Malignant Breast Pathology Flashcards
What is breast carcinoma?
Malignant tumour of epithelial cells
Where does breast carcinoma arise?
Glandular epithelium so is an adenocarcinoma
What is in situ carcinoma?
- Confined within basement membrane of acini and ducts
- Cytologically malignant but non-invasive
- Non-obligate precursor of invasive carcinoma
What do cells lining ducts show in ductal carcinoma in situ?
Cytological features of malignancy but have not yet invaded stroma
What allows ductal carcinoma to detected and how?
- Focal calcification
- Mammographically detected
How is ductal carcinoma graded?
Grade 1-3 depending on how abnormal the cells are (higher grade = higher risk of invasion)
What is lobular carcinoma sometimes called? (LCIS)
Lobular in situ neoplasia
What is lesion usually like in lobular in situ neoplasia?
Multifocal and bilateral
-Not palpable or visible grossly
Usually an incidental finding
What can LCIS progress to?
Infiltrative carcinoma
What is Paget’s disease of the nipple characterized by?
Inflammatory eczema like changes of the nipple that may involve the areola
Management of LCIS?
Discovered in biopsy: proceed to excision or vacuum biopsy to exclude higher grade lesion
What causes Pagets disease of the nipple?
High grade DCIS extending along ducts to reach the epidermis of the nipple
If someone presents with inflammatory skin changes around nipple what could there be?
Underlying Ductal carcinoma in situ (DCIS)
What is the commonest form of breast cancer and how does it present?
Infiltrating ductal carcinoma
Presents as firm/ hard lump
MIcroscopic appearance of infiltrating ductal carcinoma?
- Cords of tumour cells
- Dense collagenous stroma
- Occasional acinar formation
What % of cancers are infiltrating lobular carcinoma?
10%
Infiltrating lobular carcinomas are more likely to be?
Multifocal or bilateral
Microscopic appearance of Infiltrating lobular carcinoma?
Infiltrates tissue as single files of malignant cells
How does metastatic breast cancer spread?
Via lymphatics to axillary nodes
Most common spread of metastatic cancer?
Via blood stream to bone marrow and lung
Secondary spread of metastatic cancer?
Liver
Lung
Bones
RFs for developing breast cancer?
Increasing age Genetics (BRCA1/2) Smoking Lack of physical activity Alcohol
Risk factors for malignant cancer to do with oestrogen?
ANYTHING THAT PROLONGS CYCLICAL EXPOSURE TO SEX HORMONES INCREASE RISK
- Early menarche and late menpause increases risk
- Breast feeding reduces risk
- Obesity increases risk
- Nulliparity increases risk
How does obesity increase risk of malignancy?
Adipose tissue results in increased oestrogen
Presentation of breast cancer?
- 50% of women are asymptomatic and picked up on screening
- 505 symptomatic and of that 50%, 50% of them have a lump
Symptoms of breast cancer include?
- Dimpled or depressed skin
- Visible lump
- Nipple change
- Bloody discharge
- Texture change
- Colour change
What happens in the 1 stop clinic?
-Triple assessment: clinical assessment, imaging, pathology
- Imaging depends on age group and symptoms
- Only 10% people attending clinic have cancer
Which receptor status has best prognosis?
ER+ and/or PR+, HER2
Which cacners have the worst prognosis related to receptor status?
Triple negative
Which cancers have a poorer prognosis to do with receptor status?
-HER2 + but ER - and PR
Surgical management of breast cancer?
-Ranges from local excision to mastectomy
Radiotherapy and treating cancer?
Usually given adjuvant therapy as reduces risk of local recurrence
When is anti-oestrogen therapy used?
In those with ER+ cancers
What are pre-menopausal women given for anti-oestrogen therapy?
Tamoxifen (ER receptor antagonist) for 5 years atleast
Post menopausal women given what in anti-oestrogen therapy?
Tamoxifen or an aromatase inhibitor (letrozole for at least 5 years
What anti-oestrogen therapy is thought to be better for post-menopausal women?
Aromatrose inhibitors
When would chemotherapy be used to treat breast cancer?
- High tumour burdens
- Better response in triple negative cancers
What is targeted HER2 therapy?
HER2 receptors can be used in HER2+ cancers
-Type of monoclonal AB
Example of HER2 therapy?
Trastuzumab
Herceptin
