Module 3: Breast: Cancer Flashcards
Now moving onto breast cancer. What are the pre-disposing factors?
Female Increased Age BRCA 1 and 2 Her2Neu p53 Obesity (due to increased estrogen) Early Menarche Late Menopause Family History Race/Ethnicity ERT Granulosa Theca ovarian tumor (due to increased estrogen)
What is the most important pre-disposing factor in elderly women?
Age
What is the most important pre-disposing factor in middle aged women?
Family history and then nulluparity
Why are breast carcinoma lumps hard and fixed?
Fixed to underlying skin and pectoralis major
- -extremely desmoplastic (fibrotic)
- -non tender
What is the most common location for breast carcinoma?
Upper outer quadrant
What is the origin of all types of breast cancer?
Terminal Duct Lobular Unit (TDLU)
Breast carcinoma is spread through lymphatics, what is the order?
Axillary , Supraclavicular and Internal Mammary (thoracic)
Once breast carcinoma has infiltrated the lymphatics, what is a key symptom? what are other symptoms?
Peau d'orange: due to lymph edema or lymph obstruction nipple retraction (Ductal carcinoma -- desmoplasia -- fibrosis of cooper's ligaments) Bloody nipple discharge
What is the most accurate test for all breast cancers?
Biopsy
Eventually from the lymphatics there will be metastasis from to the blood, then where?
Lung Liver Brain Bone --most common cancer in lung
In regards to prognosis what are indicators of a poor prognosis?
- Greater than 2cm bad prognosis
- Lymph node spread and Peau d orange
- Invasion
- Her2New (EGFR) positive bad = extremely aggressive and herceptin is used to treat but does not cross blood brain barrier
- Cathepsin D: (enzyme destroys basement membrane) is bad because allows invasion and metastasis
- Aneuploidy is always bad
In regards to good prognosis what are indicators of a good prognosis?
- ER/PR positive: can treat with tamoxifen
- -tamoxifen increases chances of endometrial carcinoma
Now moving onto the types of breast cancer. There are two types Ductal and Lobular. Give some general features
Non-Infiltrating (Carcinoma in Situ) --Ductal Carcioma in Situ (DCIS) ***comedo (high grade) ** Non-comedo (Solid, cribiform, papillary, micropapillary) **Paget's Disease --Lobular Carcinoma In Situ (LCIS) Infiltrating Carcinoma -Ductal (no special type): 80% --Lobular: 10% --Tubular/Cribiform: 6% --Mucinous, medullary, papillary, metaplastic: 4-5%
First discussion will be on Lobular Carcinoma in Situ, which again is a non-infiltrating carcinoma. What is the origin and general features?
Origin: Terminal Duct Lobular Unit
Predisposing factors are the same for breast cancer
Asymptomatic most commonly: incidental finding without a mass
Usually unilateral but can be bilateral
Dyscohesive lacking E-cadherin
What is the histology for lobular carcinoma in Situ (slide 6 to the left)?
Atypical terminal duct lobular unit in an entire lobule
***atypical proliferation of inner cuboidal epithelial cells (response to estrogen)
Overall architecture of lobule is preserved
Ducts all still have single layer of outer myoepithelial cells (hence why its In-situ)
Now moving onto invasive lobular carcinoma, what are the general histological features?
Slide 7c:
- -No intact lobule architecture
- **due to loss of outer myoepithelial cells
- **therefore invasion into the stroma
- -invades interlobular first