What is a TDLU?
Terminal duct lobular unit.
What causes the epithelial cells of the TDLU to proliferate and enlarge?
Pregnancy because of estrogen.
What causes the TDLU to undergo atrophy?
What is mastitis?
Breast inflammation accompanied by tenderness, redness, and induration (firmness).
What are 2 types of mastitis?
Puerperal = lactational,
Non-puerperal = non-lactational.
What causes lactational mastitis?
What is the incidence of lactational mastitis?
What is a complication of lactational mastitis?
What causes non-lactational mastitis?
(1) duct ectasia,
(2) fat necrosis,
(3) granulomatous mastitis,
(4) inflammatory carcinoma.
What is duct ectasia?
Mastitis in elderly women: duct dilation with secretion stasis, and periductal inflammation and fibrosis.
What is fat necrosis non-lactational mastitis?
Trauma, radiation, or surgery that causes gross changes that look like cancer. FFAs complex with calcium to cause lumps!
What causes granulomatous mastitis?
Inflammation caused by ruptured silicone breast implants or TB.
Can cancer cause mastitis?
Yes! Breast cancer can cause dermatitis-like symptoms because of dermal lymphatic invasion by breast cancer = peau d'orange = erythema/edema.
What can cause breast lumps?
How many women get FC (fibrocystic changes)?
30-60% of reproductive-age women, often related to cycle.
What are symptoms of FC?
Pain/tenderness in freely mobile lumps. Pain usually develops in women over 30.
What are some signs of lump benignity?
Well-defined borders, rubbery consistency, free mobility.
What are some signs of lump malignancy?
Ill-defined borders, firm or rock-hard consistency, attachment to skin or chest wall.
What is the first usual diagnostic modality in FC?
Mammography, followed by ultrasound. Ultrasound can best visualize the cyst.
What is the histology of FC?
Duct dilation, fibrosis, apocrine metaplasia, with or without microcalcifications or duct hyperplasia.
What is proliferative FC?
FC with moderate or severe hyperplasia or atypical features like big nucleoli, dark/enlarged nuclei, mitotic activity.
How is FC treated?
NSAIDs, fitted bras, temperature therapy, hormonal supplements, decreased caffeine and chocolate.
What is a Phyllodes tumor?
Firm, mobile circumscribed mass, usually benign (malignant = cystosarcoma phyllodes), that is the most common nonepithelial neoplasm, but just 1% of tumors.
Does Phyllodes tumor need to be excised?
What can cause nipple discharge?
(6) benign tumor (fibroadenoma)
What may thick, green nipple discharge in perimenopausal women suggest?
Mammary duct ectasia, the second most common cause of discharge.
What may bloody or sticky nipple discharge suggest?
Intraductal papilloma, most common cause of nipple discharge. The papilloma is benign.
What is the most common form of breast tumor?
Does a fibroadenoma contain glandular epithelium and fibroblastic stroma?
Is biopsy more advised in younger or older patients with suspected fibroadenoma?
Older, because they are at greater risk of cancer.
What is the most common cancer in women?
What is the most common cause of cancer death in women?
What is the second most common cause of cancer and cancer deaths in women?
What percentage of breast cancers are familiar?
Does prolonged estrogen exposure lead to increased risk of cancer?
Yes, including early menarche, late menopause, nulliparity, low parity, older age first pregnancy, HRT.
Is obesity linked with breast cancer?
Is alcohol consumption linked with breast cancer?
Is some FC linked with breast cancer?
Yes, for example FC with moderate/severe hyperplasia or atypical hyperplasia.
Is family history of breast cancer linked with breast cancer independently of genetic links?
What risks does BRCA1 confer?
BRCA1 = 56-90% risk of BC / 45% risk of OC.
What risks does BRCA2 confer?
BRCA2 = 37-84% risk of BC / 15% risk of OC.
What risks does TP53 mutations confer?
BC and Li-Fraumeni/SBLA syndrome.
What is Li-Fraumeni/SBLA syndrome?
Soft tissue and bone sarcomas,
What are BRCA1, BRCA2, and TP53?
Tumor suppressor genes.
Where is BRCA1?
Where is BRCA2?
Where is the most common location of breast cancer?
What are breast cancer symptoms?
Redness + warmth,
Edema (peau d'orange),
Skin or nipple retraction,
Eczematous (scaly) nipple,
What are the four main types of BC?
Invasive/infiltrating duct carcinoma
Invasive lobular carcinoma
What is DCIS?
Duct carcinoma in situ that has not invaded through basement membrane of duct, precursor to duct carcinoma in situ.
How is DCIS found?
Suspicious calcifications on screening mammography.
How is DCIS treated?
What is the most commonly found breast cancer?
Invasive/infiltrating duct carcinoma, DCIS that has broken through the basement membraine into the stroma.
How is invasive/infiltrating duct carcinoma treated?
Resection or mastectomy.
What is LCIS?
Neoplastic epithelial enlargement of TDLU, usually without mass/calfications, usually incident finding on biopsy.
What are invasive lobular carcinomas?
Grossly and mammographically similar to invasive duct carcinoma, but histologically single-file pattern of malignant cells invading stroma from TDLU.
What percentage of BC are invasive lobular carcinoma?
Are Invasive lobular carcinomas more commonly bilateral?
What are some good prognosis BC?
Tubular, papillary (+/- nipple discharge), medullary, mucinous.
What is Paget's disease?
Cancer cells in the epidermis that are usually associated with DCIS or invasive duct carcinoma.
When is ultrasonography useful in testing for BC?
Dense breast tissue in young women, or to assess whether lesion is cystic or solid.
What is the difference between screening and diagnostic mammography?
The number of views.
Does a negative mammography rule out cancer in a women with a palpable mass?
Can MRI be used in breast cancer?
High sensitivity test, but low specificity, i.e. high false-positive rate.
Can mammography or MRI replace biopsy?
How is BC treated?
Excision/mastectomy, sentinel lymph node dissection, possible post-surgery chemotherapy/radiation/hormone therapy.
What is BC follow-up?
First 3 years: H&P every 3-6 months.
Next 2 years: H&P every 6-12 months.
Post 5 years: H&P annually.
To where does BC metastatize?
(1) Lymph nodes, especially axillary, but also interal mamillary, supraclavicular/infraclavicular.
(2) Bone, brain, lung, and liver.
When can BC recur?
How is BC staged?
Breast imaging: chest x-ray, breast MRI/CT scan;
Liver tests: GGT and ALT, liver ultrasound;
Bone scan; and
What is the most important prognostic marker in BC?
Axillary lymph node status.
80% node negative = alive and disease free 5 yrs post-Dx.
What are important prognostic markers in BC?
Axillary lymph node status, tumor size, type (i.e. tubular), grade, proliferation index.
Can Tamoxifen treatment for ER/PR+ tumors indicate better prognosis?
Can Trastuzumab treatment for HER2+ tumors indicate better prognosis?
No. Trastuzumab can be effective, but HER2 is linked with increased risk of recurrence and death.