What are risk factors for breast cancer?
Definition
- Gender - female
- Age - older
- Hormones - early period or late menopause. Use
of HRT
- Genetics - p53, HER2, BRCA1/2
- ALCOHOL INCREASES RISK
Term Definition
What tools assess risk of breast cancer? - Gail model
- Claus model
- BRCAPRO
Term Definition
How is screening for breast cancer completed? - Exams - self exam once a month, clinical
starting at age 20 every 1-3 years
- Mammogram - 40+ once yearly
- Breast MRI - high risk patients
Term Definition
How can breast cancer be prevented? - Tamoxifen - ER+, increases endometrial cancers
and VTE
- Raloxifene - only in post menopausal women.
Less risk of VTE
- Mastectomy
Term Definition
What are types of non-invasive breast cancer? - Ductal carcinoma in situ (DCIS) -15-50%
progress to invasive, stays unilateral
- Lobular carcinoma in situ (LCIS) - rarely
progresses, can affect both breasts
**basement membrane is still intact
Term Definition
What are types of invasive breast cancer? - Invasive ductal carcinoma (IDC)- most common,
worse prognosis. Metastasis to liver, lung, bone
- Invasive lobular carcinoma (ILC) - harder to
detect, metastasis to retroperitoneal
Term Definition
How does breast cancer present? - Most common: painless mass
- palpable lymph nodes
- High CEA indicates disease
Term Definition
What receptors are on breast cancer cells? - Estrogen receptor
- Progesterone receptor
- HER2 receptor - must be + to benefit from
HER2 therapy
Term Definition
What is staging for breast cancer? TNM:based on tumor size, nodal progression,
and metastasis
Term Definition
What determines breast cancer prognosis? - Tumor size
- Nodal involvement
- Young women, african americans have more
aggressive disease
Term Definition
What is oncotype? Unique to breast cancer:
- Low < 18: low risk of recurrance w/ solo
endocrine therapy. Avoid adjuvant chemo
- Intermediate 18-30 - personal decision
- High > 31 - high risk of recurrence despite
endocrine, adjuvant chemo needed
Term Definition
What is a sentinel lymph node biopsy? Dye injected near tumor, 1st lymph node to take
up dye is removed
Term Definition
How is LCIS and DCIS treated? - LCIS - observation alone.
- DCIS - Surgery with or without radiation.
Tamoxifen only in lumpectomy patients for ER+
tumors
Term Definition
What is the treatment for Early stage (I,II) breast - Surgery with or without radiation
cancer? - T = 0.6- 1 cm - Adjuvant endocrine + chemo,
HER2+ add trastuzumab
- T = >1 - Endocrine + chemo + trastuzumab
**ER1 - do not use endocrine therapy
Term Definition
When is endocrine therapy warrented in breast In hormone receptor (+) tumors:
cancer? - Tamoxifen - SERM, gold standard
- Aromatase inhibitor: post menopausal only.
Anastrazole, letrozole, Exemestane. FOR 5
YEARS
**Do not give concurrently w/ chemo
Term Definition
What are the cornerstones of breast cancer Anthracyclines and taxanes within 12 weeks of
chemotherapy? surgery
- HER2(-) - dose dense doxorubicin +
cyclophosphamide --> paclitaxel
- HER2(+) - Paclitaxel + cyclophosphamide +
trastuzumab
Term Definition
What therapy should be given to HER2+ breast
Trastuzumab/Herceptin - for all HER2+ over 1
cancers? cm
Term Definition
What is a therapy for metastatic breast cancer inExemestane + Everolimus - mTOR inhibitor
post menopausal women?
Term Definition
What is 1st line therapy for metastatic Her2+ Pertuzumab + Trastuzumab + Paclitaxel
breast cancer?
Term Definition
What are the side effects of endocrine therapy in
Hot flashes and fatigue: tx = Effexor ER 75 qd
breast cancer? AI: myalgias and arthralgias. Give vit D and
calcium supplements
Term Definition
What are side effects of anthracyclines used in Cardiotoxicity - Dexrazoxane decr toxicity.
breast cancer? Alopecia
N/V
Term Definition
When can eribulin be used for breast cancer? Failure of 2 chemo regimens for metastatic
disease
**Ixabepilone: for tx failure
Term Definition
What biologics can be used for breast cancer?- Trastuzumab - for HER2+. Infusion rxns and
cardiotoxic
- Pertuzumab - prevents dimerization
- Ado-trastuzumab - HER2 + microtubule
- Lapatinib - kinase inhibitor of EGFR and HER2
Breast cancer
Most common malignancy in American women except for skin cancer:
2nd
Breast cancer is the ____ leading cause of death from cancer.
