Malignant Breast Cancer

Question 1

in what lobe of the breast does breast cancer occur?

Answer 1

upper outer quadrant

Question 2

risk factors of breast cancer are mostly due to what factor?

Answer 2

estrogen related…others are obesity, genetical, post-menopause, atypical hyperplasia

Question 3

what are the clinical findings of breast cancer?

Answer 3

• painless mass
• nipple retraction
• skin dimpling
• fixation
• painless axillary lymphadenopathy
• hepatomegaly or bone pain

Question 4

what tool can be used as a screening test to identify breast cancer?
what does it detect?

Answer 4

mammography

• detects non-palpable masses
• detects microcalcifications that happen with ductal carcinoma in situ or sclerosing adenosis

Question 5

what can a mammography not distinguish?

Answer 5

cannot distinguish between malignant or benign breast masses

Question 6

what is the 1st spreading mechanism used by breast cancer?

Answer 6

lymph

Question 7

Outer quadrant tumors spread where?

Answer 7

axillary lymph nodes

Question 8

Inner quadrant tumors spread where?

Answer 8

internal mammary nodes

Question 9

what is the 2nd mechanism used by breast cancer to spread?

Answer 9

blood stream

Question 10

what are the common places of spread of breast cancer via blood?

Answer 10

lungs, bones, liver, brain and ovaries

Question 11

breast cancer that spreads via blood to the bones is identifiable how?

Answer 11

osteolytic bone lesions with pain being relieved by local radiation

Question 12

what is more important extra-nodal spread or nodal spread?

Answer 12

Extranodal spread has greater significance than nodal metastasis.

Question 13

what is Sentinel node biopsy?

Answer 13

• Sampling of the initial node that drains the cancer.

Question 14

what does a sentinel node biopsy that is negative tell you?

Answer 14

If negative for metastasis then the other nodes in that group are usually negative.

Question 15

what does a sentinel node biopsy that is positive tell you?

Answer 15

If positive for metastasis then there is one third chance that other nodes in that group have metastasis.

Question 16

Estrogen and progesterone receptor assay can be good for what?

Answer 16

it allows to identify if a cancer can be treated with tamoxifen (anti-estrogen)

Question 17

what test can be done in order to determine if poor prognosis can be given?

Answer 17

erb 2 (HER-neu) amplification must be present

Question 18

most breast cancer are what type?

Answer 18

adenocarcinomas

Question 19

adenocarcinomas are derived from what cell?

Answer 19

glandular epithelium

Question 20

what are the 2 categories of breast cancer? and what are they’re limitations?

Answer 20

1) non-invasive or in situ cancer - limited to ducts and lobules and don’t metastasize
2) invasive cancer - metastasize by penetrating basement membrane

Question 21

what are the non-invasive cancers?

Answer 21

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ

Question 22

what are the Invasive cancers?

Answer 22

Infiltrating ductal carcinoma
Paget’s disease of breast (nipple)
Medullary carcinoma
Inflammatory carcinoma
Invasive lobular carcinoma
Tubular carcinoma
Colloid (mucinous) carcinoma

Question 23

what is a ductal carcinoma in situ?

Answer 23

malignant cells filling the ductal lumen that haven’t crossed the basement membrane

Question 24

what patterns are found in carcinoma in situ?

Answer 24

cribriform (sieve-like)

comedo (necrotic center that can undergo calcification)

Question 25

what is lobular carcinoma?

Answer 25

non-palpable mass with malignant cells appearing as solid clusters that pack and distend the lobules

Question 26

how is lobular carcinoma usually found? with lobular carcinoma there is an increased incidence of what?

Answer 26

its incidentally found on breast biopsy and there is increased incidence on the opposite breast

Question 27

what is an Infiltrating ductal carcinoma?

Answer 27

Invasion of the stroma by malignant cells causing desmoplasia (pronounced fibroblastic proliferation)

Question 28

what is another name for Infiltrating ductal carcinoma?

Answer 28

scirrhous carcinoma

Question 29

infiltrating ductal carcinoma is composed of what type of cell?

Answer 29

of malignat cells arranged in glandular pattern, solid nests and cords

Question 30

can infiltrating ductal carcinoma be felt?

Answer 30

yes i leads to masses that are hard and gritty that deform the breast

Question 31

what is paget's disease of the nipple?

Answer 31

Is a variant of ductal carcinoma in situ or Invasive ductal carcinoma BUT involves the epidermis of the nipple or areola

Question 32

what is the clinical presentation of paget's disease of the nipple?

Answer 32

Ulceration, oozing, fissuring and eczematous change (rash) in the skin of the nipple and areola.

Question 33

what is seen at micro level in pagets disease of the nipple?

Answer 33

large cells with clear cytoplasm | found singly or in groups within the epidermis

Question 34

what is a Medullary carcinoma? and how does it look?

Answer 34

- lymphocytic infiltrate, associated with BRCA 1 mutation | - Has a soft fleshy consistency, tumor cells are large.

Question 35

what is a Inflammatory carcinoma?

Answer 35

Cancer cells block the lymphatics of the skin giving rise to orange peel appearance (peau d orange) (The skin appears reddish, swollen and hot – resembling an inflammatory process.)

Question 36

Invasive lobular carcinoma appears how?

Answer 36

tends to have cells arranged in linear fashion

Question 37

what should you know of Tubular carcinoma?

Answer 37

Develops in terminal ductules, increased incidence of cancer in opposite breast

Question 38

Colloid (mucinous) carcinoma occurs on who in the population? how does it look?

Answer 38

Usually occur in elderly women, neoplastic cells surronded by pools of extracellular mucin

Question 39

what is gynecomastia?

Answer 39

Refers to an enlargement of the adult male breast.

Question 40

why does gynecomastia happen?

Answer 40

Proliferation of glandular component in male breast | Caused by estrogen.

Question 41

what is the clinical presentation of gynecomastia?

Answer 41

bilateral Subareolar mass

Question 42

what can lead to gynecomastia?

Answer 42

Klinefelter’s Cirrhosis - can't metabolize estrogen Spironolactone