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Breast Malignancies Overview


--majority originate in glandular tissue and are adenocarcinomas
--lobular and ductal tissues are both considered glandular tissues

MAJOR RISK FACTORS
--being female (men can have breast tissue and get CA but it's doggone uncommon)
--aging
--hx of breast CA
--family hx of both mother & sis w/ breast CA
--daily alcohol intake over 2 glasses
--high premenopausal blood levels of IGF-1 (insulin-like growth facct0r)
--high post menopausal estrogen levels

MODERATE RISK FACTORS
--over 30 at first full term preg
--any 1st degree relative with hx of breast CA
--hx of benign proliferative lesion, dysplastic mammographic changes
--high dose of ionizing radiation to chest!! (mammogram is moderate risk factor)
--tobacco use
--nulliparity
--early menarche (<11 yrs)
--late menopause (>55)
--high fat diet, saturated fat rich diet
--post-menopausal obesity
--residence in urban areas and northern US (dt low vt d???)
--highest rate on planet in urban NE US
--caucasian race and over 45
--african-american and younger than 45
--hx of endometrial or ovarian CA

PROTECTIVE FACTORS
--over 15 at menarche
--breastfeeding over a year
--physical activity
--minimal alcohol consumption
--no tobacco use
--mono-unsaturated fat rich diet

SUSCEPTIBILITY
--common denominator: level and duration of exposure to endogenous estrogens
--contributing factors: early menarche, regular ovulation, late menopause, obesity, hormone replacement
--clonal line of malignant cells arising dt multiple genetic mutations
--early mutations mb inherited (mutations of breast stem cells) or acquired (radiation, chemical carcinogens, oxidative damage)
--estrogens proliferate breast epithelium-->increase the odds of DNA replication errors
--pregnancy decreases breast tissue susceptibility to somatic mutations
--earlier first preg: shorter susceptible period after menarche
--breast ca may recur in same area even after mastectomy, always exams scars & removal area

EXAM FINDINGS
--breast mass firm and hard
--painless (only painful 10-15% of the time)
--irregular borders
--mb fixed to skin or chest wall
--skin dimpling, "peau de orange"
--nipple retraction
--bloody discharge

TYPES
--ductal aka intraductal is most common, 60-80%
--lobular 30%
--nipple aka Paget's dz <5%
--other forms: inflammatory

DUCTAL CARCINOMA IN SITU-->INFILTRATING DUCTAL CARCINOMA
--DIC/IDC
--nearly 80% of all are this: most common type
--usu single hard fixed mass w/ irreg borders
--scirrhous = hard and gritty, white w/ Ca++
--cords and nests of neoplastic cells
--pleomorphic cells throughout stroma, heterogenicity of malignant duct cells
--comedo and non-comedo types, comedo has necrotic tissue and worse prognosis
--non-comedo type: cribiform, better prognosis
--Tx: lumpectomy and radiation, or mastectomy

LOBULAR CARCINOMA
--second most common histologic type after ductal
--5-10% of all
--high risk for multiple loci in affected breast or in both
--basement membrane intact
--single file invasion
--signet ring in any carcinoma means worse prognosis

PAGET'S DISEASE OF THE BREAST
--relatively uncommon, ductal in which the malig cells migrate to surface
--involves nipple and areola, looks like eczema
--often in assoc w/ underlying in-situ or invasive carcinoma
--Sx: persistent change in senation of nippe/areola usu burning & itching
--later stages may ulcerate, erosive, disfiguring
--pale cytoplasm, eccentric round nucleus


INFLAMMATORY BREAST CANCER
--IBC
--a form of ductal carcinoma distinguished by markedly inflamed appearance of breast
--especially aggressive, poor prognosis, very uncomfortable
--may present w/ot a palpable lump
--Sx: red, hot, painful & shiny breast (more skin changes than other kinds), unilateral nipple inversion
mb misdxd as mastitis esp if breast feeding
mastitis makes woman feel feverish, achy, very sick, these sx missing in CA
CA lasts longer, if mastitis lasts months you better check it
1st test: mammmogram or MRI which is better but pricier, 2nd: biopsy

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