98%
5 year survival rate of women diagnosed with localized breast cancer is ___%
17%
5 year survival rate of women diagnosed with advanced stage breast cancer with metastasis is
____%
Etiology of breast cancer:
* Heredity
* Genetic-related susceptibility
* Hormonal regulation of breast related to development of breast cancer
* Sex hormones (estrogen/progesterone) may act as tumor promoters
Risk factors for breast cancer:
* Gender: 99% occur in women
* Increasing age: gradual increase until 60, dramatic increase after 60
* Women under 25 low risk
* First full term pregnancy after age 30
* Nulliparity
* Alcohol consumption
* Sedentary lifestyle
Modifiable risk factors related to breast cancer:
* Weight gain during adulthood
* Sedentary lifestyle: 33% increase
* Dietary fat intake
* Obesity
* Alcohol intake
* Environmental factors
Family history and breast cancer:
Increased risk esp if involved family member had ovarian cancer, was premenopausal, had
bilateral breast cancer, was a first degree relative (1.5-3x)
HRT & breast cancer:
* Use of combined HRT increased risk of developing cancer, larger, more advanced case when
diagnosed
* Using estrogen alone does not seem to increase risk
5-10%
What percentage of breast cancer patients may have an inherited genetic abnormality?
BRCA1 gene (chromosome 17)
This tumor suppressor gene inhibits tumor development when it is functioning normally
40-80%
Women with BRCA mutations have what percentage lifetime chance of developing breast
cancer?
Options for women with BRCA1 & 2 mutations?
* Routine screening if strong family history
* Prophylactic bilateral oophorectomy can decrease risk of ovarian & breast cancers
* Prophylactic bilateral mastectomy may reduce risk of breast cancer by 90%
Predisposing risks for developing breast cancer in men:
* States of hyperestrogenism
* Family Hx of breast cancer
* Radiation exposure: alters cells
Pathophysiological types of breast cancer (histologic characteristics & growth patterns)
* Epithelial lining of ducts
* Epithelium of lobules
* In situ (within the duct)
* Invasive (arising from duct & invading thru wall of duct)
* Metastatic (bone, liver, lung, brain)
slow to rapid
How fast is breast cancer growth?
Factors that affect prognosis of breast cancer?
* Tumor size
* Axillary node involvement
* Tumor differentiation
* Estrogen/progesterone receptor status
* HER-2 status (receptor that regulates cell growth)
* Expression of HER-2 (overexpression = poor Prognosis)
22%
What percentage of all breast cancers are non-invasive?
Treatments for breast cancer:
* Local excision
* Lumpectomy
* Mastectomy
* Radiation
* Tamoxifen
Upper, outer quadrant
Most common location for breast cancer?
Pagets Disease
A rare breast malignancy that may be confused with infection or dermatitis
* Persistent lesion of nipple & areola w/ or w/o palpable mass
* Itching, bloody nipple discharge with superficial erosion & ulceration may present
Treatment for Paget's Disease?
* Simple mastectomy
* Modified radical mastectomy
Inflammatory Breast Cancer
The most malignant form of breast cancer (but rare):
* Aggressive, fast growth
* High risk for mets
* Skin of breast is red, warm, thickened: peau d'orange (orange peel) resemblance
* Ridges/bumps may present
* Caused by cancer cells blocking lymph channels
Treatment for inflammatory breast cancer:
* Neoadjuvant chemo
* Radiation
* Surgery
* Hormone therapy
* Biologic therapy
How is breast cancer detected?
* Lump/mammographic abnormality
* Hard, irregularly-shaped, poorly delineated, nonmobile, nontender
* May cause nipple discharge (clear or bloody), nipple retraction, infiltration, induration, dimpling
of overlying skin in large cancers
Complications of breast cancer?
