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63 Cards in this Set
- Front
- Back
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Which racial group present at a higher stage of breast cancer?
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African American women present at a high stage of breast cancer
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What % of breast cancer are sporadic vs. family hx (1° relative) and BRCA?
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80% sporadic… 13% family hx… <5% BRCA
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Name 2 family cancer syndrome.
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BRCA and Li-Fraumeni are 2 family cancer syndromes
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What percentage BRCA genes account for familial syndroms of breast ca?
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25% of familial breast ca are BRCA
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What family cancer syndrome is associcated with p53 mutation and multiple cancers?
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Li-Rraumeni is associated with p53 and multiple cancers
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What are the following associated with? Bilateral cancer of paired organs, cancer in sex that is less affected, rare cancer clusters.
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Familial cancer syndromes are associated with Bilateral cancer of paired organs, cancer in sex that is less affected, rare cancer clusters.
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Which of the following are true of BRCA related breast cancer: (1) Autosomal recessive. (2) <5% of br ca, but 30% br ca in patients > 30y/o. (3) No risk of other tumors. (4) Ashkenazi Jewish Ancestry
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BRCA related: (1) AUTOSOMAL DOMINANT NOT Autosomal recessive. (2) <5% of br ca, but 30% br ca in patients > 30y/o… LESS THAN 30 Y/O (3) YES, THERE IS A risk of other tumors. (4) Ashkenazi Jewish Ancestry
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Define "in situ carcinoma"
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In situ carcinoma: A proliferation of epithelial cells that have undergone malignant transformation --> tumor and in the premetastatic stage, when cells are still at the site of origin and confined by the BM... thus metastatic spread CANNOT occur.
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What are the two general presentations of breast cancer (and the types of breast cancer they're associated with)?
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The two general presentations of breast cancer:
1) No palpable mass: - in-situ, small invasive lesion… (2) breast mass, skin retraction/dimpling, peau d'orange/changes of inflamatory carcinoma, nipple retraction, and discharge--> invasive carcinoma, palable tumors 2-3 cm. |
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When should yearly screening and monthly self exam of breast begin?
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When should yearly screening and monthly self exam of breast begin? 20 y/o
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When should mammography screening begin?
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When should mammography screening begin? 40 y/o
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What do mammographies identify?
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soft tissue densities, archectural distortions and microcalcification… tumors 3.5-1.1 cm in size
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Which is benign, and which is carcinoma? (1) Mass with irregular spiculated margins, (2) mass with smooth margins, (3) calcification -large widely dispersed, (4) calcifications-clustered or linear branching with subtle distortion of breast parenchyma
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Benign: (2) mass with smooth margins, (3) calcification -large widely dispersed… Carcinoma: (1) Mass with irregular spiculated margins, (4) calcifications-clustered or linear branching with subtle distortion of breast parenchyma
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Match these 3 breast ca biopsies (Needle core-incisional sterotatic, excisional, and FNA), with their use(s): (cytology, histology, gross/histology)
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Needle core-incisional sterotatic: Histology… Excisional: gross/histology… FNA: cytology
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(1) Match the type of histology in Ductal Cancer In Situ with the image:
a) Cribiform b) Comedocarcinoma c) Solid d) Micropapillary (2) Describe the histology of Ductal Carcinoma. |
(1) (See image)
2) epi cells have undergone malignant transformation, but remain confined by the BM |
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Which of these images are Low Grade and which are High Grade? What histologic feature are used to make this determination?
When is this type of grading used? (hint: for which type of breast cancer) |
For DCIS, Grading:
Nuclear features: 1. low grade has uniform, small nuclei with infrequent necrosis 2. high grade which has large, bizarre nuclei and central necrosis |
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Which is the most common malignancy? Stromal neoplasms, carcinoma, hematopoetic
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Which is the most common malignancy? CARCINOMAS
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Where do carcinomas of the breast arise?
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Where do carcinomas of the breast arise? Terminal Duct Lobular Unit (TDLU)
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What are the two major type of Carcinoma? And what are their relative percentage?
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In Situ/noninvasive= 15-30% and Invasive=70-85% are the two types of carcinomas
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Where are the two locations of In situ (noninvasive) carcinoma and what is the relative percentage of each?
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In situ (noninvasive) Ductal=80% and Lobular-20%
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Where are the two locations of Invasive carcinoma and what is the relative percentage of each?
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Invasive carcinoma: ductal=90… lobular=10%
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Which is more common for all breast carcinomas, ductal or lobular?
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Ductal is more common than lobular
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In DCIS, what is the basis for grading?
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Grade: based on nuclear features and necrosis
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T/F: Invasive carcinomas do not develop from DCIS AND DCIS not usuallly bilateral.
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False… Invasive carcinomas DO develop from DCIS, BUT LCIS is 8-10x more likely… TRUE, DCIS are NOT usually bilateral
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Which of the following is NOT true of DCIS Mammography: (1) DCIS often forms a mass… (2) Calcification show up
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NOT TRUE: DCIS RARELY form masses… TRUE: Calcification do show up
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What 4 pathological evalutations are made with DCIS?
