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BRCA-1 features?
- Chromosome 17
- Associated with invasive ductal carcinoma, poorly differentiated
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BRCA-2 features?
- Chromosome 13
- Invasive ductal carcinoma – well differentiated
- Associated with melanoma
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Risk assessment model for breast cancer?
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Hereditary Breast Cancer
- - BRCA and
- - PLACH: PJS, Li-Fraumeni, Ataxia telangiectasia, Cowden’s, HNPCC
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Histological types of DCIS (five types)1.
- ComedocarcinomaQ2.
- CribiformQ3.
- MicropappilaryQ4.
- Solid5.
- PapillaryQ
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Origin of LCIS?
Terminal duct lobular units , increased risk in both breasts
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Histologic hallmark of invasive lobular carcinoma?
- Tendency of tumor cells to invade in linear strands (Indian file pattern)Q/single file pattern
- Usually the incidental finding
- Usually multicentric, multifocal and bilateral
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Metastatic pattern of Invasive lobular carcinoma?
Different pattern of metastases, propensity to involve peritoneal surface and meningesQ, less likely to metastasize to lungs or bone.
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Most common bone to metastasis in breast cancer?
Lumbar vertebra
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Calcification pattern in LCIS?
Neighborhood calcification is a unique feature of LCISQ and contributes to its diagnosis.
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Treatment of LCIS?
Observation/ Chemoprevention/ Prophylactic bilateral mastectomyQ
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Lymphatic spread of breast?
- Lymphatic spread in CA breast occurs through subareolar lymphatic plexus of Sappey’s lymphatic plexus, cutaneous lymphatics and inflammatory lymphaticsQ.
- Axillary (75%)Q and the internal mammary lymph nodesQ.
- Tumors in the posterior one third of the breast are more likely to drain to the internal mammary nodesQ.
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Nottingham Prognostic Index (NPI)
NPI= (0.2 X tumor size in cm) + Tumor grade (1-3) + LN stage (1-3)Q
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Most common type of breast cancer?
Invasive Carcinoma (MC) is the most common. Ductal carcinoma is most common variant of invasive carcinoma
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Age of presentation of DCIS and LCIS/
- LCIS – Early (44-47 years)
- DCIS – Late (54-58 years)
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Retraction of nipple is due to
fibrosis in and around subareolar duct
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Retraction/dimpling of skin is due to
involvement of cooper’s ligament
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Peau-D-orange is due to
blockage of subdermal lymphatics
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VanNuys Prognostic Index (VNPI) is used for
DCIS
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Tumor Staging of breast cancer?
T1: Tumor ≤2 cm
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T2: Tumor >2 cm and ≤5 cm
- T3: Tumor >5 cm
- T4a: Extension to chest wall, not including pectoralis muscle
- T4b: Edema (including peau d’orange) or ulceration of skin, or satellite skin nodules confined to the same breast
- T4c: Both T4a and T4b
- T4d: Inflammatory carcinoma
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Node staging of breast cancer?
- N1: Metastasis to movable ipsilateral axillary LNs
- N2a: Metastasis in ipsilateral axillary LNs fixed or matted
- N2b: Metastasis in clinically apparent ipsilateral internal mammary LNs and in the absence of clinically evident axillary LNs metastasis
- N3a: Metastasis in ipsilateral infraclavicular LNs
- N3b: Metastasis in ipsilateral internal mammary LNs and axillary LNs
- N3c: Metastasis in ipsilateral supraclavicular LNs
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Simple or Total mastectomy?
Removal of breast tissue, nipple-areola complex, and skinQ.
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Modified radical mastectomy?
Removes all breast tissue, nipple-areola complex, skin and level I and II axillary LNsQ.
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Halstead’s radical mastectomy?
Removes all breast tissue and skin, nipple areola complex, pectoralis major and minor muscles and the level I, II and III axillary LNsQ.
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