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81 Cards in this Set
- Front
- Back
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What is a carcinoma?
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Malignancy of the epithelium
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What are the 8 major risk factors of sporadic breast cancer?
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1. Gender (female)
2. Age (>50 years) 3. Geography (Western countries) 4. Family History 5. Fibrocystic changes 6. Prior breast cancer 7. Radiation 8. Unopposed estrogens |
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Carcinoma of the breast occurs in what 2 major forms?
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1. in situ Carcinoma (CIS)
2. Invasive Carcinoma |
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What are the 2 types of in situ carcinomas?
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1. Ductal Carcinoma in situ (DCIS)
2. Lobular Carcinoma in situ (LCIS) |
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Can DCIS and/or LCIS be seen on x-ray or grossly?
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NO, only microscopically
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What describes CIS cells wrt to their anatomical positions?
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They are in correct, NORMAL positions
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Does CIS have the capacity to spread?
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NO, because confined to the basement membrane
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Is CIS benign or malignant?
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Benign
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What is CIZ named for?
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Named for the structure that it occupies
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DCIS is located where?
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Ducts (Example: Terminal duct)
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What are the 3 key features of DCIS?
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1. Common form of breast cancer
2. Lacks capacity to spread 3. ALWAYS CURABLE, if treated |
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Why is DCIS significant to malignant cancer?
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Because it is a non-obligate precursor of invasive carcinoma
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Can DCIS be seen on mammogram?
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Yes, can see clusters of calcifications
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What is the best way to examine a cluster of calcifications?
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Core biopsy
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Where are calcifications seen in DCIS?
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Seen in areas of necrosis
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What disease is characterized by crusting and ulceration of the nipple?
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Paget disease of nipple
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What does paget disease of nipple signigy?
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Signifies carcinoma in ductal system
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What is leaking from the nipple in Paget disease?
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Carcinoma cells that have migrated up the ductal system
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Is there one defining architectural pattern to DCIS?
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NO
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What are the 4 malignant like cellular features of DCIS?
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1. Enlarged Cells
2. High N:C ratio 3. Prominent Nucleoli 4. Increased mitoses |
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What is the main clinical significance of DCIS?
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Benign behaving (if treated)
Can evolve into invasive cancer |
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LCIS is located where?
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In the lobules,
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What is seen histologically in LCIS?
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No lumen because acinar structures are filled with population of abnormal cells
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What are the 3 key features of LCIS?
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1. Microscopic entitity
2. Cells proliferate "in position" 3. NOT visible on mammogram, incidental microscope finding |
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Are calcifications seen in LCIS?
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NO
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What type of cells are seen in LCIS?
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Signet-ring cells
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What is the clincal significance of LCIS?
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1. Benign
2. Difficult to Excise 3. Risk factor/precurson |
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What is the usual treatment for LCIS?
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Watch and Wait (bc hard to excise)
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What is the common clinical presentation of invasive breast cancer?
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Mass on mammogram
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What are 3 key features of invasive breast cancer?
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1. Carcinoma cells no longer in situ
2. Has the capacity to spread 3. Potentially Lethal (10 year survival 50%) |
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What are the 2 ways that invasive carcinoma can spread?
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1. Through blood
2. Through lymphatics |
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What is invasive carcinoma named for?
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Named for the associated CIS
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Is there a primary growth pattern for invasive carcinoma?
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NO, many different types
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What disease can signal the presence of invasive carcinoma?
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Paget disease of nipple (recall: crusting and ulceration of nipple)
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What type of breast carcinoma presents with reddened skin, may/may not have mass, evolves rapidly, and is EXTREMELY lethal?
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"Inflammatory" breast carcinoma
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Where are the carcinoma cells located in "inflammatory" breast carcinoma?
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In the dermal lymphatics
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Is actual inflammation seen in "inflammatory" breast carcinoma?
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NO
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"Inflammatory" breast carcinoma is associated with what structure?
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Ductal
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Invasive lobular carcinoma is located where?
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In lobules (spills out from lobules)
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What is the infiltration pattern seen in invasive lobular carcinoma?
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Linear infiltration pattern
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What 3 items allow for staging of breast cancer?
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1. Tumor Size
2. Lymph Nodes 3. Metastasis |
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How many stages of breast cancer are there?
