Clinical features, risk factors, and prognosis
Pathophysiology
Imaging in screening, diagnosis, and staging
General management strategies
Miscellaneous
100
What's the most frequently diagnosed form of cancer worldwide & the leading cause of cancer mortality in women?
Peak incidence - Pre-menopause or post-menopause?
Breast cancer;
- Peak incidence
- Postmenopausal
100
BRCA are tumor suppressor genes that code for a DNA repair protein.
What is their inheritance pattern?
Autosomal-dominant
- Associated with an increased risk for breast cancer and ovarian cancer
100
Arrows show:
Arrows:
hematoxylin-eosin stain; original magnification, ×4) shows tumor cells within lymphatic vessels in the dermis
100
Why are Estrogen & progesterone receptors important here?
100
Testing for inherited BRCA1 and BRCA2 variants may be done using a __ sample
a blood sample or a saliva sample
Extra 100: Both men and women who inherit a harmful BRCA1 or BRCA2 variant, whether or not they develop cancer themselves, may pass the variant to their children. Each child has a __% chance of inheriting a parent’s variant. Why?
200
Prognosis?
(5-year survival rate?)
5-year survival rate is ∼ 40%
- All stages: 90.3%
- Stage I (local): 99%
- Stage II or III (regional): 85.8%
- Stage IV (distant): 29%
- Unstaged: 57.8%
200
Name at least two most common metastasis regions of breast cancer
200
What's typically done to evaluate a palpable breast mass?
History(including breast cancer risk assessment),
Physical Exam,
Imaging,
then Biopsy
200
Difference between SNL biopsy & ALN dissection?
(maybe # of lymph nodes removed?)
1-5 in SNL
vs
10-40 in ALN during mastectomy, simultaneously
200
__ are tumor suppressor genes that code for a DNA repair protein
Associated with an increased risk for breast cancer and ovarian cancer
Men with breast cancer are often positive for ___2
300
Name 3 risk factors
300
Case: The patient is a 39 y/o & has not yet undergone a screening mammogram despite multiple family hx of cancer.
What's the recommended age for starting annual mammogram screening?
40 to 49: The decision to start screening should be an individual one(in this case, most likely recommended)
50 to 74: Biennially
300
Standard adjuvant treatment of HER2 receptor–positive disease is trastuzumab with or without pertuzumab for 1 year after surgery.
What is the MOA of Trastuzumab?
As an antibody, one of the major mechanisms of trastuzumab is to attract immune cells to tumor sites that overexpress HER2, by a mechanism called antibody-dependent cellular cytotoxicity (ADCC).
300
Who does Multidisciplinary team consist of?
Name at least two besides breast surgeon and oncologist.
Recommendations for specialist referral
- Refer to plastic surgeon for reconstructive surgery
- Refer to fertility specialist for counseling of patients who are of childbearing age regarding options for fertility preservation
- Refer to genetic counselor, medical geneticist, or clinician experienced in cancer genetics if genetic testing for breast cancer susceptibility genes is indicated 62
- Refer to palliative care team for advanced disease
400
Name this symptom in french & the most common cause of it is _____
ALSO, Name at least another clinical feature of this cancer.
extra 100: patients with this type of cancer ^ or locally advanced tumors with skin and/or chest wall involvement should undergo: (Axillary Node dissection Or Sentinel Node Biopsy?)
Peau d' orange; Inflammatory breast cancer
- Tenderness
- Signs of metastatic disease (e.g., axillary lymphadenopathy)
- Usually no palpable mass
Former
400
How to differentiate Benign vs Malignant Lesion - Mammography findings?
(think: appearance of the lesion, margins, calcifications, further management?)
- Benign vs Malignant:
- Well-defined, circumscribed mass vs Focal mass or density
- Surrounding radiolucent ring (halo sign) vs Poorly defined, spiculated margins
- Diffuse microcalcification or coarse vs calcification
- Clustered microcalcifications vs Regular check-ups
- Possibly surgical excision vs Fine needle aspiration or core needle biopsy
400
Treatment - drug for Pre-menopausal women?
MOA?
Tamoxifen:
Competitive antagonist on the estrogen receptors of the breast → ↓ breast cancer cell growth
(Tamoxifen for 5 years with or without ovarian suppression or ablation, followed by either an additional 5 years of tamoxifen or an aromatase inhibitor to complete 10 years of endocrine treatment
Aromatase inhibitor therapy for 5 years plus ovarian suppression or ablation)
400
Breast cancers with harmful BRCA1 variants are more likely to be "triple-negative cancers."
What does Triple-Negative cancer mean?
The breast cancer cells do not have estrogen receptors, progesterone receptors, or large amounts of HER2/neu protein) than sporadic breast cancers or breast cancers with harmful BRCA2 variants.
Triple-negative cancers are harder to treat and have a poorer prognosis than other types of breast cancers.
500
Name at least two possible mutations
500
Inflammatory breast cancer (stage T4dN2M0, ER negative, PR negative, HER2 negative fluorescence in situ hybridization )
View?
Arrows?
Red Oval?
View: Mediolateral oblique mammogram
Arrows: skin thickening (involving more than one-third of the breast)
Red Oval: two irregular masses, and enlarged left axillary lymph nodes
US-guided core biopsy of the dominant mass (*) at the 11-o’clock position posterior depth showed invasive lobular carcinoma
500
Treatment method for patients with inflammatory breast cancer or locally advanced tumors with skin and/or chest wall involvement?
Patients with inflammatory breast cancer or locally advanced tumors with skin and/or chest wall involvement should undergo axillary node dissection(simultaneously w/ mastectomy) rather than sentinel node biopsy.
After total mastectomy, both Chest wall & Regional nodal irradiation.
Then, Systemic Therapy: chemotherapy, endocrine therapy, and HER2-targeting biologic therapies; other targeting agents; and immune checkpoint inhibitors.
500
Proper methods of Self Breast Cancer Examination?
- Pretend you are teaching/advising a patient/family member
A) Inspection: Look at breasts directly in a mirror, with the arms at the sides, then raised above the head. Inspect the shape of each breast and look for changes in skin texture (e.g., dimpling, puckering, orange-peel texture).
B) Palpation of breast tissue in each of the four patterns depicted to cover all breast tissue
C) Palpation of the nipple: Squeeze the nipple gently and inspect for discharge (milky or bloody).
D) Palpation of axillary breast tissue: While lying down, palpate the axillary tail of the breast, which extends into the axilla.
