Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 26 2021

Invasive Ductal Carcinoma

Images
https://upload.medbullets.com/topic/120427/images/histology.jpg
https://upload.medbullets.com/topic/120427/images/idc_tumor..jpg
https://upload.medbullets.com/topic/120427/images/inverted_breast_cancer.jpg
https://upload.medbullets.com/topic/120427/images/idc_mammo..jpg
https://upload.medbullets.com/topic/120427/images/idc_h_e.jpg
  • Snapshot
    • A 51-year-old woman presents to her primary care physician with a lump in her right breast. She says it has been there for around a year. Mammography shows a dominant mass with an irregular fibrotically stranded boundary, with some of the strands seeming to extend toward the nipple. A core biopsy was done and showed the following histology.
  • Introduction
    • Overview
      • most common type of breast cancer
        • infiltrating ductal carcinoma accounts for ~76% of breast cancer cases
      • forms a solid tumor
      • most common cancer diagnosis in women
  • Epidemiology
    • Demographics
      • commonly women in mid-30s to late-50s
    • Incidence
      • 260,000 cases per year in U.S.
      • 40,000 deaths per year
    • Risk factors
      • increasing age
      • female sex
        • breast cancer can occur in men
        • < 3,000 cases per year in U.S.
      • Caucasian race
      • obesity in post-menopausal women
      • hormone replacement therapy
  • ETIOLOGY
    • Genetics
      • inheritance
        • increased risk with BRCA1 and BRCA2 gene mutation
      • mutations
        • cancer cells can be estrogen (ER)-positive, progesterone (PR)-positive, or HER2/neu-positive
        • guides targeted treatment
  • Presentation
    • Symptoms
      • asymptomatic
      • breast lump
        • most often in upper/outer quadrant
      • nipple discharge
    • Physical exam
      • firm immobile, painless lump
      • +/- inverted nipple
      • +/- skin changes
        • redness
        • ulcerations
        • edema
        • nodularity
          • skin retraction indicates involvement of Cooper ligament
      • axillary lymohadenopathy
        • more advanced cases
      • breast skin edema with dimpling ("peau d' orange") is a finding with a poor prognosis
        • represents obstruction of the lymphatics cancer
    • See Breast Cancer General
  • Imaging
    • Mammography
      • indications
        • regular screening mammography
        • evaluation following detection of a breast lump
      • findings
        • mass with an irregular, fibrotically stranded border
    • Core or excisional biopsy
      • indications
        • diagnosis
      • findings
        • gross pathology
          • hard grey-white gritty mass invading surrounding tissue in an irregular stellate shape
        • histology
          • solid nest of neoplastic cells invading the surrounding structures
          • more poorly differentiated = higher grade
          • stains positive for E-cadherin
    • Stage with TNM Staging System
  • Studies
    • Serum calcium level
      • may be elevated
    • Alkaline phosphatase
      • elevation may indicate metastasis
    • Hormone receptor tests
      • ER
      • PR
      • Her2/neu
  • Differential
    • Invasive lobular carcinoma
      • key distinguishing factors
        • gross pathology
          • often no mass lesion is evident
        • histology
          • individual invasive cells or cells in a single file
          • negative E-cadherin staining
    • Ductal carcinoma in situ (DCIS)
      • key distinguishing factor
        • no evidence of invasion on biopsy
  • Treatment
    • Medical
      • chemotherapy
        • indications
          • tumors with high risk features
          • locally advanced tumors
          • neoadjuvant chemotherapy prior to lumpectomy
        • modalities
          • trastuzamab
            • HER2/neu-positive tumors
      • hormone therapy
        • indications
          • hormone receptor-positive tumors
        • modalities
          • tamoxifen or raloxifene
            • ER-positive tumors
            • reduces risk of metastasis
      • radiation
        • indications
          • following breast lumpectomy
    • Surgical
      • modified radical mastectomy
        • indications
          • multicentric disease
          • large tumor size in relation to breast
          • presence of diffuse malignant-appearing calcifications on imaging
          • prior chest radiation
          • pregnancy
          • positive margins after lumpectomy/re-excision
      • lumpectomy
        • indications
          • smaller tumors relative to breast size
          • patients who desire breast-conservinig therapy
        • always followed by postoperative radiation therapy
      • sentinel lymph node biopsy
        • indications
          • used for staging to detect spread of cancer
          • must be performed prior to mastectomy
          • if positive nodes detected and patient underwent lumpectomy, then sentinel lymph node biopsy may be performed again to search for additional nodes
  • Complications
    • Metastasis
    • Recurrence
      • majority of recurrences occur within first 5 years
    • Death
  • Prognosis
    • Tumor size is most important prognostic factor
    • Metastasis associated with poorer prognosis
    • Second most common cause of cancer-related death in women
Card
1 of 0
Private Note