* Recurrence is main one: local, regional or distant
* Metastatic disease involves growths of colonies of cancer cells
* Mets occur primarily via axillary lymph nodes, but can spread w/o axillary nodes even if tumor
is small
Local recurrence of BRCA (location)
Skin & chest wall
Regional recurrence of BRCA:
Lymph nodes
Distant metastases of BRCA:
Bone, Spinal cord, Brain, Lungs, Liver, Marrow
Diagnostic studies used to determine prognosis of BRCA:
* Axillary lymph node size: dissection
* Tumor size
* Estrogen/progesterone receptor status
* Cell-proliferative indices
Axillary lymph node dissection in BRCA:
The number of nodes involved can determine risk of recurrence: greatest risk if 4+ nodes are
involved
Lymphatic mapping & Sentinel lymph node dissection (SLND) for BRCA:
Blue dye is injected into tumor site to see lymph nodes involved (b/c lymph nodes drain from
tumor site): may remove b/w 1 & 4 nodes
Anesthesia necessary
BRCA tumor & prognoses:
The larger the tumor, the poorer the prognosis
Better differentiation of tumor means less aggressive.
Characteristics of Estrogen receptor positive tumors:
* Commonly well-differentiated
* Frequently have diploid (more normal) DNA & low proliferative indices
* Lower chance of recurrence
* Frequently hormone dependent & responsive to hormone therapy
Characteristics of Estrogen receptor negative tumors:
* Poorly differentiated
* High incidence of aneuploidy (high or low DNA content) & high proliferative indices
* Frequent recurrence
* Unresponsive to hormone therapy
S phase prognostic indicator for BRCA:
Percentage of tumor cells in synthesis phase: higher percentage = poorer prognosis
HER-2 prognostic indicator for BRCA:
Overexpression = poorer prognosis
* 25-30% overexpressed
* Usually indicates more aggressive tumor growth
* Test assists in selection/sequence of chemo
Treatment for BRCA is determined by what?
* Staging
* Biology of the cancer
* Presence or absence of malignant cells in lymph nodes
Most common options for resectable BRCA (tumors smaller than 4-5 cm:
* Breast conservation therapy surgery w/ rad therapy
* Modified radical mastectomy w/ or w/o breast reconstruction
* SLND (if no malignant cells found in sentinel nodes)... previously ALND was standard of care
& 12-20 nodes were removed from side of cancer
* Exam of lymph nodes determines necessity for chemo, hormone therapy, both
Lymphedema
A side effect of having lymph nodes removed... fluid accumulates in soft tissue
* Heaviness
* Pain
* Impaired motor function of arm
* Numbness
* Paresthesia of the fingers
Breast-Conserving surgery (lumpectomy)
* Removal of entire tumor w/ a margin of normal surrounding tissue
* Rad therapy to entire breast
* Chemo may be administered b4 radiation
Contraindications
* Small breast size in relation to tumor size
* Multifocal (in same quadrant) masses & calcifications
* Multicentric (more than one quadrant) masses
* Location of tumor near nipple
* Diffuse calcifications in more than one quadrant
* Those w/ contraindications for rad therapy
Advantages of breast conservation therapy:
* Preserves breast & nipple
* Minimizes risk & maximizes benefits of cancer Tx & aesthetic outcome
Disadvantages of breast conservation therapy:
* Increased cost of surgery & radiation (as opposed to just surgery)
* Side effects of radiation (soreness, edema, skin rxns, arm swelling, sensory changes in
breast/arm)
* Change in texture/sensitivity of breast
* Impaired arm mobility
* Prolonged treatment
Modified Radical Mastectomy
Removal of breast & axillary lymph nodes
Breast reconstruction can occur immediately or be delayed
Follow-Up after cancer treatment:
* Must have a semiannual exam for 2 years, then annually until end of life
* Monthly BSE on both breasts & at surgical site
* Breast imaging done at regular intervals (6 months to 1 year)
Complications
* Lymphedema
* Excision
* Irradiation
* Pain
* Heaviness/Impaired motor function of arm
* Numbness/paresthesia in fingers
* Cellulitis
* Progressive fibrosis
Postmastectomy Pain Syndrome
* Mastectomy
* Axillary node dissection
* Chest & upper arm pain
* Tingling down arms
* Numbness
* Shooting/piercing pain
* Unbearable itching
Due to injury to intercostobrachial nerves
