Diagnosing Invasive Breast Cancer
Invasive breast cancer is diagnosed using a;range of tests. These may include:;
- A mammogram ;
- An ultrasound scan
- A core biopsy of the breast and sometimes lymph nodes ;
- A fine needle aspiration of the breast and sometimes lymph nodes ;;
When there is a change to the skin or nipple a punch biopsy of the skin may be performed.;This involves taking a very small cylindrical piece of tissue from the changed area.
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.
What Does It Mean If My Ductal Carcinoma In Situ Is Described As Being Low Grade Intermediate Grade Or High Grade; Or Nuclear Grade 1 Nuclear Grade 2 Or Nuclear Grade 3; Or Low Mitotic Rate Intermediate Mitotic Rate Or High Mitotic Rate
These are all different ways of describing how the DCIS looks under the microscope:
- DCIS that is high grade, is nuclear grade 3, or has a high mitotic rate is more likely to come back after it is removed with surgery.;
- DCIS that is low grade, is nuclear grade 1, or has a low mitotic rate is less likely to come back after surgery.
- DCIS that is intermediate grade, is nuclear grade 2, or has an intermediate mitotic rate falls in between these two.
Patients with higher grade DCIS may need additional treatment.
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What Does It Mean If My Carcinoma Has Tubular Mucinous Cribriform Or Micropapillary Features
These are different types of invasive ductal carcinoma;that can be identified under the microscope.
- Tubular, mucinous, and cribriform carcinomas are “special types” of well-differentiated cancers that often have a better prognosis than the more common type of invasive ductal carcinoma .
- Micropapillary carcinoma is a type of invasive breast carcinoma that often has a worse prognosis.
If your doctor knows that your tumor is made up of one of these special types of breast cancer, he or she may recommend different treatment.
Since some tumors are made up of more than one type, the entire tumor must be removed in order to know what types your tumor contains. A needle biopsy doesnt give enough information to guide treatment.
What If My Report On Ductal Carcinoma In Situ Mentions Margins Or Ink
When the entire area of DCIS is removed, the outside surface of the specimen is coated with ink, sometimes even with different colors of ink on different sides of the specimen. The pathologist looks at slides of the DCIS under the microscope to see how close the DCIS cells get to the ink . If DCIS is touching the ink , it can mean that some DCIS cells were 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 DCIS with positive margins, your doctor will talk to you about what treatment is best.
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Can A Ductal Carcinoma Be Treated With Chemotherapy
No, most likely not. Chemotherapy uses drugs given throughout the body to kill fast-growing cells, including cancer. Because DCIS is only in the breast ducts, doctors dont usually recommend chemotherapy to treat it. Will I Need Another Surgery?
Treatment for all types of IDC is determined by the exact type of cancer and staging. Depending on the size and spread of the tumor, most women will undergo a combination of any of the following treatments: Lumpectomy. Mastectomy. Sentinel node biopsy. Axillary node dissection. Breast reconstruction. Radiation.
Targeted Therapy For Idc
Targeted therapies are medicines that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a fast or abnormal way. Targeted therapies affect the whole body, so they are considered systemic treatments.
There are many targeted therapy medicines that fall into different drug classes depending on the characteristic they target. Examples of targeted therapy drug classes include HER2 inhibitors, PARP inhibitors, CDK4/6 inhibitors, and PI3K inhibitors. Whether certain targeted therapies are used also may depend on your treatment history and other characteristics of the cancer.
Targeted therapies that can be used to treat early-stage IDC, depending on the characteristics of the cancer and your individual situation, include:
- Herceptin
- Kadcyla
- Nerlynx
- Perjeta
Targeted therapies that can be used to treat advanced-stage or metastatic IDC, depending on the characteristics of the cancer and your individual situation, include:
- Afinitor
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In Thinking About Treatment Of Cancer Should I Consider Clinical Trials
For any type or stage of breast cancer, it is well worth researching clinical trials for treatment options. Indeed, due to breast cancer patients taking part in clinical trials advances in treatment have improved immensely.
There are many agencies that conduct trials and most in the US are funded by the National Cancer Institute which is part of the National Institute of Health . It may well be worth researching your own area and the trials available.
Understanding Your Pathology Report: Breast Cancer
When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.
In a needle biopsy, a needle is used to remove a sample of an abnormal area. An excision biopsy removes the entire abnormal area, often with some of the surrounding normal tissue. An excision biopsy is much like a type of breast-conserving surgery called a lumpectomy.
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Understanding Your Pathology Report: Ductal Carcinoma In Situ
When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.
In a needle biopsy, a needle is used to remove a sample of an abnormal area. An excision biopsy removes the entire abnormal area, often with some of the surrounding normal tissue. An excision biopsy is much like a type of breast-conserving surgery called a lumpectomy.
What Is Meant By Invasive Ductal Carcinoma
Infiltrating or Invasive Ductal Carcinoma, which is also known by the name of Invasive Breast Cancer, is perhaps the most common variant of breast cancer in the United States. Invasive Ductal Carcinoma is a cancer that develops in the milk ducts of the breast and then rapidly spreads to involve the surrounding structures.
Invasive Ductal Carcinoma is so progressive that it can infiltrate even the lymph nodes and the circulatory system, which leads to the cancer spreading to various parts of the body. Even though Invasive or Infiltrating Ductal Carcinoma may be rapidly progressive, but it is still a treatable condition at least when identified in its initial stages.
There are various stages of Invasive Ductal Carcinoma. While stage 0 represents cancer that is localized; stage 1 to 4 are stages that indicates that the cancer is believed to have spread beyond its original area of development.
