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INVASIVE DUCTAL CARCINOMA (Treatment (Radiotheraphy and mastectomy…
INVASIVE DUCTAL CARCINOMA
Pathogenesis
Genetic changes
Overexpression of HER2/ NEU proto-oncogene (mostly in invasve breast cancer
Proliferation of neoplastic cells
Amplification of RAS gene and MYC gene
Mutation of tumour supresssor gene BRCA1, BRCA 2, RB and P53
Promote growth of abnormal cells
Inactivation of oestrogen receptor
Hormonal factor
Endogenous oestrogen excess
E4 stimulates production of growth factor
Proliferation of normal epithelial and cancer cells
Interact with oestrogen and progesterone receptor
Autocrine mechanism of tumour development
Proliferation of simple cuboidal lining the lactiferous duct
Infiltrate lactiferous duct and suspensory ligament of Cooper
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Compress blood vessel
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Environmental
Overexposure to exogenous oestrogen (HRT) or irradiation
Treatment
HERCEPTIN (transtuzumab)
Anastrozole/leptrozole
HRT (Tamoxifen)
Radiotheraphy and mastectomy
Palpable mass
Investigation
Mammography
CT Scan
Core needle biopsy
Ultrasound
Types of common breast cancer
Invasive
IDC: Invasive ductal carcinoma (most common - 80%)
Starts in the milk duct of the breast- breaks through the wall- grows in fatty tissure of the breast- can metastasize to lymphatic system
ILC: Invasive lobular carcinoma (second most common - 10%)
Starts in the milk-producing glands (lobules) - can metastasize
ILC does not form a distinct lump. Cells hardening or thickened and grow in single line- hard to see on
mammogram
Inflammatory breast cancer (less common-1-3%)
No lump or tumour (no on mammogram), breast appear red
Cancer cells block lymph vessel in the skin: pitted appearance like orange peel
Paget disease of the nipple (less common 1%)
Starts in breast ducts- spread to the skin of nipple and then to areola
Non Invasive
Ductal carcinoma in situ (DCIS)
Carcinoma in situ are contained in the milk ducts of the breast
Staging and grading IDC
Grading
Grade 1
● Nuclei show moderate variation in size or shape
● Many tubules
● Few mitosis
Grade 2
● Nuclei show moderate variation in size and shape
● No tubules
● No mitotic figures are noted
Grade 3
● Nuclei are displaying marked variation in size and shape
● No tubular formation
● Many mitoses
Staging