Synopsis
Breast cancer is a leading cause of death among women, with about 99% of cases diagnosed in females and only 0.5–1% in males. However, medical advancements have greatly improved the treatment and management of this complex disease. The surgical pathology of breast cancer is more than just analyzing the specimen. You need to efficiently collaborate and communicate with all the members of the team involved in the specific case of breast cancer. It is not rare that hospitals and medical institutions gather whole teams to observe, analyze and make the decision related to the further treatment of the patient. Surgical pathologists have a key role in that team. Thus, acquiring specific knowledge and experience is essential in understanding the surgical pathology of breast cancer. You need to know the characteristics of the disease, communicate with patients and other members of the team, and follow all standard procedures. The effectiveness of transparent communication with a patient hinge on one’s comprehensive understanding of the specific case, including the nature of the disease and its severity.
Surgical Pathology of Breast Cancer
You as a surgical pathologist have a critical responsibility to identify the precise type of breast cancer in a patient, given the numerous variations of breast cancer that exist. Breast cancers can be divided into two main groups: Carcinomas and Sarcomas. Carcinomas are a type of cancer that arises from the epithelial component of the breast. The epithelial component consists of the cells that line the lobules and terminal ducts. Under normal conditions, these epithelial cells are responsible for making milk. Most breast cancers comprise carcinomas. On the other hand, sarcomas are rare cancers that arise from the stromal components of the breast. These stromal component cells include myofibroblasts and blood vessel cells. Cancer arises from these supportive cells including phyllodes tumors and angiosarcoma. Sarcomas account for less than 1% of breast cancers.
Types of Breast Carcinoma
Breast carcinomas are classified into two groups, in situ and invasive carcinoma.
In Situ Carcinoma
It is a pre-invasive carcinoma that has not yet invaded the breast tissue. The in-situ cancer cells grow inside the pre-existing normal lobules or ducts. In situ carcinoma has the potential to become an invasive carcinoma that has not yet attacked the breast tissue. As a result, in situ carcinoma needs to be adequately treated to prevent the patient from developing invasive cancer.
Invasive cancers
These are cancer cells that infiltrate outside of the normal breast lobules and ducts to grow into the breast connective tissue. They have the potential to spread to other regions of the body, like lymph nodes or other organs, in the form of metastasis. Approximately 80% of breast carcinomas are invasive ductal carcinoma, followed by invasive lobular carcinoma which accounts for 10-15% of cases.
| Type of Carcinoma | In Situ Carcinoma | Invasive Carcinoma |
|---|---|---|
|
Definition |
Pre-invasive carcinoma that has not yet invaded the breast tissue. |
Cancer cells infiltrate outside of normal breast lobules and ducts to grow into breast connective tissue. |
|
Growth |
Inside pre-existing normal lobules or ducts. |
Spreads to other regions in the form of metastasis. |
|
Potential |
Potential to become an invasive carcinoma. |
Requires immediate treatment to prevent further spread. |
|
Treatment |
Adequate treatment to prevent invasive cancer. |
Treatment varies depending on stage and severity. |
Primary Carcinomas Types
Invasive ductal carcinomas and invasive lobular carcinomas have distinct pathologic features. Lobular carcinomas grow as single cells arranged individually, in single files, or sheets, and they have different molecular and genetic aberrations that distinguish them from ductal carcinomas. Ductal and lobular carcinomas may have different prognoses and treatment options, depending on other features of the cancer.
Other Categories
Other types of breast cancer, such as colloid, medullary, micropapillary, papillary, and tubular, make up the rest of the cases of invasive carcinoma. Each of these cancer types exhibits unique pathological features. Accurately distinguishing between these subtypes is crucial since they can carry distinct prognoses and treatment implications.
Role of Surgical Pathology in the Treatment of Breast Cancer
Breast cancer is a complex condition that poses a challenge to surgical pathologists, especially when a patient has an asymptomatic mass that was discovered during a routine examination or screening mammography. To confirm the diagnosis, a biopsy is performed, and you are then responsible for informing the patient about the treatment options available. These options may include surgical excision, radiation therapy, adjuvant chemotherapy, endocrine therapy, or a combination thereof. You play a crucial role in ensuring that the patient fully understands their condition and the best course of treatment to achieve the optimal outcome.