Treatment for postmastectomy pain syndrome:
* Nonsteroidal anti-inflammatory drugs (NSAIDs)
* Topical lidocaine patches
* EMLA (local anesthetic w/ lidocaine)
* Antiseizure drugs
* Guided imagery
* Biofeedback
* Physical therapy (prevent frozen shoulder)
* Psych counseling
Adjuvant Therapy for breast cancer:
* Local rad therapy
* Chemo
* Hormonal therapy
* Biologic therapy
Type of adjuvant therapy depends on what factors:
* Stage of disease
* Cancer cell characteristics
* Presence or absence of estrogen, progesterone, or HER-2 receptors
* Menstrual status
* Health
* Age
Primary Radiation Therapy
* Performed after local excision of breast mass
* 5 days/week for 5-6 weeks
* With a boost: delivered to area of original tumor = 8 more Tx
High-dose Brachytherapy (internal radiation)
* Traditionally: a multicatheter implant inserted into breast & radioactive seed placed in each
catheter to treat area
* Currently: balloon catheter allows for partial breast irradiation: may require only 5 days... seed
inserted & radiation dose applied to area w/ highest risk of recurrence: 2x/day for 5 days
Palliative Radiation
Used to stabilize painful lesions of metastases in bone, soft tissue organs, brain, chest
* Relieves pain
* Controls mets & recurrences
Systemic Therapy: Chemotherapy
Given preoperatively (neoadjuvant) sometimes to decrease size of tumor for removal
* May affect healthy cells
* Side effects: N/V, bone marrow depletion, alopecia, fatigue, weight gain
Chemo brain
Cognitive changes: concentration difficulties, memory lapses, focus & attention problems
* Affects 17-75% survivors
Systemic therapy: Hormonal
Blocks source of estrogen (which promotes tumor growth if tumor cells are estrogen-receptor
positive)
Tamoxifen
Tamoxifen
* Antiestrogen drug; blocks estrogen recepor sites of malignant cells: inhibits cancer growth
* Used in early or advanced stages of cancer, to treat recurrences, & to prevent cancer in high-
risk individuals
* Side effects: hot flashes, mood swings, vaginal discharge/dryness, increases risk of blood
clots, cataracts, stroke, uterine cancer in postmenopausal women
* Treatment lasts for 5 years
Systemic Therapy: Biologic/Targeted
* Herceptin: a monoclonal antibody to HER-2: Antibody attaches to antigen which is taken into
tumor cells... eventually killing them
* Used alone or in combo w/ other chemo to treat those that overexpress HER-2
What race of women have a higher incidence of BRCA?
white women
What race of women have lower survival rates?
African American women
What race of women is Breast cancer the most common cancer diagnosis?
Hispanic women
What race of women is least likely to be screened for breast cancer?
Hispanic women
What races of women are more likely to be diagnosed with BRCA at a much later stage?
African Americans & Hispanics
Advantages of immediate breast reconstruction:
* One surgery
* One anesthesia
* One recovery period
* Occurs before scar tissue/adhesions develop
Indications for breast reconstruction:
* Improves self-image
* Regains a sense of normalcy
* Assists in coping with loss of breast
3 Types of breast reconstruction:
* Breast implants & tissue expansion
* Musculocutaneous flap procedure
* Nipple-areolar reconstruction
Nursing Assessment Necessities:
* Hx of benign breast disease, menstruation, prgnancy, CA, BSE
* Use of hormones
* Exposure to radiation
* Family history
* Alcohol use
* Obesity
* Diet
_____ is the most common non-skin malignancy in women.
Breast carcinoma
A woman who lives to age 90 has a 1 in _____ chance of developing breast cancer.
1 in 8
What is the leading cause of cancer death in women in the US?
Lung cancer
What is the second leading cause of cancer death in women in the US?
Breast cancer
75-80% of all invasive breast cancers are _____ receptor positive.
Estrogen receptor
True or False: In the early 80's the incidence of breast cancer began to decrease in older
women due to the introduction of mammographic screening.
False, in the early 80's the incidence of breast cancer began to increase in older women due to
the introduction of mammographic screening. The main benefit of screening was the detection
of small, invasive carcinomas and in situ carcinomas.
