Breast Cancer

Front 1

2 types of breast carcinoma in situ?

Back 1

Lobar (LCIS)

Ductal (DCIS)

Front 2

Where does the carcinoma in situ arise?

Back 2

Terminal ductal lobular unit (TDLU)

Front 3

Histological feature of LCIS

Back 3

- maintains TDLU architecture

- fills and expands acini

- small, monomorphic cells

- bland, discohesive cells

- no calcification or necrosis

Front 4

Histological features of DCIS

Back 4

- distant or unfolds TDLU

- look like a duct(s)

- COMEDO: pleomorphic/ high grade, central necrosis

- NON COMEDO: calcified, cribiform (cookie cutter shape), solid

Front 5

Benign disorders of growth in BC

Back 5

-fibrocystic disease

- sclerosing adenosis

Front 6

benign neoplasia of BC

Back 6

- fibroadenoma

Front 7

malignant neoplasia

Back 7

-DCIS

- LCIS

- Invasive Lobular

- Invasive Ductal (NOS/NTS)

Front 8

What is a cyst?

Back 8

- epithelial lined sac containing proteinaceous fluid

- distinctly eosinophilic cytoplasm (apocrine metaplasia)

Front 9

what is a blue domed cyst?

Back 9

large cysts which may appear blue/brown due to turbid fluid

Front 10

whats is fibrosis?

Back 10

increased fibrous tissue (collagen)

- may cause chronic inflammation and scarring due to cyst leakage

- may result in sclerosis (hardening)

Front 11

what is adenosis?

Back 11

increased no. of acini per lobule

Front 12

what are the constituents of fibrocystic change?

Back 12

fibrosis - increased stromal fibrous tissue

cysts formation- dilatation of ducts, unfolding lobules

apocrine metaplasia

Front 13

fibrocystic change in the breast is:

Back 13

-lumpy, bumpy breasts +- mastalgia

- very common

- hormone responsive

Front 14

2 kinds of fibrocystic change:

Back 14

1. Simple: no epithelial hyperplasia (no increased cancer risk)

2. Proliferative: epithelial hyperplasia

- lumen filled with heterogenous luminal and myoepithelial cells

- irregular, slit-like fenestrations

- cancer risk increases with increase proliferation

Front 15

4 classes of fibrocystic change

Back 15

- mild

- moderate

- severe

- atypical

Front 16

what does fibrocystic change look like on a mammogram?

Back 16

microcalcifications

Front 17

what is sclerosing adenosis?

Back 17

Intralobular fibrosis

- may compress acini in centre, usually dilated at periphery

- may mimic cancer-stromal fibrosis completely compress lumens - solid cords of cells

Front 18

What in the breast can sometimes be misdiagnosed for breast cancer?

Back 18

sclerosing adenosis

Front 19

what is a fibroadenoma?

Back 19

-benign neoplasm of interlobular fibroblasts (monoclonal fibroblastic stroma)

- hyperplasia/ proliferation of ducts = adenosis

Front 20

what does a fibroadenoma look like?

Back 20

-well circumscribed

- rubbery-rapid growth compresses surrounding tissue

- freely mobile "breast mice"

Front 21

fibroadenomas are:

Back 21

- hormone responsive

- most common benign breast tumour in 20-30yo

Front 22

breast cancer epidemiology

Back 22

- most commonly diagnosed cancer in Aust women (exc non-melanoma skin ca)

- 2nd most common of cancer related death in women

Front 23

breast cancer risk factors:

Back 23

- age

-age at menarche

- age at first live birth

- first degree relatives with breast cancer

- atypical hyperplasia

- race/ethnicity (non-hispanic white @highest risk)

- oestrogen exposure

- breast density

- radiation exposure

- obesity

-breast feeding (protective)

- geography / location

Front 24

Breast Carcinogenesis:

Back 24

Front 25

Where is DCIS usually located?

Back 25

one quadrant

one breast

Front 26

Where is LCIS usually located?

Back 26

multifocal

bilateral (20-40%)

Front 27

Is e-cadherin present in IHC for LCIS?

Back 27

no

Front 28

Is e-cadherin present in IHC for DCIS?

Back 28

yes

Front 29

DCIS presentation

Back 29

usually asymptomatic

- rarely a breast lump

- Pagget's Disease (unilateral)

--> red, scaly nipple

Front 30

LCIS presentation

Back 30

Asymptomatic

- incidental finding on breast specimen

Front 31

Can LCIS be detected on mammography, if so how?

