What Is The Prognosis For Invasive Ductal Carcinoma
Based on individual markers and prognostic factors, including the staging of your tumor, your physician will work to give you a prognosis. At Johns Hopkins Medicine, our team of breast cancer specialists is dedicated to developing cutting-edge techniques for surgery, breast reconstruction, chemotherapy, biologic targeted therapy, radiation therapy and other hormonal therapies. Our research allows us to make great strides forward for patients with breast cancer.
What Is The Significance Of The Stage Of The Tumor
The stage of a cancer is a measurement of the extent of the tumor and its spread. The standard staging system for breast cancer uses a system known as TNM, where:
- T stands for the main tumor
- N stands for spread to nearby lymph nodes
- M stands for metastasis
If the stage is based on removal of the cancer with surgery and review by the pathologist, the letter p may appear before the T and N letters.
The T category is based on the size of the tumor and whether or not it has spread to the skin over the breast or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast. Since the entire tumor must be removed to learn the T category, this information is not given for needle biopsies.
The N category indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. Higher numbers after the N indicate more lymph node involvement by cancer. If no nearby lymph nodes were removed to be checked for cancer spread, the report may list the N category as NX, where the letter X is used to mean that the information is not available .
The M category is usually based on the results of lab and imaging tests, and is not part of the pathology report from breast cancer surgery. In a pathology report, the M category is often left off or listed as MX .
Dcis And Invasive Breast Cancer
If DCIS is not treated, over time it may spread into the breast tissue surrounding the ducts. It then becomes an invasive breast cancer.
Not every untreated DCIS will develop into an invasive breast cancer. But breast specialists usually advise treating DCIS. This is because it is not possible to tell for certain which individual cases of DCIS will become an invasive cancer.
Having DCIS means you have a slightly higher risk of getting cancer elsewhere in the same breast or in your other breast.
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What Are The Signs Of Invasive Breast Cancer
- A lump or thickening in or near the breast or in the underarm that continues after your monthly menstrual cycle
- A mass or lump, which may feel as small as a pea
- A change in the size, shape, or contour of the breast
- A blood-stained or clear fluid from the nipple
- A change in the feel or appearance of the skin on the breast or nipple — dimpled, puckered, scaly, or inflamed
- Redness of the skin on the breast or nipple
- A change in shape or position of the nipple
- An area that is distinctly different from any other area on either breast
- A marble-like hardened area under the skin
You may notice changes when you do a monthly breast self-exam. By doing a regular self-check of your breast, you can become familiar with the normal changes in your breasts.
Causes Of Invasive Ductal Carcinoma
Unfortunately, doctors have yet to figure out the exact cause of invasive ductal carcinoma. When you get this type of cancer, it means something damaged your cells’ DNA and caused it to change. The result is that the cells grow abnormally and uncontrollably in your breast tissue.
Doctors are still looking for genetic and environmental factors that damage the DNA. They have determined that caffeine, deodorant, microwaves and cell phone use do not lead to this type of cancer.
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What If My Report Mentions Her2/neu Or Her2
Some breast cancers have too much of a growth-promoting protein called HER2/neu . The HER2/neu gene instructs the cells to make this protein. Tumors with increased levels of HER2/neu are referred to as HER2-positive.
The cells in HER2-positive breast cancers have too many copies of the HER2/neu gene, resulting in greater than normal amounts of the HER2 protein. These cancers tend to grow and spread more quickly than other breast cancers.
All newly diagnosed breast cancers should be tested for HER2, because women with HER2-positive cancers are much more likely to benefit from treatment with drugs that target the HER2 protein, such as trastuzumab , lapatinib , pertuzumab , and T-DM1 .
Testing of the biopsy or surgery sample is usually done in 1 of 2 ways:
- Immunohistochemistry : In this test, special antibodies that will stick to the HER2 protein are applied to the sample, which cause cells to change color if many copies are present. This color change can be seen under a microscope. The test results are reported as 0, 1+, 2+, or 3+.
- Fluorescent in situ hybridization : This test uses fluorescent pieces of DNA that specifically stick to copies of the HER2/neu gene in cells, which can then be counted under a special microscope.
Many breast cancer specialists think that the FISH test is more accurate than IHC. However, it is more expensive and takes longer to get the results. Often the IHC test is used first:
Estrogen Exposure And Breastfeeding
Breastfeeding for over 1 year appears to reduce the risk of breast cancer.
Extended exposure to estrogen appears to increase the risk of breast cancer.
This could be due to a person starting their periods earlier or entering menopause at a later than average age. Between these times, estrogen levels are higher.
Breastfeeding, especially for over 1 year, appears to reduce the chance of developing breast cancer. This is possibly due to the drop in estrogen exposure that follows pregnancy and breastfeeding.
