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Semester 4 > Repro 11.2.2 Breast Cancer > Flashcards

Repro 11.2.2 Breast Cancer Flashcards

1
Q

How common is breast cancer?

A

Accounts for 20% of all malignancies in women
1 in 12 women develop breast cancer in their life
1% occurs in men
95% are adenocarcinomas (other malignant tumours of the breast are very rare

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2
Q

What increases mens risk of breast cancer?

A

Klinefelter’s syndrome
Male to female transexuals
Men treated with oestrogen for prostate cancer

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3
Q

Where are breast cancers most common?

A

Upper outer quadrant (50%)

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4
Q

What are the risk factors for development of breast cancer?

A 
Gender
Uninterrupted menses
Early menarche (<11)
Late menopause
Obesity and high fat diet
Exogenous oestrogens (HRT, OCP) 
Liver cirrhosis
(All to do with hormones)
Atypical changes on previous biopsy (4-5 times)
Previous breast cancer (x10)
Radiation
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5
Q

What factors reduce risk of breast cancer?

A

Reproductive history - parity and age at first full term pregnancy and amount of pregnancies
Breast-feeding

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6
Q

How does geography influence the risk of development of breast cancer?

A

Higher incidence in US and Europe. Possible explanation in diet, physical activity, breast-feeding and environmental factor

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7
Q

What % of breast cancers are hereditary?

A

10%

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8
Q

What genes are most commonly implicated in breast cancer?

A

3% of all breast cancers and 25% of hereditary breast cancers are attributed to mutations in BRCA1 or BRCA2
p53

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9
Q

Which BRCA gene is also implicated in ovarian cancer?

A

BRCA2

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10
Q

What are BRCA genes?

A

Tumour supressor genes - their proteins repair damaged DNA

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11
Q

What % of the population have BRCA germ line mutations?

A

0.1%

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12
Q

What is the lifetime breast cancer risk for female carriers of BRCA1?

A

60-85%

May undergo prophylactic mastectomy

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13
Q

When are familial breast cancers usually diagnosed in comparison to sporadic cases?

A

20 years earlier on average

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14
Q

What are the classification of breast carcinoma?

A

In situ or invasive

Ductal or lobular

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15
Q

What are carcinomas in situ?

A

Neoplastic population of cells limited to ducts and lobules by basement membrane, myoepithelial cells are preserved
Does not invade into vessels and therefore cannot metastasise

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16
Q

How do most DCIS present?

A

Mammographic calcifications (clusters or linear and branching) but can also present as a mass

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17
Q

How does DCIS appear microscopically?

A

Often shows central necrosis with calcification

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18
Q

How might DCIS spread?

A

Can spread through ducts and lobules and be very extensive

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19
Q

What is DCIS?

A

Ductal carcinoma in situ. Non-obligate precursor of invasive carcinoma

20
Q

How can Paget’s disease present in the breast?

A

Unilateral red crusting nipple

21
Q

What might Paget’s disease of the nipple be mistaken for?

A

Eczematous or inflammatory conditions of the nipple - should be regarded as suspicious and biopsy performed

22
Q

What is the pathophysiology of Paget’s disease in the nipples?

A

Malignant cells can infiltrate epidermis via the mammary duct epithelium. The cells proliferate leading to thickening of the affected skin

23
Q

Define an invasive carcinoma.

A

Invaded beyond BM into stroma. Can invade into vessels and can therefore metastasise to lymph nodes and other sites

24
Q

How does an invasive carcinoma present?

A

Usually as a mass or mammographic abnormality. By the time a cancer is palpable more than half the patients will have axillary lymph node metastases

25
Q

What is peau d’orange?

A

Involvement of lymphatic drainage of the skin gives rise to a dimpled affect by the hair follicles as oedema swells the skin surrounding them. A clinical appearance of breast cancer

26
Q

What are the most common types of invasive carcinoma of the breast?

A

Invasive ductal carcinoma, no special type (IDC NST) (70-80%)
Invasive lobular carcinoma (5-15%)
Tubular, mucinous etc

27
Q

What is the appearance of well/poorly differentiated IDC NST?

A

Well-differentiated - tubules lined by atypical cells

Poorly-differentiated - sheets of pleomorphic cells

28
Q

What is the 10 year survival rate for IDC NST?

A

35-50%

29
Q

What is the microscopic appearance of invasive lobular carcinoma?

A

Infiltrating cells in a single file

Cells lack cohesion

30
Q

What is the prognosis of invasive lobular carcinoma?

A

35-50% 10 year survival rate

31
Q

What are the patterns of metastasis of breast cancer?

A

Lymph nodes via lymphatics (usually ipsilateral axilla)

Distant metastases via blood vessels - bone, lung, liver, brain

32
Q

Where might invasive lobular carcinoma spread?

A 
Peritoneum
Retroperitoneum
Leptomeninges
Gastrointenstinal tract
Ovaries
Uterus
33
Q

What factors determine the prognosis of breast cancer?

A 
In situ v invasive
Histological subtype - IDC NST has poorer prognosis
Tumour grade
Tumour stage
Gene expression profile
34
Q

What is the basis of tumour staging?

A

Tumour size
Locally advanced disease - invading into skin or skeletal muscle
Lymph node metastases
Distant metastases

35
Q

How is breast cancer investigated and diagnosed?

A

Triple approach:

  1. Clinical - history, fx, examination
  2. Radiographic imaging - mammogram and ultrasound scan
  3. Pathology - fine needle aspiration cytology (FNAC) and core biopsy
36
Q

What is looked for in mammographic screening?

A

Asymmetric desities
Parenchymal deformities
Calcifications

37
Q

How are abnormalities seen in mammographic screening further assessed?

A

Further imaging
FNAC
Core biopsy

38
Q

What are the local treatment options for breast cancer?

A

Breast surgery - mastectomy or breast conserving surgery
Axillary surgery - extent depending on whether there are involved lymph nodes (sentinel node sampling or axillary dissection)
Post-operative radiotherapy to chest and axilla

39
Q

How is the type of breast surgery required determined?

A

Patient choice
Size
Site of tumour
Size of breast

40
Q

What is sentinel lymph node biopsy?

A

Intraoperative lymphatic mapping with dye and/or radioactivity of the draining or ‘sentinel’ lymph node(s) - this is the one most likely to contain breast cancer metastases
If the sentinel node(s) is negative axillary dissection can be avoided

41
Q

What is the systemic therapeutic approach to treatment of breast cancer?

A

Chemo (only if benefits thought to outweigh risks)

Hormonal/herceptin treatment (depending on hormone/Her2 receptor status)

42
Q

What is neoadjuvant chemotherapy?

A

Given before surgery

43
Q

What is Her2?

A

A member of the human epidermal growth factor receptor family
Encodes a transmembrane tryosine kinase receptor

44
Q

What is herceptin?

A

humanised monoclonal antibodies against the Her 2 protein

45
Q

How do oestrogen receptors appear under the microscope?

A

Brown stained nuclei

46
Q

How do Her2 receptors appear under the microscope?

A

Blue stained nuclei, brown cytoplasm

47
Q

How is the survival for breast cancer improved?

A 
Early detection
Neoadjuvant chemo
Use of newer therapies
Gene expression profile
Prevention of familial cases

Semester 4 (21 decks)

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