What Is Invasive Lobular Carcinoma

What Does Invasive Lobular Breast Cancer Mean

Invasive means that the cancer has invaded or spread from its original contained location in this case, from within the walls of the lobule — into the surrounding breast tissue. Over time, invasive lobular breast cancer can also spread to the lymph nodes in the underarms, beneath the breast or inside the chest or to other areas in the body away from the breast.

Expert Review And References

• King TA, Pilewskie M, Muhsen S, Patil S, Mautner SK, Park A, Oskar S, et al. Lobular carcinoma in situ: a 29-year longitudinal experience evaluating clinicopathologic features and breast cancer risk. Journal of Clinical Oncology. 2015.
• Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 79: 1117-1156.
• National Cancer Institute. Breast Cancer Treatment for Health Professionals . 2015.
• Oppong BA, King TA. Recommendations for women with lobular carcinoma in situ . Oncology . 2011.

What You Can Do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you’re taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out.

For invasive lobular carcinoma, some basic questions to ask your doctor include:

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions that occur to you.

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Bcrf Investigator Dr Steffi Oesterreich And Patient Advocate Leigh Pate Discuss How Weve Made Progress Against Lobular Breast Cancer In Just A Few Yearsand Whats Ahead

Though invasive lobular carcinoma is the second most common form of invasive breast canceraccounting for 10 to 15 percent of invasive breast cancer diagnoses and affecting nearly 40,000 people each yearit has unfortunately been understudied and misunderstood.

ILC, also known as lobular breast cancer, originates in the milk-producing glands of the breast and presents differently than other invasive breast cancers, making it more difficult to detect by traditional screening and self-exam. Recent research has not only shown that ILC is its own distinct subtype of breast cancer, but also that it may not respond as well to standard treatments, recur later, and metastasize in unusual ways.

But thanks to the tireless work of researchers and patient advocates, awareness of ILC is growing and the disease is being more rigorously studied as the unique breast cancer that it is.

BCRFs Margaret Flowers, PhD spoke with investigator Steffi Oesterreich, PhD and patient advocate Leigh Pate, founder of the Lobular Breast Cancer Alliance, about the second-annual International Invasive Lobular Breast Cancer Symposiumand how research is improving our understanding of ILC. Watch the full video above or read an edited version of the conversation below.

Dr. Oesterreich, tell us a little bit about yourself and your research.

Leigh, whats your experience with lobular breast cancer? How did you get involved in advocacy?

Anything else?

What Does It Mean If My Doctor Asks For A Special Molecular Test To Be Performed On My Specimen

Molecular tests such as Oncotype DX® and MammaPrint® may help predict the prognosis of certain breast cancers, but not all cases need these tests. If one of these tests is done, the results should be discussed with your treating doctor. The results will not affect your diagnosis, but they might affect your treatment.

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Diagnosis Of Invasive Lobular Carcinoma

The earlier youre diagnosed with ILC and start treatment, the better your outlook. As with other types of cancer, early stages of ILC are likely to be treated more easily with fewer complications. This typically but not always leads to a complete recovery and low recurrence rates.

However, early diagnosis of ILC can be a challenge, compared with the much more common IDC. Thats because the growth and spread patterns of ILC are more difficult to detect on routine mammograms and breast exams. ILC tumors are likely to have multiple origins, and they grow in single-file lines rather than a lump.

The first step in a diagnosis of ILC is a breast examination. Your doctor will feel your breast for a thickening or hardening of the tissue. They will also look for any swelling in the lymph nodes under your arms or around your collarbone.

