W12.Ch.16-The Breast Flashcards
1
Q
Etiology of breast ca
A
- causes unknown, but genetic and hormonal factors exist
- BRCA1 and BRCA1= account for 20% of familial breast ca or 3% of all breast ca. Account for 30% of of breast cancers under the age of 45.
- hormonal based on epidemiologic data which suggest that estrogens promote breast cancer formation. Oral contraceptives do not change the risk.
2
Q
Breast Ca risk factors
A
- sex: females affected 100x more than males
- Age: rare beore puberty, unusual before 30. Incidence rises after 35 and peaks around 60yo.
- race and ethnicity: whites (especially Jews)
- Genetic predisposition: mother or sister with breast cancer
- hormonal: women exposed to estrogens for prolonged periods of time have an increased risk. More common with early menarche, late menopause, nulliparous or late first pregnancy
Presence of other cancers: increased incidence if a women has had breast cancer in the other breast, or have ovarian or endometrial cancer.
Pre-malignant breast changes: pappilomatosis, atypical intraductal or lobular hyperplasia
3
Q
Pathology of breast cancer
A
- most are epithelial origin ant therefore carcinoma, 80% are invasive ductal carcinoma
- invasive ductal and lobular carcinomas are preceeded by a pre-invasive stage called ductal carcinoma in situ, and lobular carcinoma in situ
- once the tumor invades across the basement membrane, they transform into invasive adenocarcinomas that are accompanied by a very strong desmoplastic reaction. Because of this dense connective tissue, the tumor appears firm and gritty.
- this connective tissue pulls and causes puckering of the skin and retraction of the nipple
- on palpation they tumor feels firm, but does not have sharp margins because of infiltration of adjasent tissues
- 50% occur in the upper lateral quadrent, 20% are central and under the areola
- metastasize via lymph, axillary lymph nodes often have mets. Distant metastases include lung, liver, bone, brain, and adrenals
4
Q
fibrotic change
A
