Pathology Workshop-Barksy Flashcards
How is a screening mammogram different from a regular or diagnostic mammogram?
screening mammogram has a lower dose of radiation
they are both X-rays
What is ki67?
a proliferation receptor
What do EGFR & Her-2-neu have in common?
they are both in the HER family of oncogenic receptors
Does smoking cause breast cancer?
no, probably not.
What is the usu cause of breast cancer tumors? Chemical carcinogens Viruses Radiation Heredity Unknown
Unknown
unless she has BRCA 1 or 2. Would need to be mutated in both alleles.
Which comes first:
DCIS or
Infiltrating Ductal Carcinoma?
DCIS precedes infiltrating ductal carcinoma.
What is ductal carcinoma? Is it in blood vessels?
it is a carcinoma that is contained in the ductal system
no–not in blood vessels, b/c the blood vessels are always on the stromal side
How is it that some of the cells in a duct can be in the DCIS stage & some next to it are in infiltrating ductal carcinoma?
they all came from the 1 ancestral cell.
they are in different stages b/c of tumor heterogeneity.
What is the original cell that gives rise to DCIS?
it is a cancer of the ductal system
comes from an epithelial stem cell
DCIS threatens what?
LIFE
BREAST
only breast, not life.
You may lose your breast, but it won’t metastasize b/c the b.v. & lymphatics are on the other side of the duct, the stromal side.
Is it better to catch a patient at the DCIS only stage? Or is it better to catch it when part of the breast is DCIS & part is infiltrating?
Def better to catch it at the DCIS only stage.
B/c you can surgically excise & have no chance of metastasis.
If you see micro calcifications in mammographic screening…what are you suspicious of?
DCIS!
Is the cause of invasion genetic or epigenetic, the thing that causes DCIS to become invasive breast cancer?
cause unknown
thought that it could be a random breakdown of the myoepithelium of the basement membrane of the breast ducts.
If the sentinel lymph node is negative for cancer…what is the chance of metastasis?
next to nothing!
B/c the cancer will go first the sentinel lymph node.
if negative, don’t need to dissect the lymph nodes in the axilla..avoid lymph drainage blockage in arm.
**but if pos, need to check lymph nodes in axilla.
Does the presence of breast cancer in the lymph node change the stage & worsen the prognosis?
TNM grading will go from N0-N1
it does worsen the prognosis
How can you get lymph node metastasis without seeing lymphovascular invasion?
it already moved thru the lymphatics!!
Why is it so bad to have more invasion of the cancer?
more stem cells seeded
more cancer cells to deal with
more heterogeneity & harder to treat
it will metastasis & kill you
Why are some breast cancers ER+ & some are ER- & why is there her-2-neu oncogene amplification present in 25% of breast canceR?
We don’t know!
Is this pt who has DCIS & infiltrating ductal carcinoma & a pos sentinel lymph node at risk for distant metastasis?
definitely at risk b/c of the lymph node & the invasive cancer type.
Even if lymph node were neg, would be somewhat concerned.
What is adjuvant chemotherapy?
it is given after surgical or radiotherapy.
it is given w/o knowing if there is metastasis.
neoadjuvant: is given before the surgical therapy. maybe if the breast cancer were big & you wanted to shrink it first before surgery.
If you give “adjuvant chemo” to a patient with known metastases…what is it called?
just normal chemo b/c you know there is metastases.
Called adjuvant when you’re not sure & you’re doing it just in case.
Are there any tests you can do to predict likelihood of metastases?
check for circulating tumor cells
if they have a bunch of CTCs there is a higher risk of metastases.
Should we give this pt adjuvant chemotherapy following a lumpectomy?
Yes!
b/c the patient is at high risk for micro metastasis
give radiotherapy too
only don’t give radiotherapy when a pt has mastectomy
What cell is the origin of DCIS?
a stem cell (epithelial)
Why types of biomarker categories does ER fall into?
predictive-guides therapy
prognostic
tumor-even tho seen in normal breasts too
What biomarker categories does her-2/neu fall into?
predictive
prognostic
tumor
What biomarker categories does ki67 fall into?
not tumor (nonspecific)
prognostic
predictive
What biomarker categories does EGFR fall into?
prognostic
predictive (but not for breast cancer, but yes for colon cancer)
Would you rather have luminal A or triple negative breast cancer?
luminal A. better prognosis.
but you can never predict!!
