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Questions and Answers
Which of the following tumor characteristics is associated with a worse prognosis in breast cancer?
Which of the following tumor characteristics is associated with a worse prognosis in breast cancer?
- Tumor size less than 1cm
- Tumor with a discrete lymph node involvement
- Tumor located in the upper outer quadrant
- Tumor size greater than 2cm (correct)
What is the primary reason for the poor prognosis of breast cancer in pregnant women?
What is the primary reason for the poor prognosis of breast cancer in pregnant women?
- Increased risk of metastasis to the liver and peritoneum
- Hormonal stimulation of the tumor by estrogen and progesterone
- Impaired immunity due to pregnancy-related immunosuppression
- Delayed diagnosis due to nodular changes in the breast during pregnancy (correct)
Which of the following patient-related factors is associated with a worse prognosis in breast cancer?
Which of the following patient-related factors is associated with a worse prognosis in breast cancer?
- Non-invasive ductal carcinoma in situ
- Male sex (correct)
- Obesity
- Older age
What is the most important prognostic factor among tumor-related factors in breast cancer?
What is the most important prognostic factor among tumor-related factors in breast cancer?
Which of the following tumors has a good prognosis in breast cancer?
Which of the following tumors has a good prognosis in breast cancer?
What is the significance of internal mammary lymph node involvement in breast cancer?
What is the significance of internal mammary lymph node involvement in breast cancer?
Which of the following breast cancer stages has the best prognosis?
Which of the following breast cancer stages has the best prognosis?
What is the significance of skin and nipple invasion in breast cancer?
What is the significance of skin and nipple invasion in breast cancer?
What is the effect of obesity on breast cancer prognosis?
What is the effect of obesity on breast cancer prognosis?
Which of the following is a tumor-related factor that affects breast cancer prognosis?
Which of the following is a tumor-related factor that affects breast cancer prognosis?
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Study Notes
Breast Cancer Pathology and Staging
- Cells can seed into the peritoneal cavity
- Intercostal veins can metastasize to the vertebral plexus (Batson plexus), causing:
- Nodules in Douglas pouch
- Vertebral metastases (Lumbar vertebrae), which are osteolytic (90%), osteosclerotic (5%), or mixed (5%)
TNM Staging
- Tx: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ (ductal or lobular CIS, Paget's disease without mass)
- T1: < 2cm (Tmic: microinvasion < 1mm, T1a: >0.5cm, T1b: >0.5-1cm, T1c: 1-2cm)
- T2: 2-5 cm
- T3: >5 cm
- T4: Any size with:
- T4a: Fixation to chest wall (ribs, intercostal ms, serratus anterior ms)
- T4b: Skin involvement (direct infiltration, ulceration, peaud orange, satellite nodules)
- T4c: a & b
- T4d: Mastitis carcinomatosis
Lymph Node Metastasis
- Nx: Regional L.N. cannot be assessed
- N0: No regional L.N. metastasis
- N1: Ipsilateral mobile axillary L.N.
- N2:
- A: Ipsilateral matted axillary L.N.
- B: Ipsilateral internal mammary L.N. without axillary L.N.
- N3:
- A: Ipsilateral infraclavicular L.N.
- B: Ipsilateral internal mammary with axillary L.N.
- C: Ipsilateral supraclavicular L.N.
- M0: No evidence of metastasis
- M1: Distant metastasis or contralateral breast or L.N.
AJCC Staging
- American Joint Committee Cancer (AJCC) staging system
Pathology
- Skin changes due to direct infiltration:
- Skin dimpling, tethering, and puckering (earliest sign)
- Skin changes due to lymphatic infiltration:
- Peau d'orange (thick, non-pitting edematous skin)
- Cancer en cuirasse (late sign, pathognomonic)
- Cancerous satellite nodules (late sign, pathognomonic)
Prognostic Factors
- Patient-related factors:
- Age (young age = worse prognosis)
- Sex (male = worse prognosis)
- Pregnancy (worse prognosis)
- Obesity (bad prognosis)
- Tumor-related factors:
- L.N. involvement (most important)
- Number of L.N.
- Size (< 1cm = better, > 2cm = worse)
- Discrete vs. matted L.N.
- Level of L.N.
- Site (lower inner quadrant = worst)
- Metastasis (presence of distant metastases = worse)
- Pathology type (medullary, mucinous = better prognosis)
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