Malignant breast cancer

Question 1

Lifetime probability of women developing cancer? Breast cancer?

Answer 1

1/3

1/8 for breast ~ 30%

Question 2

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

Answer 2

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

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

Question 3

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

Answer 3

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

Question 4

Risk factors for breast cancer

Answer 4

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)

Question 5

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

Answer 5

BRCA1 is more than 2

Question 6

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

Answer 6

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

Question 7

Risk factors associatedvand Race associated with breast cancer

Answer 7

6. Prior biopsies: why did she need it in the first place?
7. Race: Caucasion>AA>Asian>Latina
8. Exogenous E exposure
9. Radiation exposure: to tx other malignancy
10. Cancer of opposite breast

Question 8

Most likely cancer to met to breast

Answer 8

lymphoproliferative

Question 9

Cancers originating from skin

Answer 9

carcinomas

Question 10

Does DCIS have associated risk of invasive carcinoma?

Answer 10

Yes - surgical excision is often curative

Question 11

Most sig risk factor for recurrence of DCIS?

Answer 11

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

Question 12

Low grade DCIS express

High grade DCIS express?

Answer 12

Progesterone/estrogen receptor

HER2/Neu

Question 13

What malignant breast cancer presents as rash on the nipple?

Answer 13

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

Question 14

Pagets disease of the nipple often resembles what cancer?

Answer 14

melanoma

Question 15

Does LCIS typically form a mass or calcification?

Answer 15

No: discovered incidentally

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

Question 16

Signs of locally advanced invasive carcinoma

Answer 16

1. Fixation to the underlying chest wall

Question 17

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

Answer 17

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

Question 18

Most breast carcinoma falls in what category?

Answer 18

Invasive ductal carcinoma (NOS)

*2nd most common histologic type is invasive lobular carcinoma

Question 19

Expression of tubular carcinoma

Answer 19

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

Question 20

Mucinous carcinoma

Answer 20

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

Question 21

Triple (-) prognosis

Answer 21

very poor

- not very much we can treat them with

Question 22

3 main features of medullar carcinom

Answer 22

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

Question 23

Metaplastic carcinoma

Answer 23

Usually ER/PR neg

Question 24

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

Answer 24

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

Question 25

Phyllodes tumor

Answer 25

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

Question 26

Prognostic factors of breast cancer

Answer 26

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)

Question 27

Expression of E and P receptors have what prognosis?

Answer 27

Good - more likely to respond to hormonally based therapy

Question 28

Her2/Neu overexpression has what prognosis?

Answer 28

poor prognosis | - Trastuzumab, herceptin, work better if it is being overexpressed

Question 29

Tubular, mucinous, medullary carcinoma have what prognosis?

Answer 29

better prognosis than invasive ductal carcinoma

Question 30

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

Answer 30

BRCA2 mut men also present at higher stage - but prognosis is same to women.

Question 31

Most important risk factor for breast cancer

Answer 31

age (and being female)

Question 32

Tumors from inner quadrant preferentially spread where?

Answer 32

internal mammary lymph node

Question 33

Invasive lobular carcinoma: | Tumor cells lose the fxn/expression of what key cell-cell adhesion molecules?

Answer 33

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)

Question 34

Medullary carcinoma - Presentation - Hormone receptor expression - Mutation

Answer 34

Well circumscribed mass Negative for hormone receptors does NOT overexpress Her2/neu BRCA1 mut

Question 35

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

Answer 35

Trastuzumab, Herceptin