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What Are The Stages Of Breast Cancer
There are two different staging systems for breast cancer. One is called anatomic staging while the other is prognostic staging. The anatomic staging is defined by the areas of the body where the breast cancer is found and helps to define appropriate treatment. The prognostic staging helps medical professionals communicate how likely a patient is to be cured of the cancer assuming that all appropriate treatment is given.
The anatomic staging system is as follows:
Stage 0 breast disease is when the disease is localized to the milk ducts .
Stage I breast cancer is smaller than 2 cm across and hasn’t spread anywhere including no involvement in the lymph nodes.
Stage II breast cancer is one of the following:
- The tumor is less than 2 cm across but has spread to the underarm lymph nodes .
- The tumor is between 2 and 5 cm .
- The tumor is larger than 5 cm and has not spread to the lymph nodes under the arm .
Stage III breast cancer is also called “locally advanced breast cancer.” The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue . Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes .
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.
Oncogene Expression May Negatively Affect Breast Cancer Outcome
A relatively new addition to the discussion of breast cancer survival statistics and prognosis is oncogene expression.
An oncogene is a tiny fragment of genetic material which is carried in a chromosome and can cause normal cells to become malignant.
The oncogene HER-2, in particular, has been linked to more aggressive breast cancers.
Around one-third of all breast tumours produce the HER-2 oncogene, and these patients tend to have higher rates of recurrence and lower overall breast cancer survival rates.
According to a 2013 Canadian scientific study, the overall 5-year survival rate of HER-2 positive breast cancer is 88.6%. Furthermore, the relapse-free survival rate for 5 years is 79.4%.
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Some Cases Of Dcis Will Progress Towards Invasive Breast Cancer If Left Untreated
There is a general consensus that DCIS may represent a transitional stage between the normal breast tissue and invasive breast carcinoma.
However, it is still largely unknown which types of DCIS are non-progressing towards invasive breast cancer if left untreated.
One recent study estimated that only between 100 to 270 cases of DCIS per 100000 will not progress to invasive breast cancer if left untreated.
A medical study from the United Kingdom examined 84 breast cancer screening units. This large research study looked at DCIS diagnoses between the years of 2003 and 2007 for women aged 50 to 64 years.
Data from over 5,243,658 was analyzed. The average frequency of DCIS detected was 1.60 per 1000 women. The study found that for every 3 cases of DCIS detected on screening there was one less case of invasive cancer in the next 3 years.
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Additional Types Of Invasive Ductal Carcinoma:
There are four types of invasive ductal carcinoma that are less common:
- Medullary Ductal Carcinoma This type of cancer is rare and only three to five percent of breast cancers are diagnosed as medullary ductal carcinoma. The tumor usually shows up on a mammogram and it does not always feel like a lump rather it can feel like a spongy change of breast tissue.
- Mucinous Ductal Carcinoma This occurs when cancer cells within the breast produce mucous, which also contains breast cancer cells. The cells and mucous combine to form a tumor. Pure mucinous ductal carcinoma carries a better prognosis than more common types of IDCs.
- Papillary Carcinoma This is a very good prognosis breast cancer that primarily occur in women over the age of 60.
- Tubular Ductal Carcinoma This is a rare diagnosis of IDC, making up only two percent of diagnoses of breast cancer. The name comes from how the cancer looks under the microscope like hundreds of tiny tubes. Tubular breast cancer has an excellent prognosis.
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Research Into Triple Negative Breast Cancer
Researchers are working to find new treatments for triple negative breast cancer. Much of this research involves looking for molecules in the body that are involved with cancer growth, and formulating a drug that will disable how that molecule works.
Clinical trials are in progress to determine whether these new drugs are better than the current standard treatment. If you would like more information on clinical trials, visit the clinical trials section of our website.
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Does A Benign Breast Condition Mean That I Have A Higher Risk Of Getting Breast Cancer
Benign breast conditions rarely increase your risk of breast cancer. Some women have biopsies that show a condition called hyperplasia . This condition increases your risk only slightly.
When the biopsy shows hyperplasia and abnormal cells, which is a condition called atypical hyperplasia, your risk of breast cancer increases somewhat more. Atypical hyperplasia occurs in about 5% of benign breast biopsies.
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What Is Ductal Carcinoma In
For an in-depth look at Ductal Carcinoma visit our latest post.
Basically, ductal carcinoma in-situ is a very early form of breast cancer, whereby cancer cells, of various grades, are present in the milk ducts of the breasts.
The reason ductal cancer is named in-situ at this early phase, is that the abnormal cells have not yet spread outside of the milk ducts. This explains the reason for the very good prognosis for this type of breast cancer.
What Is The Prognosis For Triple Negative Breast Cancer
Triple negative breast cancer can be more aggressive and difficult to treat. Also, the cancer is more likely to spread and recur. The stage of breast cancer and the grade of the tumor will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
Material on this page courtesy of Johns Hopkins Medicine
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How Much Do Anastrozole And Exemestane Lower The Risk Of Breast Cancer
Studies have shown that both anastrozole and exemestane can lower the risk of breast cancer in postmenopausal women who are at increased risk of the disease.
