From the Guidelines
Breast cancer can be broken down into four main categories for easy remembrance on general surgery oral boards: noninvasive carcinomas (such as lobular carcinoma in situ and ductal carcinoma in situ), operable locoregional invasive carcinoma, inoperable locoregional invasive carcinoma, and metastatic or recurrent carcinoma. When considering malignant breast disease, it's crucial to understand the diagnosis, staging, and management strategies. Breast cancer is primarily classified as ductal or lobular, with ductal carcinoma in situ (DCIS) being non-invasive and invasive ductal carcinoma (IDC) being the most common invasive type 1. Key aspects to remember include:
- Risk factors: age, family history, BRCA mutations, early menarche, late menopause, and hormone replacement therapy.
- Diagnosis: triple assessment including clinical examination, imaging (mammography, ultrasound, MRI), and tissue sampling (core needle biopsy) 1.
- Staging: uses the TNM system, evaluating tumor size (T), lymph node involvement (N), and metastasis (M).
- Treatment options: surgery (breast-conserving surgery or mastectomy with sentinel lymph node biopsy or axillary dissection), radiation therapy, chemotherapy, hormonal therapy, and targeted therapy.
- Molecular subtypes guide treatment: Luminal A, Luminal B, HER2-enriched, and Triple-negative breast cancer, with prognosis depending on stage, grade, molecular subtype, and response to therapy 1. It's also important to note that patient preference plays a significant role in the decision-making process, especially when survival rates are equivalent among available treatment options 1. In terms of specific treatment approaches, the most recent and highest quality study recommends that breast cancer treatment be divided into the treatment of local disease with surgery, radiation therapy, or both, and the treatment of systemic disease with cytotoxic chemotherapy, endocrine therapy, biologic therapy, or combinations of these 1.
From the FDA Drug Label
The safety and efficacy of trastuzumab in women receiving adjuvant chemotherapy for HER2 overexpressing breast cancer were evaluated in an integrated analysis of two randomized, open-label, clinical trials (Studies NSABP B31 and NCCTG N9831) Breast tumor specimens were required to show HER2 overexpression (3+ by IHC) or gene amplification (by FISH) Disease characteristics included 90% infiltrating ductal histology, 38% T1, 91% nodal involvement, 27% intermediate and 66% high grade pathology, and 53% ER+ and/or PR+ tumors
To break down malignant breast disease in an easy-to-remember way for general surgery oral boards, consider the following key points:
- HER2 status: Breast cancer can be classified as HER2-positive or HER2-negative, with HER2-positive tumors having a worse prognosis.
- Tumor characteristics:
- Histology: Infiltrating ductal carcinoma is the most common type.
- Tumor size: T1 tumors are smaller, while larger tumors have a worse prognosis.
- Nodal involvement: The presence of lymph node metastases indicates a worse prognosis.
- Grade: High-grade tumors have a worse prognosis than low-grade tumors.
- Hormone receptor status:
- ER+ and/or PR+: Tumors that are estrogen receptor-positive and/or progesterone receptor-positive may respond to hormonal therapy.
- ER- and PR-: Tumors that are negative for both estrogen and progesterone receptors may not respond to hormonal therapy. 2
From the Research
Malignant Breast Disease Breakdown
To break down malignant breast disease in an easy-to-remember way for general surgery oral boards, consider the following key points:
- Unusual malignant breast tumors account for about 10% of malignant breast tumors and include subtypes such as mucinous, tubular, medullary, and papillary carcinomas 3
- These tumors can exhibit MRI features similar to those of benign or low suspicious lesions, making diagnosis challenging 3
- Understanding the pathologic features of these tumors, including tissue content and growth pattern, can help define specific clues for diagnosis 3
Key Tumor Subtypes
Some key tumor subtypes to remember include:
- Mucinous carcinoma
- Medullary carcinoma
- Tubular carcinoma
- Intraductal papillary carcinoma
- Invasive papillary carcinoma These subtypes can be distinguished by their unique MRI characteristics and pathologic features 3
Diagnostic Considerations
When diagnosing malignant breast disease, consider the following:
- MRI characteristics, including shape, margins, signal intensity, and dynamic curve 3
- Pathologic features, including tissue content and growth pattern 3 Note that there is no direct evidence from the provided studies to support the breakdown of malignant breast disease in the context of general surgery oral boards, except for the information on unusual malignant breast tumors 3. The study on oral cancer 4 is not relevant to this topic.