Malignant Breast Conditions

Question 1

What are the risk factors for breast cancer?

Answer 1

• earlier menarche
• later menopause
• older first pregnancy/child birth
• oral contraception
• HRT
• diabetes
• tallness
• obesity
• alcohol
• denser breast tissue on mammography
• positive family history

Question 2

List some symptoms of breast cancer

Answer 2

• new lump/thickening in breast/axilla
• altered shape, size, feel of the breast - pain
• skin changes: puckering, dimpling, peau d’orange, rash, redness
• nipple changes: tethering/inversion, discharge, eczema like changes in Paget’s disease

Question 3

Describe the treatment of breast cancer

Answer 3

• surgery (aim to remove all cancer tissue with margins free of cancer)
• WLE with subsequent radiotherapy/chemotherapy optimal
• larger cancers may require mastectomy to achieve clear margins

Question 4

Describe steroid hormone receptor mutations in cancer

Answer 4

• overexpression of the oestrogen and progesterone receptors are common in breast cancer
• can be treated with an oestrogen antagonist eg. Tamoxifen

Question 5

How can tumours be targeted by aromatase inhibitors?

Answer 5

• in post-menopausal women aromatase inhibitors can target oestrogen stimulation of tumour growth
• prevents conversion of androgens to oestrogens

Question 6

How can HER2 cancers be treated?

Answer 6

• can be targeted by monoclonal antibody trastuzumab (herceptin) which targets HER2 overexpression
• can reduce risk of relapse in HER2 positive cancer and prolong survival in systemic metastatic breast cancer

Question 7

List the prognostic factors in breast cancer

Answer 7

• carcinoma grade and stage (size and lymph node involvement)
• ER/PR/HER2 status (important in prediction of response to endocrine therapy)

Question 8

Describe breast cancer grading

Answer 8

1. Nuclear pleomorphism (well differentiated and slow growing)
2. Number of mitoses per mm2
3. Degree of gland formation by cancer cells (poorly differentiated and fast growing)

Question 9

Describe carcinoma in situ

Answer 9

• ductal carcinoma in situ
• lobular carcinoma in situ
• less commonly (atypical ductal hyperplasia and atypical lobular neoplasia)
• proliferation of markedly abnormal epithelial cells within basement membrane
• no extension into breast stroma
• no communication with blood vessels/lymphatics
• no possibility of metastases

Question 10

Describe molecular classification of breast cancer

Answer 10

• luminal A ER+: low grade, less proliferative, better prognosis
• luminal B ER+: high grade, more proliferative, worse prognosis
• 3 subtypes of ER+ cancer: normal breast-like, HER2 and basal like:
• HER2 = HER2 gene amplification
• basal-like = express genes associated with basal/myoepithelial cells, aggressive with overlap with cancers in BRCA1 mutation

Question 11

How is invasive ductal carcinoma and invasive lobular carcinoma differentiated?

Answer 11

Morphological differences (result of loss of E-Cadherin)