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Where is most breast cancer located?
In the breast.. lol.. UOQ
What is a cancer presentation that can be confused?
What is a modality used to diagnose whether a mass is cancerous or not?
- Core biopsy
- sx- lumpectomy
What is the most common histology type of breast cancer?
Infiltrating ductal carcinoma
What breast cancer has the lowest survival rate?
What is the gross histology of infiltrative ductal carcinoma (NST)?
- stellate shaped
- firm to hard/gritty cut surface due to fibrosis
What is the histopathology of DC-NST?
- neoplatic cells arranged in glands, nests, cords, tubules and anastomosing masses that infiltrate the prmoninet pink staining fibrous extracellular matrix
- Desmosplastic tissue
What type of breast cancer has desmoplastic tissue?
infiltrating ductal carcinoma- NST
What is the size of most infiltrative ductal carcinomas- NST?
<_2 cm in size
What is the best prognostic marker of breast cancer?
What are some of the sequalea of axially lymph node resection?
lymphadema which leads to numbness, pain, tingling sensations, and increased risks for wound healing complications and seroma formation
Sentinel lymph node
SNL is the first lymph node or first group of lymph nodes of a given lymphatic basin to receive lymphatic drainage
What is the presentation of inflammatory carcinoma?
rapid onset edema, warmth and erythema. and or orange peel. Very aggressive tumor
What is the histology of inflammatory carcinoma of the breast cancer?
dermal lymphatics distended by clusters of tumor cell and there is minimal inflammation
Loss of E-cadherin is associated with what type of cancer?
What percentage of breast cancer is lobular carcinoma?
Incidence of sentinel nodes increases with what?
with the size of the tumor
What is adjuvant therapy?
any therapy given before, during or after surgery to destroy small occult micrometastisis, decrease the risk of breast cancer recurrence and improve survival
What are the different types of adjuvant therapy?
- hormonal therapy (tamoxifen and aromatase inhibitors)
- chemo regimens
- trastuzamab (HER2 blockers)
When is a lumpectomy and radiation done?
lumpectomy for tumors less than 5 cm
Which ER/PR phenotype is the most responsive to hormonal therapy? less responsive?
- Most: ER/PR +
- Least: ER/PR -
Tamozifen what is it? who is it used for? what are the side-effects?
- cloacks estrogen receptros and their signaling
- used for pre- and post- menopausal women
- side-fects- hot flashes. depression, coagulapathy,increase risk of uterine cancer, DVT
- used in chemoprevention for ductal hyperplasia with atypia
When are aromatase inhibitors used and what are the side-effects?
- they are only used in post-menopausal women
- side-effects: hot flashes, depression, osteoporosis, joint pains
What predicts the response to receptor blockade using Herceptin?
What is HER2?
- membrane receptor for EGF overexpressed in 20-25% of breast cancers
- poor prognostic marker of breast cancer
So a patient that has triple negative cancer what is she like?
- Younger patient
- probably AA since there is a higher prevalence in them
patient with triple negative is here. What will her mams say? what will her gross tumor look like?
- lack of micro calcifications and speculation that leads to a decreased mam dx
- high grade in a solid med pattern (high grade balsa like carcinomas)
Patient with triple negative breast cancer wants to know what will her disease look like?
- bad prog
- often recur and they have poor survival rates
- met to spinal cord, meninges, brain, liver and lung
- they do respond to conventional chemo but not hormonal therapy
ER/PR is what type of prognostic factor? Her2/NEU?
They are both weak prognostic factors but HER2/NEU is a good predictor of how they will respond to trastuzumab
What is the mechanism of trastuzumab?
induces tumor cell killing via ADCC by NK cells; blocks the formation of the heterodimer, cleaves the extracellular of the receptor domain off and induces receptor uptake that increases destruction in lysosomes.
What does triple negative carcinoma mean?
How do you gene profile? and what does it do?
- id luminal A, B, basal, and EGFR+
- define patient subpopulations that differ in prognosis