Malignant Breast Pathology Flashcards

1
Q

What is breast carcinoma?

A

Malignant tumour of epithelial cells

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2
Q

Where does breast carcinoma arise?

A

Glandular epithelium so is an adenocarcinoma

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3
Q

What is in situ carcinoma?

A
  • Confined within basement membrane of acini and ducts
  • Cytologically malignant but non-invasive
  • Non-obligate precursor of invasive carcinoma
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4
Q

What do cells lining ducts show in ductal carcinoma in situ?

A

Cytological features of malignancy but have not yet invaded stroma

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5
Q

What allows ductal carcinoma to detected and how?

A
  • Focal calcification

- Mammographically detected

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6
Q

How is ductal carcinoma graded?

A

Grade 1-3 depending on how abnormal the cells are (higher grade = higher risk of invasion)

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7
Q

What is lobular carcinoma sometimes called? (LCIS)

A

Lobular in situ neoplasia

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8
Q

What is lesion usually like in lobular in situ neoplasia?

A

Multifocal and bilateral
-Not palpable or visible grossly

Usually an incidental finding

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9
Q

What can LCIS progress to?

A

Infiltrative carcinoma

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10
Q

What is Paget’s disease of the nipple characterized by?

A

Inflammatory eczema like changes of the nipple that may involve the areola

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11
Q

Management of LCIS?

A

Discovered in biopsy: proceed to excision or vacuum biopsy to exclude higher grade lesion

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12
Q

What causes Pagets disease of the nipple?

A

High grade DCIS extending along ducts to reach the epidermis of the nipple

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13
Q

If someone presents with inflammatory skin changes around nipple what could there be?

A

Underlying Ductal carcinoma in situ (DCIS)

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14
Q

What is the commonest form of breast cancer and how does it present?

A

Infiltrating ductal carcinoma

Presents as firm/ hard lump

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15
Q

MIcroscopic appearance of infiltrating ductal carcinoma?

A
  • Cords of tumour cells
  • Dense collagenous stroma
  • Occasional acinar formation
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16
Q

What % of cancers are infiltrating lobular carcinoma?

17
Q

Infiltrating lobular carcinomas are more likely to be?

A

Multifocal or bilateral

18
Q

Microscopic appearance of Infiltrating lobular carcinoma?

A

Infiltrates tissue as single files of malignant cells

19
Q

How does metastatic breast cancer spread?

A

Via lymphatics to axillary nodes

20
Q

Most common spread of metastatic cancer?

A

Via blood stream to bone marrow and lung

21
Q

Secondary spread of metastatic cancer?

A

Liver
Lung
Bones

22
Q

RFs for developing breast cancer?

A
Increasing age 
Genetics (BRCA1/2)
Smoking
Lack of physical activity 
Alcohol
23
Q

Risk factors for malignant cancer to do with oestrogen?

A

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
24
Q

How does obesity increase risk of malignancy?

A

Adipose tissue results in increased oestrogen

25
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
26
Symptoms of breast cancer include?
- Dimpled or depressed skin - Visible lump - Nipple change - Bloody discharge - Texture change - Colour change
27
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
28
Which receptor status has best prognosis?
ER+ and/or PR+, HER2
29
Which cacners have the worst prognosis related to receptor status?
Triple negative
30
Which cancers have a poorer prognosis to do with receptor status?
-HER2 + but ER - and PR
31
Surgical management of breast cancer?
-Ranges from local excision to mastectomy
32
Radiotherapy and treating cancer?
Usually given adjuvant therapy as reduces risk of local recurrence
33
When is anti-oestrogen therapy used?
In those with ER+ cancers
34
What are pre-menopausal women given for anti-oestrogen therapy?
Tamoxifen (ER receptor antagonist) for 5 years atleast
35
Post menopausal women given what in anti-oestrogen therapy?
Tamoxifen or an aromatase inhibitor (letrozole for at least 5 years
36
What anti-oestrogen therapy is thought to be better for post-menopausal women?
Aromatrose inhibitors
37
When would chemotherapy be used to treat breast cancer?
- High tumour burdens | - Better response in triple negative cancers
38
What is targeted HER2 therapy?
HER2 receptors can be used in HER2+ cancers | -Type of monoclonal AB
39
Example of HER2 therapy?
Trastuzumab | Herceptin