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IV
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What 3 markers are looked at to predict response to SPECIFIC treatments?
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1. Estrogen Receptors
2. Progesterone Receptors 3. HER-2/neu OVER-expression, amplification (not seen in normal tissue) |
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Carcinoma with estrogen/progesterone receptors are susceptible to what treatment type?
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Respond to anti-hormonal agents
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If the cancer is HER-2/neu protein positive, it is susceptible to what treatment?
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Herceptin
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The new oncotype Dx Breast Cancer assay target what specific patient group (with what 2 specific characteristics)?
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1. Node-negative (not in lymphnodes)
2. ER-positive (estrogen receptor) Then looks are 16 other cancer related genes to get risk/recurrence |
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What treatment is used for that patient group?
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5yr tamoxifen treatment
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What is the treatment if patients on the oncotype Dx are low risk?
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No chemo
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What is the treamtent if patients on the oncotype DX are high risk?
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Chemo
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What are 2 key features of breast carcinoma in men?
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1. Uncommon (1%)
2. Ductal Carcinoma ONLY |
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What genetic syndrome is associated with breast carcinoma in males?
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Klinefelters syndrome (XXY)
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How does the staging, treatment, and outcome of male carcinoma compare to women?
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SAME
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What are fibrocystic changes?
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Non-cancerous bumps that can sometimes cause cyclic pain and tenderness
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Are fibrocystic changes palpable?
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YES
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Are calcifications seen in fibrocystic changes?
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YES
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What is the clinical significance of fibrocystic changees?
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Some FCCs are risk markers for devo of later cancers
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What are the 2 categories of fibrocystic changes?
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1. Proliferative
2. Non-proliferative |
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What are the 4 types of non-proliferative FCC changes?
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1. Fibrosis - excess collagen leads to mass
2. Cysts - starts as small ducts, then grow 3. Adenosis - multiple confluent lobules 4. Apocrine metaplasia - replacement of epithelial with that of the axilla (Arm pit) |
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What are 4 types of proliferative FCC?
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1. Sclerosing adenosis
2. Usual duct hyperplasia 3. Atypical duct hyperplasia 4. Atypical lobular hyperplasia |
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What characterizes usual duct hyperplasia?
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Increase in # of cells w/ in a duct
Resembles DCIS but has no unique identifying feature?? |
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What describes Atypical duct hyperplasia?
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Has some, but not all, of features of DCIS
A borderline category of DCIS |
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What describes atypical lobular hyperplasia?
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has some, but not all, of features of LCIS
Borderline lesion |
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What is the risk of non-proliferative FCCs?
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None
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What is the risk of sclerosing adenosis/usual ductal hyperplasia?
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Slight (2x)
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What is the risk of ATYPICAL ductal and lobular hyperplasia?
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Moderate (4-5x)
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What is the risk of ATYPICAL ductual/lobular hyperplasia AND family history of breast cancer?
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HIGH (10x)
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What are the 2 categories of benign tumors of breast?
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1. Stromal Tumors
2. Epithelial Tumors |
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What are the 2 types of benign stromal tumors?
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1. Fibroadenoma
2. Phyllodes Tumor |
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What is the benign epithelial tumor?
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Intraductal Papilloma
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What is the most common benign tumor?
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Fibroadenoma
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What is the treatment for fibroadenoma, how effective is it?
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Excision --> ALWAYS curative
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Are Phyllodes tumors common?
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NO
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What is the treatment for phyllodes tumor?
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Excision --> almost always curative
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Do fibroadenomas has well circumscribed borders?
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YES
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Do phyllodes tumors have well circumscribed border?
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NO, invasive border
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Which is more deadly, fibroadenomas or phyllodes tumor?
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Phyllodes tumor (6% mortality vs 0%)
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What benign condition causes nipple bleeding?
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Intraductal papilloma
(Benign epithelial Tumor) |
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What are the 2 common examples of infections and non-infectious inflammation?
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1. Postpartum infections
2. Traumatic Fat Necrosis |
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What are the major pathogens of post-partum infections?
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Staph and Strep
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Traumatic fat necrosis is related to what?
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To trauma --> reaction to injured fat
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What type of inflammation is seen in traumatic fat necrosis?
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Granulomatous inflammation
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