Regarding breast cancer all are true except
Invasive Breast Carcinoma Invasive breast cancers have been described as lobular or duc- tal in origin.128-131 Early classifications used the term lobular to describe invasive cancers that were associated with LCIS, whereas all other invasive cancers were referred to as ductal. Current histologic classifications recognize special types of breast cancers (10% of total cases), which are defined by spe- cific histologic features. To qualify as a special-type cancer, at least 90% of the cancer must contain the defining histologic features. invasive breast cancers are described as invasive ductal carcinoma of no special type (NST). These can- cers generally have a worse prognosis than special-type cancers. Foote and Stewa originally proposed the following classifica- tion for invasive breast cancer125: 1. Paget's disease of the nipple 2. Invasive ductal carcinoma--Adenocarcinoma with produc- tive fibrosis (scirrhous, simplex, NST), 80% 3. Medullary carcinoma, 4% 4. Mucinous (colloid) carcinoma, 2% 5. Papillary carcinoma, 2% 6. Tubular carcinoma, 2% 7. Invasive lobular carcinoma, 10% 8. Rare cancers (adenoid cystic, squamous cell, apocrine) Medullary carcinoma is a special-type breast cancer; it accounts for 4% of all invasive breast cancers and is a frequent phenotype of BRCA1 hereditary breast cancer. Grossly, the can- cer is soft and hemorrhagic. A rapid increase in size may occur secondary to necrosis and hemorrhage. On physical examina- tion, it is bulky and often positioned deep within the breast. Bilaterality is repoed in 20% of cases. Medullary carcinoma is characterized microscopically by: (a) a dense lymphoreticular infiltrate composed predominantly of lymphocytes and plasma cells; (b) large pleomorphic nuclei that are poorly differentiated and show active mitosis; and (c) a sheet-like growth pattern with minimal or absent ductal or alveolar differentiation. Approxi- mately 50% of these cancers are associated with DCIS, which characteristically is present at the periphery of the cancer, and <10% demonstrate hormone receptors. In rare circumstances, mesenchymal metaplasia or anaplasia is noted. Because of the intense lymphocyte response associated with the cancer, benign or hyperplastic enlargement of the lymph nodes of the axilla may contribute to erroneous clinical staging. Women with this cancer have a better 5-year survival rate than those with NST or invasive lobular carcinoma. Ref: schwaz's principles of surgery 10th edition Pgno: 521
Increase with increasing age
Medullary cancer has the poorest prognosis
Involvement of subdermal lymphatic carries bad prognosis
Increased incidence with estrogen exposure
Endocrinology and breast