True or False: The breast cancer mortality rate for all women has slowly declined over the last
decade.
True
What is the most significant risk factor for breast cancer?
Being female
True or False: The risk of breast cancer increases with age.
True
The incidence of breast cancer rises throughout a woman's lifetime, peaking at the age of
_____ years.
75-80
True or False: Women who experience a first full-term pregnancy at ages younger than 20
years have half the risk developing breast cancer of nulliparous women or women over the age
of 35 at their first birth.
True
Which of the following is NOT a risk factor for breast cancer? A) Age at menarche B) Age at first
live birth C) First degree relative with breast cancer D) Smoking E) Race
D) Smoking
Which of the following is NOT a risk factor for breast cancer? A) Diet B) Obesity C) Aromatase
inhibitors D) Atypical hyperplasia E) Geography
C) Aromatase inhibitors
What racial group is most likely to develop breast cancer?
Caucasians
What racial group is most likely to die from breast cancer?
African americans (and hispanics)
True or False: Estrogen exposure decreases the risk of breast cancer.
False, estrogen exposure increases the risk of breast cancer.
True or False: Progesterone exposure decreases the risk of breast cancer.
False, progesterone exposure increases the risk of breast cancer.
The moderate or heavy consumption of _____ increases the risk of breast cancer.
Alcohol
The risk of breast cancer is _____ in obese premenopausal women and _____ in obese
postmenopausal women.
Decreased, Increased
Patients with the _____ gene mutation have an increased risk for breast and ovarian cancers.
BRCA
What form of the BRCA gene is associated with an increase in the risk of developing ovarian
carcinoma as well as breast cancer?
BRCA1
What form of the BRCA gene is associated with a small increase in the risk of developing
ovarian carcinoma but is associated more frequently with male breast cancer?
BRCA2
True or False: Most women diagnosed with breast cancer have a family history of breast
cancer.
False, 15% of women diagnosed with breast cancer have a family history, conversely 85% of
new diagnosis have no family history of breast cancer.
True or False: Genetic testing for breast cancer is usually limited to individuals with a strong
family history or those belonging to certain ethnic groups.
True
True or False: The major susceptibility genes for breast cancer are proto oncogenes.
False, the major susceptibility genes for breast cancer are tumor suppressors.
True or False: The majority of sporadic cancers occur in postmenopausal women and are
estrogen receptor negative.
False, the majority of sporadic cancers occur in postmenopausal women and are estrogen
receptor positive.
The _____ proposes that malignant changes occur in a stem cell population that has unique
properties distinguishing them from more differentiated cells.
Cancer stem cell hypothesis
The most likely cell type of origin for the majority of breast carcinomas is the _____ cell.
Estrogen receptor-expressing luminal cell
The most likely cell type of origin for estrogen receptor negative breast carcinomas is the _____
cell.
Estrogen receptor-negative myoepithelial cell
Place the following inorder according to the proposed precursor-carcinoma sequences in breast
cancer: High grade DCIS, Proliferative disease, Atypical hyperplasia, Non-proliferative disease,
Low/moderate grade DCIS
Non-proliferative disease > Proliferative disease > Atypical hyperplasia > Low/moderate grade
DCIS > High grade DCIS
True or False: Greater than 95% of breast malignancies are squamous cell carcinomas.
False, greater than 95% of breast malignancies are adenocarcinomas.
Breast carcinomas are divided into in situ carcinomas and invasive carcinomas. _____ refers to
a neoplastic proliferation that is limited to ducts and lobules by the basement membrane.
Carcinoma in situ
Breast carcinomas are divided into in situ carcinomas and invasive carcinomas. _____ refers to
a neoplastic proliferation that has penetrated through the basement membrane into the stroma.
Invasive carcinoma
What are the two different histological types of breast cancer?
(1) Ductal (2) Lobular
Breast cancers are divided histologically into ductal and lobular. By current convention, _____
refers to carcinomas of a specific type, and _____ is used more generally for adenocarcinomas
that have no other designation.
Lobular, Ductal
Among cancers detected mammographically, almost half are _____.
Ductal carcinoma in situ (DCIS)
In terms of breast cancer, _____ consists of a malignant clonal population of cells limited to
ducts and lobules by the basement membrane.
