Pathology: Breast and Cervical Flashcards
1
Q
Normal Breast Anatomy
A
- Branched tubulo-alveolar glands
- Series of ducts surrounded by stroma (CT) and fat
- Each breast is drained by a collecting duct terminating in the nipple
- The collecting duct has several branches, which end in a terminal ductal-lobular unit (TDLU), the basic functional and histopathological unit of the breast
- The TDLU is composed of a small segment of terminal duct and a cluster of ductules, which are the effective secretory units (where breast cancers are most likely to arise as they are responding to hormonal signals and are undergoing cycles of cell proliferation)
2
Q
Breast Tissue: Hormones
A
- Breast tissue is responsive to hormonal changes
- Oestrogen: growth
- Progesterone: secretory
3
Q
Menopause
A
- Lobules begin to recede
- Mostly ducts, adipose tissue and fibrous tissue
4
Q
Fibrocystic Change
A
- Benign breast lesion
- Common (50% incidence) in women ages 25-45 (pre-menopausal as usually due to hormonal influence)
- Present as lumps or lumpy areas in the breast, sometimes pain -> can vary with menstrual cycle
- Lumps may be fluid filled (cysts) or solid (fibrous tissue), accompanied by hyperplasia
- Associated with hormonal imbalance (increased oestrogen to progesterone ratio)
5
Q
Fibroadenoma
A
- Benign breast lesion (usually one solitary lump)
- Most common in younger women
- Present as a palpable, mobile, firm, non-tender mass
- Forms from the proliferation of epithelial and mesenchymal elements
- Can be hormone responsive
6
Q
Malignant and Premalignant Lesions
A
- Most cancers of the breast originate from the epithelial cells that line that ducts and lobules of the breast
- Carcinoma in situ -> neoplastic proliferation limited to ducts and lobules by basement membrane
- Invasive carcinoma has penetrated through the basement membrane into the stroma
7
Q
In Situ Carcinoma
A
- Malignant population of cells confined to ducts and/or acini, NO invasion through basement membrane
- 2 main histological types: ductal carcinoma in situ (most common) and lobular carcinoma in situ
8
Q
Invasive Carcinoma Presentation
A
- Presentation: lump, discomfort, nipple change or discharge, change in shape of breast, skin tethering
9
Q
Common Types of Breast Cancer
A
Infiltrating ductal carcinoma (70%)
- Most common
- Typically ‘schirrous’ firm stellate mass
- Malignancy duct forming cells infiltrate parenchyma
Infiltrating lobular carcinoma (8%)
- Less cohesive and tend to invade in single file
- Slower growing, more likely to be hormonal responsive
10
Q
Factors Effecting Prognosis
A
- Grade: differentiation
- Stage: size/spread
- Lymphovascular invasion
- Presence of oestrogen and progesterone receptors in tumour cells
- HER2 overexpression
11
Q
Invasive Carcinoma: Local vs Met spread
A
- Local spread: skin, nipple, underlying muscle/chest, pleura
- Metastatic spread: axillary lymph nodes, lungs, bone, liver
12
Q
Breast cancer risk factors
A
- Genetic factors (BRCA 1, 2 p53
- Increased lifetime of oestrogen exposure
- Environmental and dietary influences e.g. obestiry, alcohol
- Past history of certain breast diseases
- Age (accumulation of genetic mutations over time)
13
Q
Management of Breast Cancer
A
- Surgery
- Axillary node clearance
Subsequent Management: - Radiotherapy
- Chemotherapy
- Anti-oestrogen therapy e.g. tamoxifen
- Trastumab (herceptin)
14
Q
Mammographic Screening
A
- Every 2 years for women aged 50-69
- Aim is to detect cancers early
- Breast abnormalities show various radiological abnormalities, including: increased densities and calcification
15
Q
Cervical Cancer Epidemiology
A
- Around 85% of the global burden occurs in the less developed regions
- Disparity is due to cervical cancer develops as a rare outcome of persistent infection with one or more oncogenic types of HPV
- Known risk factor, long prodromal phase = opportunity for intervention
