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Reproduction & Sexual Health > Malignant Breast Disease > Flashcards

Malignant Breast Disease Flashcards

1
Q

Name the most common breast malignancy

A

Carcinoma

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2
Q

Name three metastatic malignancies that can occur in the breast

A

Carcinoma - bronchial, ovarian serous, clear cell of kidney
Melanoma
Soft tissue

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3
Q

Name three miscellaneous malignant diseases

A

Malignant phyllodes tumour - stromal component
Angiosarcoma - post radiotherapy
Lymphoma - breast, lymph nodes

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4
Q

Define breast carcinoma

A

A malignant tumour of breast epithelial cells that arises in the glandular epithelium of the terminal duct lobule unit

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5
Q

What are the two vague types of precursor lesion?

A

Ductal

Lobular

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6
Q

Name four ductal precursor lesions

A

Epithelial hyperplasia of usual type
Columnar cell change
Atypical ductal hyperplasia
Ductal carcinoma in situ

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7
Q

What are the two types of lobular precursor?

A

Atypical lobular hyperplasia

Lobular carcinoma in situ

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8
Q

Define in situ carcinoma

A

Confined within basement membrane of acini and ducts

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9
Q

What is the difference between atypical lobular hyperplasia and lobar carcinoma in situ?

A

ALH - <50% lobule involved

Lobular carcinoma in situ >50% lobule involved

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10
Q

What does a lobular carcinoma in situ look like?

A

Interlobular proliferation of characteristic cells, small/intermediate nuclei, solid proliferation, intra-cytoplasmic lumen/vacuoles

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11
Q

Are lobular carcinoma in situ ER positive or negative?

A

Positive

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12
Q

What staining can help identify lobular carcinoma in situ?

A

E-cadherin negative - deletion and mutation of CDH1 gene on chromosome 16

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13
Q

Describe the clinical features of lobular carcinoma in situ?

A

Multifocal and bilateral, incidence decreases after menopause not palpable or visible but may cacify and be seen on mammogram. Usually incidental

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14
Q

What is the risk of invasive carcinoma with lobular carcinoma in situ?

A

8 times higher

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15
Q

How is lobular carcinoma in situ managed?

A

Core biopsy - excision/vacuum biopsy to exclude high grade

Follow up

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16
Q

What are the three classifications of DCIS?

A

Low
Intermediate
High grade

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17
Q

How are most cases of DCIS detected?

A

Breast screening

18
Q

Define DCIS

A

Cytologically malignant epithelial cells confined within the basement membrane of the duct

19
Q

What can occur as DCIS starts to spread?

A

Paget’s Disease of Nipple

20
Q

Describe Paget’s Disease of Nipple

A

High grade DCIS extends along the ducts to reach the epidermis of the nipple - non-invasive carcinoma in situ causing ulceration and discolouration

21
Q

How is DCIS classified?

A

Cytological grade
Histological type
Presence of necrosis

22
Q

How is DCIS managed?

A

Surgery
Adjuvent Radiotherapy
Chemoprevention

23
Q

Define malignant breast carcinoma

A

Malignant cells that have breached the basement membrane

24
Q

Name the different types of breast carcinoma

A

Tubular
Lobular
Ductal (G1, G2, G3)
Pleo lobular

25
Q

State the risk factors for breast carcinoma

A 
Age 
Reproductive History 
Hormones (OCP, HRT)
Previous breast disease 
Geography 
Lifestyle 
Genetics
26
Q

What genetic mutations predispose to breast cancer?

A 
BRCA1
BRC2
TP53
PTEN
STKII/LKBI
ATM
27
Q

What percentage of the population have a BRCA mutation?

A

0.1%

28
Q

Describe the staging of breast carcinoma

A

T0-4 - local invasion (stroma, skin, chest wall muscle)
N0-N3 - lymphatics
M0-M1 - blood borne

29
Q

Where does breast carcinoma tend to spread?

A

Bone, liver, brain, lungs, abdomen, female genital tract

30
Q

Describe the grading of breast carcinoma

A

Differentiation

  • tubular (1-3)
  • nuclear (1-3)
  • mitotic (1-3)
31
Q

What differentiation scores correspond to which grade?

A 
3-5 = grade 1
6/7 = grade 2 
8/9 = grade 3
32
Q

What is intrinsic profiling based on?

A

Genes

33
Q

What types are ER negative?

A

Basal-like
HER2+
Normal

34
Q

What types are ER positive?

A

Luminal subtypes A - low proliferation

B and C - high proliferation

35
Q

Name three hormone receptors

A

Oestrogen receptor
Progesterone receptor
HER2

36
Q

Describe the oestrogen receptor and associated treatment

A

Expression predicts response to anti-oestrogen therapy - oophorectomy, tamoxifen, aromatase inhibitor (letrozole), GnRH antagonist (goserilin)

37
Q

Describe HER2

A

Human epidermal growth factor receptor 2 - over expression or amplification - responds to trabtuzamab (herceptin)

38
Q

What is herceptin?

A

Monoclonal antibody that blocks the receptor

39
Q

Which receptor profile has worst prognosis?

A

Triple negative

40
Q

What does NHS PREDICT include and determine?

A

Histopathology, ER, Clinical factors (age and menopause), HER2, mode of detection
Calculates survival table

Reproduction & Sexual Health (36 decks)

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