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What 4 pathological evalutations are made with DCIS? Invasion, grade, size, margins
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In Paget's disease of the Nipple, which direction does spread of cancer occur? How does this present?
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Sread: occurs from nipple ducts to nipple skin and areolas… Presents: wth ulcerated oozing nipples
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Which of the following is true of Lobular Carcinoma In Situ: (1) 20% of in situ… (2) formation of incidental mass… (3) considered a marker for increased risk for invasive carcinoma (4) generally unilateral (5) requires close observation.
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Which of the following is true of Lobular Carcinoma In Situ: TRUE: (1) 20% of in situ… (3) considered a marker for increased risk for invasive carcinoma … (5) requires close observation… FALSE: (2) Incidental, but does NOT USUALLY WITH MASS (4) generally unilateral USUALLY BILATERAL
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Which type of carcinoma is identified with this histological description? (1) proliferation of small unifomr cells with termal ducts and lubules (acini)… (2) no necrosis or microcalcifications
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Lobular carcinoma in situ: HISTOLOGY: (1) proliferation of small unifomr cells with termal ducts and lubules (acini)… (2) no necrosis or microcalcifications
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Which type of breast cancer is identified with this histological description? A proliferation of epithelial cells that have undergone malignant trasfomration and have grown beyond the confines of the basement membrane (of the duct or lobule) into the breast paenchyma... metastatic spread CAN occur?
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INVASIVE BREAST CANCER: A (1) proliferation of epithelial cells that have undergone malignant trasfomration and (2) have grown beyond the confines of the basement membrane (of the duct or lobule) into the breast paenchyma... (3) metastatic spread CAN occur
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Define: adenocarcinoma (in general terms)
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A cancer that develops in the glandular lining of an organ
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Give the % breakdonw of invasive ducttal carcinoma vs. invasive lobular carcinoma.
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Invasive ductal carcinoma: 90% vs. invasive lobular carcinoma: 10%
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Where is the first site of invasive carcinoma metastasis?
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Where is the first site of invasive carcinoma metastasis? AXILLARY NODES
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Besides the axillary nodes, where else does invasive carcinoam of the breast metastasize to?
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Besides the axillary nodes, where else does invasive carcinoam of the breast metastasize to? LIVER, LUNGS, BONES, and CNS
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(1) How do invasive breast carcinomas present? (2) How do tumors present if neglected?
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(1) How do invasive breast carcinomas present? A MASS… (2) How do tumors present if neglected? LARGE ULCERATED LESIONS
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(1) the type of breast cancer, and it's subtypes.
(2) Which is the least aggressive form? (3) Which is most common? |
(1) Assign the correct name of these Invasive ductal Carcinomas: (1) Medullary Carcinoma, (2) Tubular Carcinoma, (3) Colloid/Mucinous Carcinoma, (4) Invasive Ductual Carcinoma NOS.
(2) Which is the least aggressive form? NOS (3) NOS is the most common |
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What does NOS stand for?
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NOS is NOT OTHERWISE SPECIFIED when referring to Invasive ductal carcinoma
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Which cellular structures are used in the grading of invasive ductal carcinoma?
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Which cellular structures are used in the grading of invasive ductal carcinoma? NUCLEAR POLYMORPHISM (1-3), TUBULE FORMATION (1-3) , and MITOTIC ACTIVITY (1-3)
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In terms of survival, what does the modified Bloom-Richardson Scores I, II, III signify?
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I = 80% survival in 16 years… II/III= 60% survival in 16 years
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Which of the following is NOT TRUE of invasive breast cancer? Spread to chest wall, spread to the skin (causing dimpling), spread to submental lymph node
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Which of the following is NOT TRUE of invasive breast cancer? (TRUE) Spread to chest wall, (TRUE) spread to the skin (causing dimpling), (NOT TRUE) spread to submental lymph node
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Which is NOT true of Invasive Lobular Carcinoma (a) Tend to be uni-lateral and multicentric (b) Invade in a diffuse pattern (c) Gross: well-defined firm areas (d) Single-file pattern and targetoid patterns present (e) Are graded
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Which is NOT true of Invasive Lobular Carcinoma (a) FALSE: Tend to be BILATERAL NOT uni-lateral and multicentric (b) Invade in a diffuse pattern (c) FALSE Gross: ILL-DEFINED NOT well-defined firm areas (d) (TRUE) Single-file pattern and targetoid patterns present (e) FALSE Are NOT graded
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Match the type of invasive breast cancer (Invasive Ductal-NOS vs. Invasive Lobular) to the correct pattern of infiltration ( tubules, nests, sheets vs. single cells, multicentric in breast targetoid)
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(1) Invasive Ductal-NOS: tubules, nests, sheets… (2) Invasive Lobular: multicentric in breast targetoid
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Match the type of invasive breast cancer (Invasive Ductal-NOS vs. Invasive Lobular) to the correct cytology (pleomorphic vs. uniform)
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(1) Invasive Ductal-NOS: pleomorphic… (2) Invasive Lobular: uniform
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What is the best prognosticator for invasive breast cancer? What proportion of women have THIS at presentation?
