Malignant Breast Disease Flashcards
Name the most common breast malignancy
Carcinoma
Name three metastatic malignancies that can occur in the breast
Carcinoma - bronchial, ovarian serous, clear cell of kidney
Melanoma
Soft tissue
Name three miscellaneous malignant diseases
Malignant phyllodes tumour - stromal component
Angiosarcoma - post radiotherapy
Lymphoma - breast, lymph nodes
Define breast carcinoma
A malignant tumour of breast epithelial cells that arises in the glandular epithelium of the terminal duct lobule unit
What are the two vague types of precursor lesion?
Ductal
Lobular
Name four ductal precursor lesions
Epithelial hyperplasia of usual type
Columnar cell change
Atypical ductal hyperplasia
Ductal carcinoma in situ
What are the two types of lobular precursor?
Atypical lobular hyperplasia
Lobular carcinoma in situ
Define in situ carcinoma
Confined within basement membrane of acini and ducts
What is the difference between atypical lobular hyperplasia and lobar carcinoma in situ?
ALH - <50% lobule involved
Lobular carcinoma in situ >50% lobule involved
What does a lobular carcinoma in situ look like?
Interlobular proliferation of characteristic cells, small/intermediate nuclei, solid proliferation, intra-cytoplasmic lumen/vacuoles
Are lobular carcinoma in situ ER positive or negative?
Positive
What staining can help identify lobular carcinoma in situ?
E-cadherin negative - deletion and mutation of CDH1 gene on chromosome 16
Describe the clinical features of lobular carcinoma in situ?
Multifocal and bilateral, incidence decreases after menopause not palpable or visible but may cacify and be seen on mammogram. Usually incidental
What is the risk of invasive carcinoma with lobular carcinoma in situ?
8 times higher
How is lobular carcinoma in situ managed?
Core biopsy - excision/vacuum biopsy to exclude high grade
Follow up
What are the three classifications of DCIS?
Low
Intermediate
High grade
How are most cases of DCIS detected?
Breast screening
Define DCIS
Cytologically malignant epithelial cells confined within the basement membrane of the duct
What can occur as DCIS starts to spread?
Paget’s Disease of Nipple
Describe Paget’s Disease of Nipple
High grade DCIS extends along the ducts to reach the epidermis of the nipple - non-invasive carcinoma in situ causing ulceration and discolouration
How is DCIS classified?
Cytological grade
Histological type
Presence of necrosis
How is DCIS managed?
Surgery
Adjuvent Radiotherapy
Chemoprevention
Define malignant breast carcinoma
Malignant cells that have breached the basement membrane
Name the different types of breast carcinoma
Tubular
Lobular
Ductal (G1, G2, G3)
Pleo lobular
State the risk factors for breast carcinoma
Age Reproductive History Hormones (OCP, HRT) Previous breast disease Geography Lifestyle Genetics
What genetic mutations predispose to breast cancer?
BRCA1 BRC2 TP53 PTEN STKII/LKBI ATM
What percentage of the population have a BRCA mutation?
0.1%
Describe the staging of breast carcinoma
T0-4 - local invasion (stroma, skin, chest wall muscle)
N0-N3 - lymphatics
M0-M1 - blood borne
Where does breast carcinoma tend to spread?
Bone, liver, brain, lungs, abdomen, female genital tract
Describe the grading of breast carcinoma
Differentiation
- tubular (1-3)
- nuclear (1-3)
- mitotic (1-3)
What differentiation scores correspond to which grade?
3-5 = grade 1 6/7 = grade 2 8/9 = grade 3
What is intrinsic profiling based on?
Genes
What types are ER negative?
Basal-like
HER2+
Normal
What types are ER positive?
Luminal subtypes A - low proliferation
B and C - high proliferation
Name three hormone receptors
Oestrogen receptor
Progesterone receptor
HER2
Describe the oestrogen receptor and associated treatment
Expression predicts response to anti-oestrogen therapy - oophorectomy, tamoxifen, aromatase inhibitor (letrozole), GnRH antagonist (goserilin)
Describe HER2
Human epidermal growth factor receptor 2 - over expression or amplification - responds to trabtuzamab (herceptin)
What is herceptin?
Monoclonal antibody that blocks the receptor
Which receptor profile has worst prognosis?
Triple negative
What does NHS PREDICT include and determine?
Histopathology, ER, Clinical factors (age and menopause), HER2, mode of detection
Calculates survival table