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Less Common Types Of Invasive Breast Cancer
There are some special types of breast cancer that are sub-types of invasive carcinoma. They are less common than the breast cancers named above and each typically make up fewer than 5% of all breast cancers.;These are often named after features seen when they are viewed under the microscope, like the ways the cells are arranged.
Some of these may have a better prognosis than the more common IDC. These include:
- Adenoid cystic carcinoma
- Low-grade adenosquamous carcinoma
- Medullary carcinoma
Some sub-types have the same or maybe worse prognoses than IDC. These include:
- Metaplastic carcinoma
- Micropapillary carcinoma
- Mixed carcinoma
In general, all of these sub-types are still treated like IDC.
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 Is The Difference Between Invasive Ductal Carcinoma And Ductal Carcinoma In Situ
DCIS means the cancer is still contained in the milk duct and has not invaded any other area. IDC is cancer that began growing in the duct and is invading the surrounding tissue. Cancer;staging;done by a physician, along with a physical exam and medical history can help identify the best;treatment options.
Materials on this page courtesy of National Cancer Institute
Common Breast Cancer Types
After skin cancer, breast cancer;is the most common type of cancer diagnosed in women. About 284,200 cases will be diagnosed in 2021, according to the American Cancer Society . Men also may develop breast cancer, though its much more rare.
Breast cancer is classified into different types based on how the cells look under a microscope. Most breast cancers are carcinomas, a type of cancer that begins in the linings of most organs.
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What Does It Mean If My Carcinoma Is Called Invasive Ductal Carcinoma Invasive Lobular Carcinoma Or Carcinoma With Ductal And Lobular Features
Breast carcinomas are often divided into 2 main types: invasive ductal carcinoma and invasive lobular carcinoma, based on how they look under the microscope. In some cases, the tumor can have features of both and is called a mixed ductal and lobular carcinoma. Another term for invasive ductal carcinoma is invasive mammary carcinoma of no special type, because it is the most common type of breast carcinoma.
Both invasive ductal carcinomas and invasive lobular carcinomas arise from the cells lining the ducts and lobules in the breast. In general, invasive lobular and invasive ductal carcinomas of the breast arent treated differently.
What Is The Significance Of The Reported Size Of The Tumor
If the entire tumor or area of cancer is removed, the pathologist will say how big the area of cancer is by measuring how long it is across , either by looking at it under the microscope, or by gross examination of the tissue removed during surgery. The size of the tumor in the breast is part of what determines the stage; of the cancer, which influences treatment and prognosis.
A needle biopsy only samples a part of the tumor, so measurements of the size of the cancer are often not given. Later, when the tumor is removed , a more accurate measurement is obtained.
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What If My Report Mentions Lymph Nodes
If breast cancer spreads, it often goes first to the nearby lymph nodes under the arm . If any of your underarm lymph nodes were enlarged , they may be biopsied at the same time as your breast tumor. One way to do this is by using a needle to get a sample of cells from the lymph node. The cells will be checked to see if they contain cancer and if so, whether the cancer is ductal or lobular carcinoma.
In surgery meant to treat breast cancer, lymph nodes under the arm may be removed. These lymph nodes will be examined under the microscope to see if they contain cancer cells. The results might be reported as the number of lymph nodes removed and how many of them contained cancer .
Lymph node spread affects staging and prognosis . Your doctor can talk to you about what these results mean to you.
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:
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Symptoms Of Invasive Breast Cancer
Symptoms;of invasive breast cancer include:;
- A lump or thickening of the breast tissue;
- A change in the size or shape of the breast;
- A change of skin texture such as puckering or dimpling of the skin;
- A lump or swelling under the arm;
- Changes to the nipple, for example it has become pulled in ;
- Discharge from the nipple;
- Less commonly, a type of rash involving the nipple known as;Pagets disease of the breast;
Routine breast screening;can often pick up cancer before a woman notices any symptoms. Therefore, some women will be diagnosed with invasive breast cancer after attending breast screening without having any of the symptoms above.
Symptoms Of Invasive Ductal Carcinoma
Invasive breast cancer doesn’t always have obvious signs or symptoms that affect your daily life. This is why regular screenings are essential to detect this type of cancer in its early stages.
Common symptoms of invasive ductal carcinoma include:
- Lump in the breast
- Red skin or rash on the breast
- Pain or changes in the appearance of the nipple
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What Is Ductal Carcinoma In Situ
Ductal Carcinoma in Situ , also known as intraductal carcinoma, accounts for one of every five new breast cancer diagnoses. It’s an uncontrolled growth of cells within the breast ducts. Its noninvasive, meaning it hasnt grown into the breast tissue outside of the ducts. The phrase “in situ” means “in its original place.”
DCIS is the earliest stage at which breast cancer can be diagnosed. It’s known as stage 0 breast cancer. The vast majority of women diagnosed with it can be;cured.
Even though its noninvasive, it can lead to invasive cancer. It’s important that women with the disease get treatment. Research shows that the risk of getting invasive cancer is low if youve been treated for DCIS. If it isnt treated, 30% to 50% of;women with DCIS will get invasive cancer. The invasive cancer usually develops in the same breast and in the same area as where the DCIS happened.
Continued
Treating Invasive Breast Cancer
Treatment of invasive breast cancer depends on how advanced the cancer is and other factors. Most women will have some type of surgery to remove the tumor. Depending on the type of breast cancer and how advanced it is, you might need other types of treatment as well, either before or after surgery, or sometimes both.
See Treating Breast Cancer for details on different types of treatment, as well as common treatment approaches based on the stage or other factors.
Our team is made up of doctors and;oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
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