Malignant Lesions Flashcards
How many women will get breast cancer?
1 in 8 women living to 85
What percentage of breast lumps are cancerous?
20%
What percentage of breast cancer is genetically linked?
16-25%
In what region of the breast does cancer most often develop?
UOQ
When is there an increased risk of lymph node involvement?
lesion over 1 cm
What factors affect the outcome of breast cancer?
size, multicentricity, lymph node involvement, mets
What are risk factors for developing breast cancer?
- advanced age
- personal or family history
- benign proliferative disease with atypia
- early onset of menstruation, late menopause
- late age of 1st pregnancy
- nulliparity
- radiation exposure
- estrogen use
- post menopausal obesity
What percentage of breast malignancies are invasive and noninvasive?
80% invasive, 20% non
What types of malignancies are invasive?
invasive ductal carcinoma
- tubular
- medullary
- colloid
- papillary
invasive lobular carcinoma
What types of cancer are noninvasive?
- ductal carcinoma in situ (DCIS)
- lobular carcinoma in situ (LCIS)
How does invasive cancer spread? What is it AKA?
- tumor cells grow past basement membrane layer of duct wall into surrounding breast tissue
- gain access to lymphatics and blood vessels
- AKA infiltrating
What is noninvasive cancer? What is it AKA?
- tumor cells are confined to duct in site of origin
- low risk of mets
- AKA in situ, staying in place
What are the major histological categories of breast malignancies?
- ductal epithelial origin
- lobular origin
- stromal tissue origin
- metastatic disease to breast
What is Mondor’s disease?
- aids in early detection
- thrombophlebitis of superficial veins in breast & anterior thorax
What is the clinical presentation of Mondor’s disease?
- pain
- palpable
- red, subcutaneous cords
- fibrous bands
What is the most common noninvasive breast cancer?
ductal carcinoma in situ AKA intraductal carcinoma
What is the earliest detectable form of breast cancer? What percentage of detected malignancies does it make up?
DCIS, 20-40%
What is the etiology of DCIS?
malignant transformation of epithelial cells lining duct without extension past duct wall
Where does DCIS typically arise?
in TDLU near lobule junction
What are clinical signs of DCIS?
- asymptomatic, vis on screening
- variable palp mass
- serous/bloody nipple discharge
What are the grades of DCIS and what are the characteristics of them?
Low nuclear grade/ non-comedo
- well differentiated
- atypical ductal hyperplasia = precursor
-better prognosis
Intermediate grade
High nuclear grade/comedo
- poorly differentiated
- more aggressive & progresses to invasive
- large neoplastic cells fill duct
- duct distention with plug like necrotic material that has calcs
What is Paget’s disease of the nipple?
- uncommon form of DCIS
- involves epidermal layer of the nipple
- tumor cells spread along a subareolar duct, extend to nipple/areola
- progresses to invasive
What is the clinical presentation of Paget’s disease of the nipple?
- erythema
- ulceration
- eczema crusting
- nipple discharge
- itching
What is lobular carcinoma in situ AKA? Who does it affect MC?
AKA lobular neoplasia, perimenopausal women 45-55
What is LCIS?
- marker for increased risk of future development of IDC/ILC
- not considered true cancer
- usually multicentric and bilateral
What is the etiology of LCIS? What are the symptoms?
- originates in epithelium of acini, doesn’t extend past basement membrane
- no palp mass or physical symptoms
What does LCIS look like on US and mamm?
- not usually detected through imaging
- diagnosed microscopically during biopsy
What is papillary carcinoma?
- slow growing, good prognosis
- usually noninvasive but can become invasive
- invasive: well circumscribed, show only focal areas of invasion
Who does papillary carcinoma typically occur in?
older women
What is the etiology of papillary carcinoma?
- central duct lesion: can arise from preexisting papilloma
- peripheral duct lesion: arises within TDLU from area of hyperplasia/papillomatosis
What are the clinical signs of papillary carcinoma?
- bloody nipple discharge: earliest sign
- palp mass, large can bulge skin
- skin dimpling, ulceration, nipple retraction
What is intracystic papillary carcinoma?
- form of DCIS, papillary carcinoma growing in a duct
- can become invasive & extend out of duct
- can cause obstruction & cyst formation
- blood filled cavity if there is infarction or torsion of stalk
- nipple discharge common
What is the MC breast cancer? What percentage of cancers does it make up?
invasive ductal carcinoma, 80%