Malignant breast pathology Flashcards
common breast cancer after radiotherapy
angiosarcoma
common metastatic tumours to breast
lung ovary kidney melanoma soft tissue (leiomyosarcoma)
what type of cancer is breast carcinoma
adenocarcinoma
what does breast carcinoma arise in
terminal duct lobular unit
what are the 2 precursor lesions to breast carcinoma
ductal carcinoma in situ
lobular in situ neoplasia
what are the precursor cancers contained in
basement membrane
if passes basement membrane - invasive and malignant
histology of LISN
intralobular proliferation
small-intermediate sized nuclei
intracytoplasmic lumens/vacuoles
what does LISN test positive for
ER
what does LISN test negative for
E-cadherin (a tumour suppressor gene)
loss of this means unopposed proliferation
what precursor is mire common
DCIS
what is DCIS involving nipple called
paget’s
risk factors for breast carcinoma
age (40-60) early menarche late menopause first pregnancy >30 nulliparity not breastfeeding HRT and OCP previous breast Ca lifestyle
what gene is associated with breast cancer
BRCA 1 and 2
where is breast carcinoma likely to metastasize to
bone liver brain lungs abdo viscera female genital tract
what hormone receptors can breast cancer express
oestrogen (ER)
progesterone (PR)
HER2
what hormone receptor expression is an indication of a poor prognosis
HER2
if the tumour expresses oestrogen receptors, what medication can be given
tamoxifen aromatase inhibitors (letrozole) GnRH antanoists (goserilin - zoladex)
why can aromatase inhibitors only be given to post-menopausal women
initiates menopause
what can be given if tumour expresses HER2 receptors
Herceptin - trastuzamab
TNM staging for breast cancer
T1 - <2cm
T2 - 2-5cm
T3 - >5cm
T4 - pos d’orange/fixed to chest wall
N1 - mobile ipsilateral nodes
N2 - fixed nodes
M1 - distant metastases
Breast carcinoma stages
stage 1 - confined to breast and mobile
stage 2 - confined to breast, monile, nodes in ipsilateral axilla
stage 3 - tumour fixed to pec major but not chest wall, fixed ipsilateral nodes or skin involvement
stage 4 - complete fixation to chest wall or distal mets
management of early invasive breast cancer
breast conserving surgery and radiotherapy
if tumour >5mm, mastectomy and radiotherapy
