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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
Q

Presentation of breast cancer?

A
  • 50% of women are asymptomatic and picked up on screening

- 505 symptomatic and of that 50%, 50% of them have a lump

26
Q

Symptoms of breast cancer include?

A
  • Dimpled or depressed skin
  • Visible lump
  • Nipple change
  • Bloody discharge
  • Texture change
  • Colour change
27
Q

What happens in the 1 stop clinic?

A

-Triple assessment: clinical assessment, imaging, pathology

  • Imaging depends on age group and symptoms
  • Only 10% people attending clinic have cancer
28
Q

Which receptor status has best prognosis?

A

ER+ and/or PR+, HER2

29
Q

Which cacners have the worst prognosis related to receptor status?

A

Triple negative

30
Q

Which cancers have a poorer prognosis to do with receptor status?

A

-HER2 + but ER - and PR

31
Q

Surgical management of breast cancer?

A

-Ranges from local excision to mastectomy

32
Q

Radiotherapy and treating cancer?

A

Usually given adjuvant therapy as reduces risk of local recurrence

33
Q

When is anti-oestrogen therapy used?

A

In those with ER+ cancers

34
Q

What are pre-menopausal women given for anti-oestrogen therapy?

A

Tamoxifen (ER receptor antagonist) for 5 years atleast

35
Q

Post menopausal women given what in anti-oestrogen therapy?

A

Tamoxifen or an aromatase inhibitor (letrozole for at least 5 years

36
Q

What anti-oestrogen therapy is thought to be better for post-menopausal women?

A

Aromatrose inhibitors

37
Q

When would chemotherapy be used to treat breast cancer?

A
  • High tumour burdens

- Better response in triple negative cancers

38
Q

What is targeted HER2 therapy?

A

HER2 receptors can be used in HER2+ cancers

-Type of monoclonal AB

39
Q

Example of HER2 therapy?

A

Trastuzumab

Herceptin

40
Q

RFs for breats cancer?

A 
Woman 
Old age 
Gene mutations 
Alcohol consumption Early menarche 
Fam History of breast cancer 
Nulliparity
41
Q

Presnettaion of breast cancer?

A 
Dimpled or depressed skin 
Visible lump 
Nipple change (inversion)
Bloody discharge 
Texture change 
Colour change 
Paget's disease of nipple
42
Q

What is pagets disease of nipple?

A

Erythematous weeping lesion on the nipple and areola or excema of nipple

43
Q

Diagnosis of breast cancer?

A

US can diagnose malignant solid mass
Mammogram in over 40s
Core needle biopsy= DEFINITIVE

44
Q

Typical finding in breast cancer?

A

Stellate solid mass can be circular and calcifications noncasting

45
Q

Treatment of breast cancer?

A
  • 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
Q

Essential component of breast conserving therapy?

A

Radiation therapy

47
Q

What is adjuvant systemic therapy?

A

Chemo and hormonal therapy and targeted therapies

48
Q

When is radiation therapy essential?

A

Used after mastectomy if tumour larger than 5cm, 3 or mode nodes or +ve surgical margins

49
Q

How much of lobule is involved in atypical lobular hyperplasia?

A

<50% of lobule

50
Q

Management of LISC?

A

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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