Ductal carcinoma in situ (DCIS)
What are the five architectural types of ductal carcinoma in situ (DCIS)?
(1) Comedocarcinoma (2) Solid (3) Cribriform (4) Papillary (5) Micropapillary
Ductal carcinoma in situ (DCIS) can be divided into comedocarcinoma and noncomedo DCIS.
_____ is characterized by the presence of solid sheets of pleomorphic cells with high-grade
hyperchromatic nuclei and areas of central necrosis?
Comedocarcinoma
Ductal carcinoma in situ (DCIS) can be divided into comedocarcinoma and noncomedo DCIS.
_____ consists of a monomorphic population of cells with nuclear grades ranging from low to
high.
Noncomedo
What noncomedo architectural type of ductal carcinoma in situ (DCIS) has intraepithelial spaces
are evenly distributed and regular in shape (cookie cutter-like)?
Cribriform
What noncomedo architectural type of ductal carcinoma in situ (DCIS) completely fills the
involved spaces?
Solid
What noncomedo architectural type of ductal carcinoma in situ (DCIS) grows into spaces along
fibrovascular cores that typically lack the normal myoepithelial cell layer?
Papillary
What noncomedo architectural type of ductal carcinoma in situ (DCIS) is recognized by bulbous
protrusions without a fibrovascular core, often arranged in complex intraductal pattern?
Micropapillary
_____ is a rare manifestation of breast cancer (1% to 4% of cases) that presents as a unilateral
erythematous eruption with a scale crust. It often associated with pruritus and is sometimes
mistaken for eczema.
Pagets disease
True or False: Paget's disease is rarely associated with an underlying breast cancer.
False, 95% of patients with paget's disease will have breast cancer.
True or False: The breast carcinomas associated with pagets disease are usually well
differentiated, estrogen receptor positive, and underexpress HER2/neu.
False, the breast carcinomas associated with pagets disease are usually poorly differentiated,
estrogen receptor negative, and overexpress HER2/neu.
DCIS with microinvasion is diagnosed when there is an area of invasion through the basement
membrane into stroma measuring no more than _____ cm.
0.1
Ductal carcinoma in situ (DCIS) can be divided into comedocarcinoma and noncomedo DCIS.
What type is most commonly associated with microinvasion?
Comedocarcinoma
True or False: Ductal carcinoma in situ (DCIS) usually progresses to invasive cancer if not
treated appropiately.
True
What are the three major risk factors for recurrence of breast cancer?
(1) Grade (2) Size (3) Margins
True or False: Breast conservation is appropriate for most women with ductal carcinoma in situ
(DCIS).
True
_____ for ductal carcinoma in situ (DCIS) is curative for over 95% of patients and is associated
with the smalled risk of recurrence.
Mastectomy
What type of carcinoma in situ is always an incidental biopsy finding, since it is not associated
with calcifications or stromal reactions that produce mammographic densities?
Lobular carcinoma in situ
True or False: Lobular carcinoma in situ (LCIS) is bilateral in most cases.
False, lobular carcinoma in situ is bilateral in 20-40% of cases.
True or False: Lobular carcinoma in situ (LCIS) is most common in postmenopausal women.
False, lobular carcinoma in situ is more common in young women, with 80% to 90% of cases
occurring before menopause.
What type of carcinoma in situ is associated with a loss of expression of e-cadherin, a
transmembrane cell adhesion protein that contributes to the cohesion of normal breast epithelial
cells?
Lobular carcinoma in situ
What type of carcinoma in situ is often said to be dyscohesive?
Lobular carcinoma in situ
True or False: Overexpression of HER2/neu is common in patients with lobular carcinoma in
situ.
False, overexpression of HER2/neu is not observed in patients with lobular carcinoma in situ.
True or False: Lobular carcinoma in situ and ductal carcinoma in situ progress to invasive
carcinomas at similar frequencies.
True
In the absence of mammographic screening, invasive carcinoma almost always presents as a
_____.
Palpable mass
What percent of palpable breast tumors are associated with axillary lymph node metastases?
50%
True or False: In older women undergoing mammography, invasive carcinomas most commonly
present as a radiopaque mass.
False, in older women undergoing mammography, invasive carcinomas most commonly present
as a radiodense mass.
What is the most common type of carcinoma in situ?