Back 31

No

Front 32

Can DCIS be detected on mammography, if so how?

Back 32

yes

linear branching calcification

Front 33

what is the cancer risk per year for LCIS and DCIS?

Back 33

1% and accumalative

Front 34

What cancer can LCIS progress into?

Back 34

Lobular invasive

Ductal Invasive

Front 35

What cancer can DCIS progress into?

Back 35

Ductal Invasive

Other types

Front 36

Treatment options for LCIS:

Back 36

-careful followup --> screening (mammography)+ tamoxifin

- bi-lateral mastectomy (prophylactic)

Front 37

Treatment options for DCIS:

Back 37

-wide local excision

- radiotherapy

Front 38

What can eczema be mistaken for in the breast?

Back 38

Paggets Disease

Front 39

Incidence of Invasive Lobular Breast Cancer?

Back 39

20%

Front 40

Incidence of Invasive Ductal Breast Cancer?

Back 40

70-80%

Front 41

The histology of Invasive Lobular BC?

Back 41

- single file "indian file"

- discohesive

- encircle normal cells (targetoid)

- signet ring cells (cytoplasmic mucin vacuole)

- normal ducts visible within cancer lesion

- +- desmoplasia

Front 42

The histology of Invasive Ductal BC?

Back 42

- heterogenous

-tubules, cords, sheets, and nests

- cohesive

- strong desmoplastic response

- no normal ducts within cancer lesion

Front 43

Is e- cadherin present in Invasive Lobular?

Back 43

no

Front 44

is e-caderin present in invasive ductal?

Back 44

yes

Front 45

receptors are in invasive lobular?

Back 45

ER +ve

HER2 -ve

Front 46

receptors in invasive ductal?

Back 46

2/3 --> ER +ve, HER2 -ve

1/3 --> HER2 +ve

Front 47

what are the clinical presentations of invasive breast carcinoma?

Back 47

- breast lump/ pain

- nipple retraction/ discharge

- peux d'orange

- axillary lymph node involvement

- mets

- cachexia

- fatigue

Front 48

signs of invasive BC in mammography?

Back 48

densely "stellate" (hard)

Front 49

possible met. location for invasive lobular?

Back 49

- CSF

- Serosal surfacess

- GIT

- ovary

-uterus

- bone marrow

Front 50

possible met. location for invasive ductal?

Back 50

any site

- lung

-bone

- liver

- adrenal gland

- brain

Front 51

possible treatment options for invasive BC?

Back 51

-Surgery

+- chemotherapy

+- hormonal therapy (ER +ve)

+- radiotherapy (breast conservation surgery)

+- Herceptin (HER2 +ve)

Front 52

genes involved in hereditary breast cancer?

Back 52

BRCA1/2 (3% of BC)

tumour supressor/ DNA repair genes

p53 Li Fraumeni Syndrome

Front 53

Diagnosing BC?

Back 53

TRIPLE ASSESSMENT:

1. Histology and Clinical Examination

2. Imaging

3. Tissue Biopsy

Front 54

There are 3 types of imaging

1. Mammography

2. Ultrasound

3. MRI

When is each test appropriate to use?

Back 54

1. xray for elderly women

2. younger women

3. for those who have hereditary cancer

Front 55

Major prognostic factors

Back 55

- Invasive vs CIS

- Mets

- LN mets (worse with increase no.)

- Tumour size

- locally invasive

- inflammatory cancer - invaded dermal lymphatics

Front 56

At which size, can a tumour be malignant?

Back 56

< likely to become malignant if <1cm (mammograms can pick this up)

> likely to become malignant if between 2-3 cm (breast self-examination can detect this)

Front 57

Minor prognostic markers:

Back 57

- histological subtype (Ductal NOS worse)

- Histological grade: well, mod, poorly differentiated

- IHC (ER, PR)

- HER2/neu gene amplification

-lymph/vascular invasion

- proliferative rate

- DNA content

- gene expression profile

Front 58

What is HER2/ neu?

Back 58

HER2 protein is a transmembrane glycoprotein in the epidermal growth factor receptor family

-overexpressed in 20% of BC due to gene amplification

Front 59

HER2/neu is associated with:

Back 59

-poor outcome

- high nuclear grade

- poor response to hormonal therapy

- HER2 targeted therapy (Herceptin- Her2 monoclonal antibody)

Front 60

Staging Breast cancer (AJCC):

Back 60