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Charis & Ellie VS Breast > Malignant Breast Pathology > Flashcards

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
  • May calcify

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?

A

10%

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17
Q

Infiltrating lobular carcinomas are more likely to be?

A

Multifocal or bilateral

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18
Q

Microscopic appearance of Infiltrating lobular carcinoma?

A

Infiltrates tissue as single files of malignant cells

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19
Q

How does metastatic breast cancer spread?

A

Via lymphatics to axillary nodes

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20
Q

Most common spread of metastatic cancer?

A

Via blood stream to bone marrow and lung

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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
40
RFs for breats cancer?
``` Woman Old age Gene mutations Alcohol consumption Early menarche Fam History of breast cancer Nulliparity ```
41
Presnettaion of breast cancer?
``` Dimpled or depressed skin Visible lump Nipple change (inversion) Bloody discharge Texture change Colour change Paget's disease of nipple ```
42
What is pagets disease of nipple?
Erythematous weeping lesion on the nipple and areola or excema of nipple
43
Diagnosis of breast cancer?
US can diagnose malignant solid mass Mammogram in over 40s Core needle biopsy= DEFINITIVE
44
Typical finding in breast cancer?
Stellate solid mass can be circular and calcifications noncasting
45
Treatment of breast cancer?
- Surgical excision needs minimum of 1mm margin - Breast conserving therapy= preferred treatment - Modified radical mastectomy - Breast reconstruction - Radiation therapy - Adjuvant systemic therapy - Oncotype diagnostic therapy
46
Essential component of breast conserving therapy?
Radiation therapy
47
What is adjuvant systemic therapy?
Chemo and hormonal therapy and targeted therapies
48
When is radiation therapy essential?
Used after mastectomy if tumour larger than 5cm, 3 or mode nodes or +ve surgical margins
49
How much of lobule is involved in atypical lobular hyperplasia?
<50% of lobule
50
Management of LISC?
If discovered on core biopsy: excise or vacuum biopsy to exclude higher grade lesion If on vacuum or excision biopsy dixcovery: Follow up and clinical trials

Charis & Ellie VS Breast (10 decks)

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