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Invasive Lobular Carcinoma

Definition


Disease: Invasive Lobular Carcinoma Invasive Lobular Carcinoma
Category: Gynecological diseases
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Disease Definition:

The cancer that starts in the milk-producing glands (lobules) of the breast is known as invasive lobular carcinoma. Invasive lobular carcinoma is invasive cancer that indicates the breaking out of the cancer cells out of the lobule where they start and have the potential to spread to other areas of the body.


Invasive lobular carcinoma makes up a small portion of all breast cancers. The most common type of breast cancer starting in the breast ducts (ductal carcinoma). Certain breast cancer contains both lobular and ductal cancer cells.


 Invasive lobular carcinoma doesn’t typically form a lump, as most women expect with breast cancer. Rather invasive lobular carcinoma more usually results in a thickening of the tissue or fullness in one part of the breast.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Signs and symptoms may appear in the early stages of invasive lobular carcinoma. Invasive lobular carcinoma may result in the following as it grows larger:

 

 

  • A new area of fullness or swelling in the breast
  • A change in the texture or look of the skin over the breast, like thickening or dimpling
  • An area of thickening in part of the breast


A firm breast lump is less likely to result from invasive lobular carcinoma when compared to other kinds of breast cancers.
In the case of experiencing any concerning signs or symptoms, consulting a doctor then would be wise. The doctor would be able to start screening tests for breast cancer.


Physical exam and breast X-rays (mammograms) may be included in routine screening tests. Several different organizations vary on their screening recommendations, but many suggest women with an average risk of breast cancer consider starting yearly mammograms in their 40s. Starting mammograms or other tests at an earlier age may be recommended when one has a family history of breast cancer or other factors that increase the risk of breast cancer.

Causes:

It is still unknown what exactly causes invasive lobular carcinoma.


How invasive lobular carcinoma forms
When cells in one or more milk-producing glands of the breast develop mutations in their DNA, invasive lobular carcinoma starts. The mutations tell the cells to divide and quickly grow. The cancer cells can spread to other parts of the body.


The earliest marker of abnormal cells within the lobule is a condition known as lobular carcinoma in situ (LCIS). LCIS is not cancer, even though the term includes the word “carcinoma”. It is rather considered as an indicator of high risk of breast cancer.


Abnormal cells may break out of the lobules at some point invading or “infiltrating” the surrounding tissue, becoming invasive lobular carcinoma. Lobular carcinoma seem to break out of the lobule in single file, only to invade later on surrounding breast tissue in a web-like manner. The affected area may have a different feel from normal breast tissue, but it is unlikely to feel like a lump.


The following are factors that may raise the risk of invasive lobular carcinoma, such as:


Being female: Although men are able to develop breast cancer as well as women do, yet there’s a greater likelihood for women to do so.
Older age: There’s a greater likelihood for breast cancer to occur as one is getting older. Women with invasive lobular carcinoma seem to be a few years older than women diagnosed with other kinds of breast cancer.
Lobular carcinoma in situ (LCIS): When one has been diagnosed with LCIS, abnormal cells confined within the breast lobules, the risk of developing invasive cancer in either breast is increased. LCIS isn’t cancer, but is an indication of high breast cancer risk.
Postmenopausal hormone use: There’s a greater risk of invasive lobular carcinoma when a woman uses the female hormones estrogen and progesterone during and after menopause. Researchers believe the hormones to be stimulating tumor growth and additionally making tumors harder to be seen on mammograms. It’s not known if newer hormone regimens, such as lower dose combinations, are able to increase the risk of invasive lobular carcinoma.
Inherited genetic cancer syndrome: Women suffering from a rare inherited condition known as hereditary diffuse gastric cancer syndrome have a high risk of both stomach (gastric) cancer and invasive lobular carcinoma. Women suffering from certain inherited genes may have a high risk of breast and ovarian cancers.

Complications

Complications:

The following are complications resulting from invasive lobular carcinoma:


Cancer in the other breast: There’s a greater likelihood for invasive lobular carcinoma to occur in both breasts when compared to other types of breast cancer. Examination of the other breast may be recommended looking for signs of cancer when one has been diagnosed with invasive lobular carcinoma in one breast.
Cancer that spreads to other areas of the body: Invasive lobular carcinoma is slow to spread (metastasize) beyond the breast, but it can spread to other areas of the body.

Treatments:

Depending on the cancer type, its stage and one’s overall health and preferences, treatment options may be determined. Treatment usually consists of surgery and additional (adjuvant) therapy that may include chemotherapy, hormone therapy and radiation.


Surgery
Surgery for invasive lobular carcinoma may include:
Removing the cancer and small portion of healthy tissue: Known as lumpectomy or a wide local excision, this operation permits a person to keep most of their breast tissue. The tumor itself is removed as well as a margin of normal tissue surrounding the tumor to make sure all the cancer that can be removed is taken out. Negative or “clean” margins decrease the chance of leaving any cancer in the breast. One may either need additional surgery until negative margins are achieved or the surgeon may decide to remove the entire breast when the margins are positive.
Removing all of the breast tissue: Mastectomy is an operation to remove all of the breast tissue. Mastectomy can simply be the removal of all the breast tissue, the ducts, fatty tissue, skin and lobules, such as areola and nipple. Another option is a modified radical mastectomy that involves removing all of the breast tissue, as well as removing certain skin and lymph nodes in the armpit close to the affected breast.
Sentinel lymph node biopsy: The surgeon identifies the lymph node that receives the lymph drainage from the cancer in order to determine whether cancer has spread to the lymph nodes near the breast or not. This lymph node is removed and tested for breast cancer cells (sentinel node biopsy). The chance of detecting cancer in any of the remaining nodes is small in case there hasn’t been any cancer found, which is why no other nodes are required to be removed.
Axillary lymph node dissection: Additional lymph nodes in the armpit will be removed (axiillary lymph node dissection) when cancer has been detected in the sentinel node. The best course of treatment such as whether chemotherapy or radiation therapy will be required or not can be determined through the knowledge of how far the cancer has spread.


Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Treatment usually involves receiving two or more drugs in different combinations. Chemotherapy can be given through a vein, taken in pill form or both ways. Chemotherapy is commonly used after surgery to kill any remaining cells for invasive lobular carcinoma. Additionally, chemotherapy can be used preceding surgery to shrink a tumor. Chemotherapy may make it possible to choose lumpectomy over mastectomy preceding surgery for women with large breast tumors.


Radiation Therapy
Radiation therapy is usually used after lumpectomy to kill any remaining cancer cells in the breast and under the arm. High-powered energy beams are used in radiation therapy to kill cancer cells. The patient is laid on a table while a large machine moves around them directing energy beams at precise points in the breast during radiation therapy.


Hormone Therapy
Hormone therapy may be an option when the cancer relies on hormones to fuel its growth. Most invasive lobular carcinomas are hormone receptor positive which indicates their use of hormones as fuel to grow. A sample of the tumor cells is tested to determine whether the cancer is hormone receptor positive. If it is, hormone therapies are able to block the body from producing hormones or block the cancer cells’ ability to use the hormone. One class of hormone therapy drugs known as selective estrogen receptor modulators (SERMs) that includes tamoxifen is able to be used in women who are premenopausal and also those who have gone through menopause as well. Another class of hormone therapy drugs known as aromatase inhibitors is beneficial only in women who have experienced menopause. This class includes the drugs exemestane, Letrozole  and anastrozole.

Prognosis:

Not Available

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