24
Q

Most important sarcoma in the breast? How does it develop?

A

angiosarcoma

  1. Spontaneously
  2. Treatment associated (following radiation therapy)
  3. Chronic edema of the limb (stewart-Treves syndrome)

*if woman has been treated for breast cancer, keep an eye out for angiosarcoma in first 5 yrs following

25
Q

Phyllodes tumor

A

Mixed tumor derived from stroma and epithelium

  • leaflike projections
  • differ from fibroadenomas by:
    1. Mitotic rate
    2. Overgrowth of hypercellular stromal component
    3. Infiltrative borders
26
Q

Prognostic factors of breast cancer

A
  1. Lymph node metastasis!
    - most imp factor
  2. Tumor size
    - second most imp factor
  3. Presence of invasion
  4. Distant metastases
  5. Locally advanced disease
  6. Inflammatory carcinoma

*dont confuse with risk factors
(Fam hx, exposures)

27
Q

Expression of E and P receptors have what prognosis?

A

Good - more likely to respond to hormonally based therapy

28
Q

Her2/Neu overexpression has what prognosis?

A

poor prognosis

- Trastuzumab, herceptin, work better if it is being overexpressed

29
Q

Tubular, mucinous, medullary carcinoma have what prognosis?

A

better prognosis than invasive ductal carcinoma

30
Q

Which is more risky for males, BRCA1 or 2 mut?

A

BRCA2 mut

men also present at higher stage - but prognosis is same to women.

31
Q

Most important risk factor for breast cancer

A

age (and being female)

32
Q

Tumors from inner quadrant preferentially spread where?

A

internal mammary lymph node

33
Q

Invasive lobular carcinoma:

Tumor cells lose the fxn/expression of what key cell-cell adhesion molecules?

A

E-Cadherin
- thats why you see the single files in Invasive lobular carcinoma
- and why it is more likely to spread to CSF, GI, ovaries, uterus, peritoneum
(not lungs)

34
Q

Medullary carcinoma

  • Presentation
  • Hormone receptor expression
  • Mutation
A

Well circumscribed mass

Negative for hormone receptors

does NOT overexpress Her2/neu

BRCA1 mut

35
Q

If HER2/neu is being overexpressed, which drugs to use?

A

Trastuzumab, Herceptin

LC 02 (15 decks)

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