Postradiation Angiosarcoma of Breast

Postradiation Angiosarcoma of Breast

Article
Women's Health
Diseases & Conditions
+1
Contributed byKrish Tangella MD, MBAMar 28, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • Mammary Postradiation Angiosarcoma
  • Radiation-Induced Angiosarcoma of Breast
  • Radiation-Induced Mammary Angiosarcoma

What is Postradiation Angiosarcoma of Breast? (Definition/Background Information)

  • Angiosarcomas are infrequently seen, malignant, and often rapidly developing tumors that present few signs and symptoms in the early stages. The tumors arise from the vascular linings that involve the blood vessels. Breast angiosarcomas are of two types - primary and secondary
  • Postradiation Angiosarcoma of Breast is a highly-aggressive tumor that occurs secondary to irradiation to the breast region and surrounding skin; the malignancy develops as a complication of the radiation therapy. These tumors are regarded as types of high-grade malignancies that spread and infiltrate the surrounding tissues and organs. “High-grade” means that the tumor is very aggressive
  • Postradiation Angiosarcoma of Breast is observed in slightly older women about 5-6 years after undergoing radiation therapy for other health conditions to the breast region. The cause of formation of the tumor is presently not well-established
  • The signs and symptoms of the tumor include the presence of single or multiple skin lesions on the breast along-with skin-thickening (sometimes) and redness. Postradiation Angiosarcoma of Breast can spread to the local and distant regions
  • A treatment of the condition is based on the healthcare provider’s evaluation and is considered on a case-by-case basis. The prognosis of individuals with Postradiation Angiosarcoma of Breast is usually poor as it is a highly-aggressive tumor

Who gets Postradiation Angiosarcoma of Breast? (Age and Sex Distribution)

  • Postradiation Angiosarcoma of Breast may affect a wide age range of individuals. More often, the (secondary) tumor is diagnosed in older women (median age 70 years) in comparison to primary breast angiosarcomas (median age 40 years)
  • The malignancy develops on an average 5-6 years after radiation therapy to the region. In some rare cases, the condition may develop even within 1-2 years of radiation treatment
  • There is no known ethnic or racial preference, and the condition is seen worldwide

What are the Risk Factors for Postradiation Angiosarcoma of Breast? (Predisposing Factors)

The risk of Postradiation Angiosarcoma of Breast is linked to the following factors:

  • A previously performed radiotherapy for breast cancer is the primary risk factor for the condition. The time interval for radiation-induced angiosarcoma development, following radiation treatment for breast cancer, may vary from 5-10 years or more
  • The risk may be greater for women who have undergone breast-conserving surgery to remove tumors from the region. The risk for cancer development in women who have undergone mastectomy is slightly lesser

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Postradiation Angiosarcoma of Breast? (Etiology)

The exact cause and mechanism of formation of Postradiation Angiosarcoma of Breast is presently unknown. It may be associated with permanent DNA damage that occurs from irradiation. The malignancy may develop after a few years as a reactive process to radiation exposure, typically in the form of radiotherapy to the breast/chest region (undertaken for other health conditions).

  • Genetic abnormalities observed in some of the radiation-induced tumors include mutations on the KDR, PLCG1, and PTPRB genes
  • High-level MYC gene amplification at the chromosome location 8q24 is commonly observed in the tumor
  • Around 5% of the tumors also exhibit FLT4 gene amplifications at 5q35

Angiosarcoma of breast can also arise in a background of lymphedema invasions in those who underwent breast surgery. This is known as lymphoedema-associated angiosarcoma of breast.

What are the Signs and Symptoms of Postradiation Angiosarcoma of Breast?

The signs and symptoms of Postradiation Angiosarcoma of Breast may include:

  • It can occur as single or multiple reddish patches, plaques, papules or nodules on skin
  • Sometimes, it may present as thickening of skin with redness
  • The cancer can occur in the breast, residual breast tissue, or skin of the chest wall, where radiation has been administered
  • Atypical vascular lesions may either precede the malignancy or be present concurrently with radiation-induced angiosarcoma
  • In some cases, the tumor may be painful
  • In most cases, the initial tumor growth periods are asymptomatic
  • The tumor may initially grow at a moderate rate, and then suddenly start progressing rapidly during the later stages
  • Enlarged lymph nodes
  • In some individuals, bleeding disorders, anemia, internal bleeding, and liver damage may be observed. These may occur suddenly and spontaneously

How is Postradiation Angiosarcoma of Breast Diagnosed?

A diagnosis of Postradiation Angiosarcoma of Breast may involve:

  • Complete physical examination with comprehensive medical and family history evaluation, including assessment of radiation therapy to the breast region
  • Breast exam to check for any lumps or unusual signs in the breasts
  • Blood tests including complete blood count (CBC) test
  • Mammogram: A mammogram uses X-rays to provide images of the breast
  • Galactography: A mammography using a contrast solution, mostly used to analyze the reason behind a nipple discharge
  • Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
  • Positron emission tomography (PET) scan to help determine, if the cancer has spread to other organ systems
  • Breast biopsy:
    • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
    • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
    • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

  • Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue
  • Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
  • Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Postradiation Angiosarcoma of Breast?

The complications of Postradiation Angiosarcoma of Breast may include:

  • Severe emotional stress caused by the presence of a breast malignancy
  • Metastasis of the tumor to local and regional sites - this radiation-induced tumor is highly-malignant, and it can metastasize aggressively to several organs of the body
  • Recurrences following surgery; the tumor can have a high recurrence rate
  • Side effects from treatment

How is Postradiation Angiosarcoma of Breast Treated?

The management of Postradiation Angiosarcoma of Breast is based on the evaluation of the condition by the healthcare professionals. It may involve several treatment modalities.

How can Postradiation Angiosarcoma of Breast be Prevented?

  • Presently, there is no definitive method available to prevent Postradiation Angiosarcoma of Breast
  • Individuals who have undergone radiation therapy to the breast/chest region are strongly recommended to consider regular medical screening at periodic intervals for early detection of secondary malignancies that may develop in the vicinity of the radiation treatment

What is the Prognosis of Postradiation Angiosarcoma of Breast? (Outcomes/Resolutions)

  • The prognosis of Postradiation Angiosarcoma of Breast is usually poor. The overall median survival is less than 5 years
  • In many cases, metastasis to the distant regions/organs is commonly noted at the time of detection of the malignancy

Additional and Relevant Useful Information for Postradiation Angiosarcoma of Breast:

The following DoveMed website links are useful resources for additional information:

https://www.dovemed.com/healthy-living/womens-health/

https://www.dovemed.com/diseases-conditions/cancer/

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Krish Tangella MD, MBA picture
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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