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The best prognostci factor in invasive breast cancer is ymph node involvement (lymphovascular invasion)… 1/3 have LN involvement at presentation
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What is a complication of axillary node dissection?
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Nerve damage is a complication of axillary node dissection
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What are the 3 steps in sentinel lymph node biopsy?
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"(1) vital dye and radiolabelled sulfur colloid are injected into the tumor bed (2) Using a detector, the “hottest” 2-3 “sentinel” nodes are identified, representing the nodes to receive the initial drainage including metastatic cells from tumor (3) Sentinel node evaluation:Examined with multiple levels on slides. Immunohisto-chemical analysis to find rare cytokeratin positive (i.e. epithelial) cells in lymph node
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What are the 3 prognostic factors for breast carcinoma?
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What are the 3 prognostic factors for breast carcinoma? Lymph status (most important), tumor size, hisologic subtypes
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What is the % likelihood for 10 year survival for the following number of lymph nodes: 0, 1-3, >10?
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What is the % likelihood for 10 year survival for the following number of lymph nodes: 0 ND=70-80%… 1-3=35-40%… >10 LN=10-15%
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What is the likelihood of survival for a tumor size ≤ 1.0 cm?
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What is the likelihood of survival for a tumor size ≤ 1.0 cm? 98% 10 year survival
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For these Histologic subtypes of invasive ductal carcinoma (tubular, colloid and medullary) vs. (NOS) what is the survival percentage after 30 years?
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For these Histologic subtypes of invasive ductal carcinoma, the survival percentage after 30 years: (tubular, colloid and medullary) = 60% vs. (NOS) =20%
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What are 7 prognostic factor associated with breast carcinoma?
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(1) Tumor grade,
(2) Stage (Tumor, Node, Metastases) (3) Steroid receptor status (estrogen/progesterone), (4) Lymphovascular invasion- dismal prognosis of inflammatory carcinoma (Extensive involvement of dermal lymphatics) (5) Oncogene expression (HER-2/Neu) (6) Loss of tumor suppressor gene function (p53 mut.) (7) Others incl. DNA content, tumor associated angiogenesis |
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Match the stage (0-IV) to the following to the extent of spread of invasive tumor : In situ
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Stage 0: In situ
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Match the stage (0-IV) to the following to the extent of spread of invasive tumor: > 5cm, + LN; fixed LN, skin/chest wall involvement (46%)
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Stage III: > 5cm, + LN; fixed LN, skin/chest wall involvement (46%)
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Match the stage (0-IV) to the following to the extent of spread of invasive tumor: < 2 cm, without node involvement (5 yr SR 87%)
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Stage I: < 2 cm, without node involvement (5 yr SR 87%)
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Match the stage (0-IV) to the following to the extent of spread of invasive tumor: Distant metastases (13%)
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Stage IV: Distant metastases (13%)
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Match the stage (0-IV) to the following to the extent of spread of invasive tumor : < 5 cm + nonfixed lymph nodes, or >5 cm w/o LN; - distant mets (75%)
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Stage II: < 5 cm + nonfixed lymph nodes, or >5 cm w/o LN; - distant mets (75%)
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Which types of receptors are present in invasive breast carcinomas?
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Which types of receptors are present in invasive breast carcinomas? Estrogen and progesterone
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What are the Rx for ER+ ?
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"What are the Rx for ER+ ? (1) Estrogen antagonist (Tamoxifen) (2) Surgery to remove ovaries or aromatase inhibitors (Arimidex), both surgery and aromatase inhibitors decrease estrogen production
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Does E-® + have a good or poor prognosis?
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E-® has a good prognosis
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Besides a mutation in Her-2/Neu, (human epidermal growth factor) what is needed for the progession to cell proliferation?
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Besides a mutation in Her-2/Neu, what is needed for the progession to cell proliferation? Besides Her-2/neu mutation, gene amplification is needed, which leads to over-expression of the Her2 protein (a membrane receptor) --> cell proliferation
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What percentage of breast cancers have an overexpression of Her2 protein?
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15-30% of breast carcinomas have an overexpression of Her-2 proteins
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What type of invasive breast cancer does this 3+ staining indicate?
Is this a milder form of invasive breast cancer? What is the Rx for this? |
What type of invasive breast cancer does this 3+ staining indicate? Invasive lobular carcinomar (+ Her-2/neu)
Is this a milder form of invasive breast cancer? NO - more aggressive; shorter survival and shorter disease free interval What is the Rx for this? Use and antibody that binds to Her2 receptors and causes endocytosis |
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What are the 5 adjuvant treatments for invasive breast cancer?
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"What are the 5 adjuvant treatments for invasive breast cancer?
(1) Hormonal manipulation (a) Treatment (b) Chemoprevention (2) External radiation, brachytherapy (3) Chemotherapy (4) Antibody therapy (5) Others including anti-angiogenic therapies, multiple trials |
