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62. Breast carcinoma. Pathogenesis, types, prognosis: Difference between revisions

62. Breast carcinoma. Pathogenesis, types, prognosis (view source)

Revision as of 09:35, 6 June 2022

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(Created page with "=== Definition and epidemiology === Breast cancer is the most common malignancy in women and it’s the second most common cause of cancer mortality. The condition is related to increased oestrogen. When we talk about breast cancer we can mean either non-invasive or invasive carcinoma. These tumors develop from different parts of the terminal duct lobular unit (TDLU). They most frequently affect the upper outer quadrant of the breast. Breast cancer is most common in old...")
 
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** Other types
** Other types


Ductal carcinoma in situ (DCIS) is the most common non-invasive carcinoma. The tumor cells originate from the duct of the terminal duct lobular unit and fill ducts of the breast. At this stage the tumor cells do not invade past the basement membrane of the ducts. If the tumor cells start to invade past the basement membrane the tumor becomes an invasive carcinoma.
'''Ductal carcinoma in situ''' (DCIS) is the most common non-invasive carcinoma. The tumor cells originate from the cells of the terminal duct lobular unit and fill ducts of the breast. The name is a bit misleading as it doesn't always develop from the ducts.
 
At this stage the tumor cells do not invade past the basement membrane of the ducts. If the tumor cells start to invade past the basement membrane the tumor becomes an invasive carcinoma.


Cells in the centre of the ducts die by necrosis as they don’t receive enough nutrients and oxygen. This forms calcifications that are visible on mammography. High grade DCIS is called the ''comedo'' type is characterised by severe atypia and extensive central necrosis and calcification.
Cells in the centre of the ducts die by necrosis as they don’t receive enough nutrients and oxygen. This forms calcifications that are visible on mammography. High grade DCIS is called the ''comedo'' type is characterised by severe atypia and extensive central necrosis and calcification.
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DCIS can also be present simultaneously as an invasive carcinoma, as seen in the invasive ductal carcinoma slide.
DCIS can also be present simultaneously as an invasive carcinoma, as seen in the invasive ductal carcinoma slide.


Lobular carcinoma in situ (LCIS) originates from the lobules of the terminal duct lobular unit. Like for DCIS the tumor cells don’t invade past the basement membrane of the lobules; when they do the condition is called invasive lobular carcinoma. LCIS doesn’t produce calcifications or masses, so they’re often discovered incidentally.
'''Lobular carcinoma in situ''' (LCIS) also originates from the the cells of the terminal duct lobular unit. This name is also a bit misleading, suggesting that it only develops in the lobule, but this is false. However, they are more frequently present in the lobules.
 
Like for DCIS the tumor cells don’t invade past the basement membrane of the lobules; when they do the condition is called invasive lobular carcinoma. The most important difference between LCIS and DCIS is that LCIS very rarely produces calcifications or masses, so they’re often discovered incidentally.


Unlike DCIS, LCIS is often multifocal and occurs in both breasts simultaneously. They’re not removed surgically but rather treated with chemotherapy and regular follow-up.
Unlike DCIS, LCIS is often multifocal and occurs in both breasts simultaneously. They’re not removed surgically but rather treated with chemotherapy and regular follow-up.
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The tumor cells in LCIS have lost an intercellular adhesion molecule called E-cadherin, which causes them to be disconnected from each other.
The tumor cells in LCIS have lost an intercellular adhesion molecule called E-cadherin, which causes them to be disconnected from each other.


Invasive carcinoma: Many subtypes of invasive carcinoma exist. All of them can cause clinical findings like:
'''Invasive carcinoma:''' Many subtypes of invasive carcinoma exist. All of them can cause clinical findings like:


* Firm, palpable mass
* Firm, palpable mass