Sketchy Path: Reproductive & GU - "Breast Cancer"

Question 1

List the three most common cancers in women and their order of most deaths.

Answer 1

Most common:

1) Breast
2) Lung
3) Colorectal

Number of deaths:

1) Lung
2) Breast
3) Colorectal

Question 2

What kind of protein is BRCA?

Answer 2

Tumor suppressor (like the cancer-fighting ribbons)

Question 3

BRCA is inherited in a ___________ manner.

Answer 3

autosomal dominant (like the dominant domino)

Question 4

Other than BRCA, what other disorders increase risk of breast cancer?

Answer 4

Li-Fraumeni: brain, bone, adrenals, breast (like the brain nut, the bone squash, and the adrenal… lemon? on the table with the “Plea 53 Do Not Cross” barrier)

Question 5

Other than genetics, what predisposes women to breast cancer?

Answer 5

Estrogen exposure:

• Early menarche (“Early Bloomers” seeds)
• Late menopause (“Late Deciduous” seeds)
• HRT (paused Estro Grow commercial behind woman)
• Obesity (she’s supposed to be obese but looks thin to me)
• Nulliparity (no kids around, I guess?)

Question 6

_____________ decreases the risk of breast cancer.

Answer 6

Breastfeeding (like the woman running away from Cooper Family Farms with her baby at her chest)

Question 7

List the three mutations often found in breast cancer.

Answer 7

• Estrogen (two female toothpicks in the cantaloupe)
• Progesterone (PROtecting dOmE)
• Her2/Neu (women with 2 NEwborns)

Question 8

The worst kind of breast cancer (molecularly) is ________________.

Answer 8

triple negative (like how you need to “try all 3 before they’re gone” on the sample sign)

Question 9

______________ has central necrosis.

Answer 9

DCIS

Question 10

How is DCIS usually diagnosed?

Answer 10

With small specks of calcification on screening mammogram (like the small white dots on the outside of the turnip)

Generally it does not get big enough to make a palpable mass.

Question 11

How does LCIS differ from DCIS on pathology and imaging?

Answer 11

It does not calcify so it won’t be seen on imaging. Rather, it only shows up incidentally in breast biopsies.

Question 12

Invasive ductal carcinoma has what characteristics?

Answer 12

• Hard
• Irregular borders
• Immobile
• Most frequently in upper-outer quadrant

(Think of the spiculated squash.)

Question 13

When a tumor invades Cooper’s (aka the suspensory) ligament, ____________ can result.

Answer 13

nipple retraction

Question 14

Which malignant lesion is more likely to be bilateral?

Answer 14

Lobular (like the girl brandishing the two large leaves)

Question 15

The classic pathologic appearance of lobular carcinoma is _______________.

Answer 15

cells in a line (“Indian-file”)

Think of the kids in line behind the girl with the large leaves.

Question 16

Inflammatory breast cancer results from _______________.

Answer 16

invasion into the skin lymphatics

Question 17

List the less common types of breast cancer.

Answer 17

• Medullary, which presents with small blue cells (like the workers with blue hats under the MiD jULY sign)
• Mucinous, which presents with lots of mucin (like the dog drooling)
• Tubular, which has tubules invading the stroma (like the woman with the tubular onions)
• Paget’s disease of the breast, which has adenocarcinoma of the ductal cells –basically DCIS –that extends into the areolae (like the eroded PAssion fruit)

Question 18

Unlike in the breast, extramammary Paget’s is _____________.

Answer 18

benign (like the happy kid with Paget’s cells on her lap)

Question 19

Breast cancer in men is almost always associated with ____________.

Answer 19

BRCA2 mutations (like the guy leaning on the broccoli with two florets)