Breast cancer

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Breast cancer

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Questions

USMLE® Step 1 style questions USMLE

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A 50-year-old woman comes for a follow-up meeting after she was diagnosed with invasive ductal carcinoma breast cancer. A 2-cm spiculated lesion was seen on mammography and confirmed with biopsy. She would like to know what the prognosis is for her condition. Which of the following findings is the worse prognostic factor for her conditions?  

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2024

2023

2022

2021

Aromatase inhibitors p. 674

breast cancer p. 725

Axillary lymph nodes

breast cancer and p. 668

BRCA1/BRCA2 genes p. 220

breast cancer and p. 668

Breast cancer

hypercalcemia and p. 219

incidence/mortality of p. 202

key associations p. 734

oncogenes and p. 220

paclitaxel for p. 445

paraneoplastic cerebellar degeneration and p. 219

postmenopausal women p. 725

tamoxifen for p. 446

trastuzumab for p. 446

tumor suppressor genes and p. 220

Breast tumors (malignant) p. 668-669

aromatase inhibitors for p. 674

breastfeeding and p. 646

hormonal contraception contraindication p. 675

Estrogen p. 648, 674

benign breast tumors p. 667

breast cancer p. 668

Inflammatory breast carcinoma p. 668

Lymph drainage

malignant breast tumors p. 668

Obesity

breast cancer risks p. 668

Tamoxifen p. 446, 674

for breast cancer p. 725

Transcript

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Breast cancer, or breast carcinoma, is an uncontrolled growth of epithelial cells within the breast. It’s the second most common cancer in women, but can also, on rare occasion, affect men as well.

Breast cancer is also the second leading cause of cancer deaths in women after lung cancer. This is largely due to the fact that oftentimes breast cancers don’t cause any pain or discomfort until they’ve spread to nearby tissues.

The breasts are milk-producing glands that sit on the chest wall, on either side of the breast-bone. They lie on top of the ribs and the pectoral muscles, and they’re divided into three main parts.

The glandular tissue that makes the milk, is made up of 15 to 20 lobules. Inside each of these lie a bunch of grape-like structures called the alveoli, which are modified sweat glands surrounded by a basement membrane made largely of collagen.

Zooming in on the alveoli, there’s a layer of alveolar cells that secrete breast milk into the lumen which is the space in the center of the gland.

Wrapping around the alveolus are special myoepithelial cells that squeeze down and push the milk out of the lumen of the alveolus, down the lactiferous ducts, and out one of the pores on the nipple.

Now, surrounding the glandular tissue is the stroma, which contains adipose or fat tissue, and this makes up the majority of the breast.

Suspensory ligaments called Cooperʼs ligaments, run through the stroma and help keep it in place. These ligaments attach to the inner surface of the breast skin on one end and the pectoralis muscles on the other.

Just below the skin over the breast, there’s a network of tiny lymphatic vessels that drain the lymph, which is a fluid containing cellular waste products and white blood cells. These lymphatic vessels mainly drain into a group of lymph nodes in the axilla, or the armpit.

Now, the cells of glandular tissue have receptors for certain hormones like, estrogen and progesterone, which are released by the ovaries, and prolactin which is released by the pituitary gland.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Mammographic Density and the Risk and Detection of Breast Cancer" New England Journal of Medicine (2007)
  6. "Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy" The Lancet (2012)
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