Ductal carcinoma in situ (DCIS)
True or False: Most invasive breast carcinomas are no special type carcinomas.
True
What type of invasive carcinoma is often described as scirrhous/hard?
No special type (NST)
_____ differentiated ductal carcinomas show prominent tubule formation, small round nuclei,
and rare mitotic figures.
Well-differentiated
_____ differentiated ductal carcinomas may have tubules, but solid clusters or single infiltrating
cells are also present.
Moderately differentiated
_____ differentiated ductal carcinomas often invade as ragged nests or solid sheets of cells with
enlarged irregular nuclei.
Poorly differentiated
In terms of invasive ductal breast cancer, what profile of gene expression is the largest group
and consists of cancers that are estrogen receptor positive and HER2/neu negative?
Luminal A
In terms of invasive ductal breast cancer, what profile of gene expression is estrogen receptor
positive, has an increased poliferative rate, and is HER2/neu positive?
Luminal B
In terms of invasive ductal breast cancer, what profile of gene expression is estrogen receptor-
positive, HER2/neu-negative, and characterized by the similarity of its gene expression pattern
to normal tissue?
Normal breask-like
In terms of invasive ductal breast cancer, what profile of gene expression is notable for its
absence of estrogen receptor, PR, and HER2/neu (triple-negative) and the expression of
markers typical of myoepithelial cells?
Basal-like
Many basal like carcinomas are associated with the _____ gene mutation.
BRCA1
In terms of invasive ductal breast cancer, what profile of gene expression is estrogen receptor
negative with an overexpress HER2/neu?
HER2 positive
A HER2 positive gene profile is associated with an elevated risk of _____ metastasis.
Brain
_____ receptor positive breast cancers are very responsive to chemotherapy and herceptin (or
trastuzumab)
Her2/neu receptor
_____ receptor positive breast cancers are less responsive to chemotherapy and more
responsive to hormonal therapy (tamoxifen).
Estrogen receptor
What type of invasive carcinoma has been reported to have a greater incidence of bilaterality?
Invasive lobular carcinomas
What type of invasive carcinoma is associated with the presence of dyscohesive infiltrating
tumor cells, often arranged in single ("indian") file or in loose clusters or sheets?
Invasive lobular carcinomas
What type of invasive carcinoma is most common in women in the sixth decade and presents as
a soft well-circumscribed mass?
Medullary carcinoma
Medullary carcinomas have a _____ gene expression profile.
Basal-like
What type of invasive carcinoma is most common in older women and tends to grow slowly over
the course of many years?
Mucinous (colloid) carcinoma
What type of invasive carcinoma is has the consistency and appearance of pale gray-blue
gelatin?
Mucinous (colloid) carcinoma
What type of invasive carcinoma is typically detected as small irregular mammographic
densities in women in their late 40s?
Tubular carcinoma
More than 95% of tubular carcinomas are estrogen receptor _____ and HER2/neu _____.
Positive, Negative
True or False: Tubular carcinoma has a poor prognosis.
False, tubular carcinoma has an excellent prognosis.
What type of invasive carcinoma is composed of well-formed angulated tubules lined by a single
layer of cells with small uniform nuclei?
Tubular carcinoma
Metaplastic carcinomas have a _____ gene expression profile.
Basal-like
What two type of invasive carcinoma have a basal-like pattern of gene expression?
(1) Medullary (2) Metaplastic
True or False: Invasive carcinomas with basal like gene expression profiles have a relatively
good prognosis.
False, invasive carcinomas with basal like gene expression profiles have a relatively poor
prognosis.
What are the six major prognostic factors of breast cancer?
(1) Invasive carcinoma vs. in situ disease (2) Distant metastases (3) Lymph node metastases
(4) Tumor size (5) Locally advanced disease (6) Inflammatory carcinoma
_____ is an enlargement of the male breast.
Gynecomastia
What is the most important cause of hyperestrinism in men?
Cirrhosis of the liver
Gynecomastia can occur anytime in adult life when there is cause for _____.
Hyperestrinism
What form of the BRCA gene is most associated with an increase in the risk of developing male
breast cancer?
BRCA2
What chromosomal abnormality is sometimes associated with male breast carcinoma?
Klinefelter syndrome
True or False: The majority of all male breast cancers are estrogen receptor positive.
True
