Pathology: Breast Cancer Flashcards
2 family history risk factors for breast cancer
- Breast cancer
- Ovarian cancer
5 personal history risk factors for breast cancer
- BRCA 1/2 mutations
- Bx with ADH
- LCIS or DCIS
- Dense breast tissue (mammogram)
- Radiation
5 reproductive history risk factors for breast cancer
- Early menarche (<12)
- Late menopause
- Late age at first term pregnancy
- Nulliparity
- HRT
3 lifestyle risk factors for development of breast cancer
- Weight
- Sedentary life
- Alcohol consumption
3 precursors to breast cancer
- Ductal epithelial hyperplasia
- Atypical ductal hyperplasia
- Ductal carcinoma in situ - invasive carcinoma
3 minor lesions of the breast
- Supernumerary nipple
- Congenital inversion of the nipple
- Galactocele
Findings of nonproliferative fibrocytic changes on histology
- Cysts (blue dome)
- Fibrosis
4 moderate risk (1.5x) findings of proliferative fibrocytic changes in histology
- Hyperplasia
- Sclerosing adenosis (mimicking carcinoma)
- Florid hyperplasia
- Sclerosing adenosis
2 high risk (5x) findings of proliferative fibrocytic changes
Atypical hyperplasia
Ductal/lobular
3 types of in-situ carcinomas of the breast
- Ductal carcinoma in-situ (DCIS)
- Lobular carcinoma in-situ (LCIS)
- Mammary Paget Disease
7 types of invasive carcinomas
- Ductal
- Lobular
- Medullary
- Tubular
- Mucinous
- Micropapillary
- Metaplastic Breast Cancer
Most common invasive breast carcinoma
Ductal NOS
Profile of lobular invasive carcinoma (5)
- E-cadherin negative
- ER+
- PR+
- Her2 -
- May not feel as mass
Profile of medullary invasive carcinoma
- Good prognosis
- Triple negative
Profile of tubular invasive carcinoma (4)
- Very good prognosis
- ER+
- PR-
- Her2-
Profile of mucinous invasive carcinoma (5)
- Good prognosis
- Older patients
- ER+
- PR+
- Her2-
Type of invasive carcinoma that has frequent lymph node metastasis
Micropapillary
Profile of metaplastic breast cancer (2)
- Heterogenous group
- Usually triple negative
Modified Scharff-Bloon-Richardson Grading System
- Well-differentiated / low grade (I/III)
- Intermediate grade (II/III)
- Poorly differentiated / high grade (III/III)
If e-cadherin positive, what is the type of breast cancer?
Ductal
If e-cadherin is negative, what is the type of breast cancer?
Lobular
Profile of breast cancer that tends to metastasize to brain
- Triple negative
- Her2+
3 other common breast lesions aside from carcinomas
- Fibroepithelial lesions
- Fibroadenoma
- Phyllodes tumor
- Papilloma
Most common breast tumor in young women
Fibroadenoma
NOTE: Usually appears before 30 and can regress after menopause
Gross appearance of fibroadenoma
- Round
- Rubbery (can compress it)
- Well-circumscribed
Risk of cancerous progression of fibroadenoma
None
Histological profile of fibroadenoma
Biphasic (stromal and epithelial)
NOTE: Carcinoma = epithelial only
Histological profile of phyllodes tumor
More pronounced stroma; very cellular (can make a sarcoma)
7 prognostic factors of breast cancer
- Axillary lymph node status
- Tumor size
- Vascular invasion
- Grade
- Tumor subtype
- ER/PR expression
- Her2
- Overexpression/amplification
3 predictive factors of breast cancer
- ER/PR
- HER2
- Oncotype DX (RT-PCR – 21 GENES, RECURRENCE SCORE)
- Predict benefit from chemotherapy and hormonal therapy
5 treatments for breast cancer
- Surgery
- Radiation therapy
- Hormonal therapy
- Chemotherapy
- Targeted therapy: herceptin, lapatinib
4 intrinsic subtypes of breast cancer
- Luminal A (ER+ and/or PR+, HER2-)
- Luminal B (ER+ and/or PR+, HER2+)
- HER2 (ER-)
- Basal-Like (Triple negative, cytokeratin 5/6+ and or/ EGFR+)
Most common subtype of breast cancer
Luminal A
Prognosis of Luminal A breast cancer subtype
- Less aggressive
- Lower histological grade
- Good prognosis
- Hormone responsive
Risk factor for Luminal A breast cancer
Associated with increasing age
Which Luminal subtype has a worse outcome?
Luminal B
Prognosis of HER2+ (ER-) breast cancer subtype
- Highly aggressive
- High grade histology
- Outcome improved with HER2
2 risk factors for HER2+ (ER-) breast cancer subtype
Risk as young age greater than luminal subtypes
African American ethnicity may be factor
Prognosis of basal-like breast cancer
Aggressive
High-grade histology
High mitotic rate
Risk factors for basal-like breast cancer
Younger age (<40)
More likely premenopausal African American women