In one large study, taking anastrozole for five years lowered the risk of developing estrogen receptor-positive breast cancer by 53 percent. In another study, taking exemestane for three years lowered the risk of developing estrogen receptor-positive breast cancer by 65 percent.
The most common side effects seen with anastrazole and exemestane are joint pains, decreased bone density, and symptoms of menopause .
Last reviewed by a Cleveland Clinic medical professional on 12/31/2018.
How Is Invasive Ductal Carcinoma Treated
The main aim of treatment of Invasive Ductal Carcinoma is to eliminate the cancer cells and prevent any chances of recurrence of this disease. For this, a lumpectomy, which is surgical removal of the tumor, is done. Along with the mass, the surrounding tissue which has been infiltrated by the tumor is also removed .
In cases, if the lump in Invasive Ductal Carcinoma is too large or the cancer has spread to encompass the whole breast, then mastectomy or surgical removal of all breast tissues is done . This is followed by chemotherapy to kill any remaining cancer cells. At times, radiation of the affected area is also done to get rid of any cancer cells.
Other treatments for Infiltrating or Invasive Ductal Carcinoma include: hormonal therapy if the cancer is believed to be caused by hormonal factors. To check whether the cancer has spread to other parts of the body a PET scan will be done. In this study, radioactive material is injected into the veins and a thorough monitoring is done through imaging.
The areas affected by cancer will light up on the screen confirming metastasis. If the cancer has metastasized then further treatment in the form of radiation and chemotherapy will be done to eliminate all the cancer cells.
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Are Women Opting Against Ductal Carcinoma In Situ Treatment
Its no surprise that these results were met with some raised eyebrows and of course concerns in the medical community, especially considering DCIS is almost exclusively diagnosed by mammography and some women may view these findings as a green light to cancel those appointments or ignore a diagnosis of DCIS.
Yet, there is no right way to treat DCIS. Like any cancer, there are a variety of factors at play ranging from the biology of the tumor and patients age to menopausal status and lifestyle.
The most common type of non-invasive breast cancer, DCIS, is considered non-invasive because it has not yet spread beyond the milk ducts to the surrounding tissue. While this type of breast cancer isnt life threatening, having DCIS can increase a womans chance of later developing invasive breast cancer.
So the question remains: does it matter if I have DCIS? Should I opt for a double mastectomy, no mastectomy, lumpectomy? Or should I do nothing? Of course, there is no simple answer when it comes to the treatment of breast cancer and that logic holds true for women facing a DCIS diagnosis. We are all unique individuals armed with a vast array of biological characteristics and risks and physicians must treat your cancer with this same multi-faceted approach.
Treatment For Invasive Breast Cancer
As with all types of breast cancer, the treatments youre offered will depend on the features of invasive breast cancer seen under the microscope. This includes the size, grade, hormone receptor status and HER2 status.
Treatment aims to remove the cancer and reduce the risk of it coming back or spreading to other parts of the body.
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What Are The Causes Of Invasive Ductal Carcinoma Of Breast
The exact cause of development of Invasive Ductal Carcinoma of Breast is currently not clearly known.
- Studies have shown that such tumors may be caused by hormonal influence
- Certain gene mutations have also been reported in the tumors. Research is being performed to determine how these mutations contribute to the formation of the tumors
What If My Report Mentions Margins Or Ink
When an entire tumor is removed, the outside edges of the specimen are coated with ink, sometimes even with different colors of ink on different sides of the specimen. The pathologist looks at slides of the tumor under the microscope to see how close the cancer cells get to the ink . If cancer cells are touching the ink , it can mean that some cancer was left behind, and more surgery or other treatments may be needed. Sometimes, though, the surgeon has already removed more tissue to help make sure that this isnt needed.
If your pathology report shows positive margins, your doctor will talk to you about what treatment is best.
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What Does It Mean If My Report Mentions Estrogen Receptor Or Progesterone Receptor
Receptors are proteins on cells that can attach to certain substances, such as hormones, that circulate in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone. These 2 hormones often fuel the growth of breast cancer cells.
An important step in evaluating a breast cancer is to test a portion of the cancer removed during the biopsy to see if they have estrogen and progesterone receptors. Cancer cells may contain neither, one, or both of these receptors. Breast cancers that contain estrogen receptors are often referred to as ER-positive cancers, while those containing progesterone receptors are called PR-positive cancers. Women with hormone receptor-positive cancers tend to have a better prognosis and are much more likely to respond to hormone therapy than women with cancers without these receptors.
All breast cancers and pre-cancers, with the exception of lobular carcinoma in situ , should be tested for these hormone receptors when they have the breast biopsy or surgery.
Results for ER and PR are reported separately and can be reported in different ways:
- Negative, weakly positive, positive
- Percent positive
- Percent positive and whether the staining is weak, moderate, or strong.
How the results of your tests will affect your therapy is best discussed with your doctor.