Malignant Conditions of the Breast Flashcards
What are the risk factors for breast cancer
- Earlier menarche,
- Later menopause,
- Being older at first pregnancy/childbirth
- Oral contraception use.
- HRT
- Obesity,
- Tall
- Dense breast tissue
- Alcohol
- Positive family history
What are the symptoms of a possible breast cancer
- New lump/thickening in breast or axilla,
- Altered shape, size or feel of the breast
- Skin changes: puckering, dimpling, peau d’orange (skin oedema), rash, redness or feels different
Nipple changes: tethering/inversion, discharge, eczema-like changes
Rare changes: widespread inflammation, redness, pain
What are some methods of investigating a breast abnormality
- Clinical examination: Inspection in different positions and palpations,
- Imaging: ultrasound, X-ray (can show microcalcification), mammography and MRI,
- FNA cytology with microscopy of cells recovered.
- Core biopsy with microscopy of tissue sections (gold standard)
- Excisional biopsy which can be diagnostic and/or treatment
What is the treatment of breast cancer?
- Surgery which aims to remove all cancer tissue with free margins or mastectomy
- Neoadjunctive treatment (chemotherapy/endocrine therapy)
- Oestrogen/progesterone positive carcinomas can respond to endocrine treatment such as tamoxifen which is an ER antagonist.
- Her2+ breast cancers, which have a worse prognosis, can be treated with the monoclonal antibody Herceptin (trastuzumab). It can reduce risk of relapse and prolong survival.
How are lymphnodes tested for cancer?
Sentinel node biopsy. If negative, nodes may not need to be removed. Prevents needs for axillary clearance which has significant morbidity (limited movement and lymphoedema)
What endocrine treatment can be given in postmenopausal women?
- Aromatase inhibitors eg, letrazole. These can block the conversion of androgens into oestrogen. This process often occurs in fatty tissue
Explain the importance of endocrine treatments
- Chemotherapy cannot prevent metastatic relapses at distance sites but endocrine treatments can
What are the main pathological prognostic factors?
- Carcinoma grade (Based off nuclear pleomorphism, number of mitoses per mm2 and degree of gland formation),
- Carcinomas stage (size and lymph node involvement),
What is the Nottingham prognostic index?
It combines tumour grade, stage and size into a numerical prognostic index.
What is the most imporant molecular test done in breast cancer?
- The expression of sex steroid receptors. Her2 is also important
What are the two major divisions of breast cancers
- Invasive ductal carcinoma
- Invasive lobular carcinoma
Describe features of carcinoma in situ cancers
- Can get ductal/lobular carcinoma in situ.
- There is proliferation of markedly abnormal epithelial cells within the BM bit no extension of breast stroma, no communication with blood vessels or lymphatics and no possibility of metastasis.
- equates to high grade dysplasia with atypical lobular/ductal hyperplasia equating to low grade dysplasia.
What is the site of origin for ductal/lobular hyperplasia/CIS?
Terminal duct lobular unit
What are the different types of ER+ cancers?
Luminal A ER+ - Low grade, less proliferative and better prognosis.
Luminal B ER+ - High grade, more proliferative and poor prognosis. Can have HER2 expression
What are the different types of ER- cancers?
- Normal breast like,
- HER2,
- Basal-like: associated with basal/myoepithelial cells over the breast. Aggressive
