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Week 3 - Female GU Pathology > Pathology of the Breast 2: Breast Cancer > Flashcards

Pathology of the Breast 2: Breast Cancer Flashcards

1
Q

List the risk factors for breast cancer under the following headings:

  1. Reproductive [3]
  2. Hormonal [2]
  3. Anatomical/Physiological [1]
  4. Behavioural [2]
  5. Genetic [2]
A
  1. Reproductive
    • early menarche (menstruation)
    • late menopause
    • late 1st pregnancy
  2. Hormonal
    • hormonal replacement therapy (HRT)
    • oral contraceptive use (increased oestrogen)
  3. Anatomical/Physiological
    • dense breast on mammography
  4. Behavioural
    • alcohol
    • smoking
    • obesity
  5. Genetic
    • positive family history
    • BRCA 1/2, Li Fraumeni
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2
Q

How does breast cancer typically present at:

  1. the breast? [3]
  2. the nipple? [3]
  3. the axilla? [1]
A
  1. the breast:
    • lump/thickening
    • skin changes: “peau d’orange”
    • redness
  2. the nipple:
    • rash/redness
    • new inversion
    • discharge
  3. the axilla:
    • lump
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3
Q

What is peau d’orange and what is it caused by? [2]

A
  1. dimpled appearance of the breast skin, resembling an orange peel
  2. due to a tumour blocking lymphatic drainage
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4
Q

What is Paget’s Disease? [1]

A

malignant condition of the nipple

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5
Q

Describe the age ranges for breast screening [2]

A
  1. women aged 50-70yrs old are invited every 3 years
  2. women over 70yrs can self-refer
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6
Q

The advantage of screening is that most tumours that are discovered are usually…? [3]

A
  1. asymptomatic
  2. small
  3. lower grade & stage
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7
Q

What is the definition of pre-invasive/dysplastic lesions? [4]

A
  1. dysplastic lesions represent the stage before invasive malignancy
  2. it’s malignant-looking proliferation of epithelial cells within the basement membrane
  3. no extension into the breast stroma
  4. no communication with blood vessels/lymphatics so no possibility of metastasis
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8
Q

What are the dysplastic lesions in the breast tissue called and what are the 2 types? [3]

A
  • in breast, dysplastic lesions are called carcinoma in-situ
    • ductal carcinoma in-situ (DCIS)
    • lobular carcinoma in-situ (LCIS)
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9
Q

Which is more severe: LCIS or DCIS? [1]

A

DCIS

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10
Q

What are the unique histological findings in DCIS that isn’t found in LCIS? [2]

A
  1. calcifications present
  2. lesion can be extensive and form a significant mass/lesion without processing to invasive cancer and can co-exist with invasive malignancy
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11
Q

What are the 2 types of invasive malignancy? [2]

A
  1. invasive ductal carcinoma
  2. invasive lobular carcinoma
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12
Q

What is unique about invasive lobular carcinoma? [5]

A
  1. more likely to be bilateral and multifocal
  2. cells are:
    • small
    • bland
    • discohesive - due to loss of the cell adhesion molecule E-cadherin
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13
Q

Give 3 examples of non-cancer tumours of the breast [3]

A
  1. sacroma
  2. lymphoma
  3. malignant phyllodes
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14
Q

Describe the features of luminal-A breast cancer [4]

A
  1. hormone-receptor positive (ER+)
  2. HER2 negative
  3. has low levels of protein Ki-67 (protein that helps control how fast cancer cells grow)
  4. better prognosis
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15
Q

Describe the features of luminal-B breast cancer [4]

A
  1. hormone-receptor positive (ER+)
  2. HER2 positive or negative
  3. has high levels of Ki-67
  4. worse prognosis
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16
Q

Describe the features of triple-negative breast cancer [3]

A
  1. HER2 negative
  2. PR negative
  3. ER negative
17
Q

Describe the features of basal type breast cancer [2]

A
  1. aggressive
  2. includes some BRCA cancers
18
Q

Name and describe the 5 prognostic factors used when describing cancers [5]

A
  1. hormone receptor status (PR/ER)
    • predicts behaviour and sensitivity to hormonal treatments
  2. HER2 status
    • ​​HER2 amplification generally predicts a poorer prognosis but it will allow treatment with herceptin, rixitumab and similar drugs
  3. Staging
    • a measure of how far the tumour has spread
    • usually the TMN system is used
  4. Grade
    • ​​measures the intrinsic aggressiveness of tumour (how fast it grows)
  5. Nottingham Prognostic Index (NPI)
    • a way of combining grade and stage together into a single number
19
Q

How do you calculate the Nottingham Prognostic Index (NPI)? [4]

A

NPI = [0.2 x S] + N + G

where:

  • S = the size of index lesion in cms
  • N = the node status:
    • 0 nodes = 1
    • 1-3 nodes = 2
    • >3 nodes = 3
  • G = the grade of the tumour
20
Q

What are the 4 factors that affect what type of surgery is offered as treatment of breast cancer? [4]

A
  1. size of the tumour
  2. type of tumour
  3. size of breast
  4. location of tumour
21
Q

Describe the features of wide local excision [3]

A
  1. aims to take just the tumour with a rim of normal tissue in order to preserve the remaining breast
  2. usually combined with radiotherapy in order to minimise the risk of recurrence
  3. pathological assessment of margins is important
22
Q

Describe the features of a mastectomy (including when it would be carried out) [2]

A
  1. mastectomy is the surgical removal of the breast
  2. done when the size, extent or location of a tumour means that this is the safest option
23
Q

Describe the features of axillary surgery [4]

A
  1. breast cancer tends to spread to the axillary lymph nodes
  2. sentinel node biospy is done first
    • as this is the node that tends to get affected first so identifying and removing the sentinel node will allow for assessment of whether or not lymphatic metastasis has occurred
      • if negative, no further treatment is required
      • if positive, further surgery (clearance) is given + axillary radiotherapy (1)
24
Q

When is radiotherapy given? [2]

A
  1. given to the breast following wide local excision to reduce risk of recurrence
  2. sometimes given to axilla if positive sentinel node found
25
Q

Name the 2 types of hormonal therapy (including drug names) and state when each are given [4]

A
  1. tamoxipen
    • blocks hormone function and is given after surgery of ER+/PR+ tumours
  2. letrozole (aromatase inhibitors)
    • ​​given to post-menopausal women who don’t have production of endogenous oestrogen from ovaries but from soft tissue such as fat
26
Q

Describe the 2 types of chemotherapy [4]

A
  1. neoadjuvant
    • ​​before surgery to reduce tumour size
  2. adjuvant
    • ​​after surgery to reduce risk of metastasis to distant site
    • particularly used in triple-negative breast carcinomas (as hormonal therapies won’t work)

Week 3 - Female GU Pathology (7 decks)

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