Pathophysiology of Breast Cancer
The surgical pathology of breast cancer often includes dealing with the pathophysiology of breast cancer. The disease invades locally and spreads through the regional lymph nodes, bloodstream, or both. Metastatic breast cancer can affect almost every organ in the body, such as the lungs, liver, bone, brain, or skin. It is worth noting that most skin metastases occur near the site of the breast surgery. Scalp metastases are not very common. Some breast cancers may recur sooner than others and the recurrence can often be predicted based on the tumor markers. It can also occur even 10 years after initial diagnosis and treatment in patients who have an estrogen-receptor-positive tumor.
| Aspect | Description |
|---|---|
|
Infiltration |
Breast cancer invades locally and can spread through the regional lymph nodes, bloodstream, or both. |
|
Metastases |
Metastatic breast cancer can affect almost every organ in the body, including the lungs, liver, bone, brain, or skin. Most skin metastases occur near the site of the breast surgery, while scalp metastases are rare. |
|
Recurrence |
Recurrence of breast cancer can occur sooner or later and can be predicted based on tumor markers. Some patients may experience recurrence even 10 years after initial diagnosis and treatment, particularly those with estrogen-receptor-positive tumors. |
Useful Drugs
Estrogen and progesterone receptors that are present in some breast cancers are nuclear hormone receptors that promote DNA replication and cell division when the appropriate hormones bind to them. Therefore, drugs that block these receptors may be useful in treating tumors with the receptors. About two-thirds of postmenopausal patients with cancer have estrogen receptor-positive (ER+) tumors. The incidence of ER+ tumors is lower among premenopausal patients.
What Are the Symptoms of Breast Cancer?
Patients often detect breast cancers themselves through routine physical examinations or mammography screenings. The most common and well-known symptom of breast disease is breast enlargement or thickening of the breast. Symptoms can also include breast pain, but the pain itself is never the sole presenting symptom.
Paget Disease of the Nipple
When associated with an underlying in situ or invasive carcinoma, breast cancer can present as skin changes, including erythema, crusting, scaling, and discharge. These changes can often appear benign, leading patients to overlook them for a year or more.
Inflammatory Breast Cancer
One common manifestation of breast cancer is characterized by erythema and enlargement of the breast, often without an associated mass. Additionally, the skin may appear thickened or discolored, resembling the texture of an orange peel. This change in the breast’s appearance can also be accompanied by nipple discharge.
Metastatic Disease
There are also patients with breast cancer that show signs of metastatic disease. These could be pathologic fractures, abdominal pain, jaundice, and dyspnea. Asymmetry or a dominant mass may also be detected during a physical breast examination. This mass is distinctly different from the surrounding breast tissue.
Benign Disorders
When it comes to benign disorders, diffuse fibrotic changes are present, especially in a quadrant of benign disorders of the breast, usually the upper outer quadrant. More advanced breast cancers are characterized by fixation of the mass to the chest wall or overlying skin, and satellite nodules or ulcers in the skin.
Conclusion
The surgical pathology of breast cancer is a complex area that is quite facilitated. To effectively manage breast cancer cases, surgical pathology of breast cancer requires not only expertise in standard procedures but also a deep understanding of the disease. Effective communication and collaboration with other healthcare professionals are also crucial for optimal patient care. A surgical pathologist needs to have proper training and experience. Effective decision-making plays a crucial role in managing breast cancer since the progression of a patient’s treatment hinges on it. Successful communication is vital for both patients and medical team members involved in the process. Everything is important, from symptoms to surgical pathology examination to treatment. Surgical pathology is complex because of the requirements but also facilitated because of the advancements in science and technology. The development of digital microscopy has facilitated managing this field. PreciPoint’s digital equipment helps you to interpret specimens, share information, collaborate, and communicate with your peers to achieve the best results in the end.