Other diagnostic tests may include:

Features Of Invasive Lobular Breast Cancer

• In the U.S., the incidence of the diagnosis of lobular breast cancer is increasing more rapidly than that of ductal cancer.
• In postmenopausal women, hormone replacement therapy may carry a stronger risk for lobular cancer than for ductal cancer risk.
• Invasive lobular carcinoma arises in older women the tumors tend to be larger but better-differentiated tumors
• Invasive lobular cancer has a less well-defined than invasive ductal carcinoma, so may be more difficult to completely excise.
• Invasive lobular carcinomas do not always present with a palpable mass. This is because a fibrous tissue reaction is less common in cases of ILC.

of the histology of invasive lobular carcinoma shows A. targetoid infiltration by small round cancer cells, aroundvessels and ducts B. the single-cell, Indian file invasive pattern.

There are several variants of invasive lobular carcinoma . However, whatever the variant might be, it is the degree of differentiation or the grade that is now recognized to have prognostic meaning .

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How Is Lobular Breast Cancer Different From Other Breast Cancers

Compared to other types of breast cancer, lobular breast cancer:

• Has different symptoms than other more common types of breast cancer.
• May be harder to see on mammogram because it does not cause a firm or distinct lump.
• May not be diagnosed until the cancer is large enough to cause symptoms.
• Is more likely to involve both breasts.
• Can reoccur many years after the first diagnosis and cancer can spread to different-than-typical sites like the stomach, intestine, ovary, kidneys, ureters and eye.

Preparing For An Appointment

Start by making an appointment with your family doctor if you have any signs or symptoms that worry you.

If your doctor finds cancer from a biopsy performed on the area of concern, you may be referred to a doctor who specializes in treating cancer .

Because appointments can be brief, and because there’s often a lot to discuss, it’s a good idea to be well-prepared. Here’s some information to help you get ready, and what to expect from your doctor.

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Invasive Lobular Carcinoma Treatment

Treatment for ILC involves one or more methods. Surgery and radiation therapy are local treatments, meaning they focus on the area of the cancer. Systemic treatments, like chemotherapy and hormone therapy, target any cancer cells that may have spread.

Surgery

Most women with invasive lobular carcinoma have surgery. Depending on the size of your tumor and how much its spread, you may have one of two types:

• Lumpectomy. Your doctor takes only the tumor and some of the tissue around it.
• Mastectomy. They remove part or all of your breast, with or without nearby lymph nodes and muscle.

Continued

Your doctor may take samples from the lymph nodes in your armpits to check for cancer. They might also remove the lymph nodes. These procedures are called sentinel lymph node biopsy and axillary lymph node dissection.

Radiation therapy

High-energy radiation can destroy cancer cells that may be left behind after surgery. Your doctor may use a machine to deliver the energy from outside your body or insert radioactive seeds or pellets into your body near where the cancer was removed .

Chemotherapy

Chemotherapy, or chemo, is when your doctor uses one or more medicines to kill cancer cells. You may get them before surgery to shrink a tumor or afterward to destroy any remaining cells. They come in pills that you swallow and in liquid that goes directly into your bloodstream . Drugs that can treat ILC include:

Continued

Morphological Characteristics Of Lobular Neoplasia And Invasive Lobular Carcinoma

Diagnostic criteria for lobular neoplasia and ILC are now well established and described and so are only briefly outlined below. The term lobular neoplasia was introduced to encompass a spectrum of in situ neoplastic proliferations including atypical lobular hyperplasia and lobular carcinoma in situ , which describe different levels of involvement of individual lobular units. The descriptions ALH and LCIS are widely used to classify these lesions since they confer different relative risks for the patient to subsequently develop invasive cancer compared with the general population . By definition, neoplastic cells of LN remain confined to the terminal duct-lobular unit, but they may exhibit pagetoid spread in which cells can migrate along the ductal system between the basement membrane and normal epithelial cell population .

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Treatments For Invasive Lobular Carcinoma

Treatment options depend on how far the cancer has progressed and your overall health.

• Surgery your doctor may suggest a lumpectomy, in which a surgeon removes infected tissue, or a mastectomy, in which a surgeon removes an entire breast.
• Chemotherapy your doctor may suggest chemotherapy alongside surgery chemotherapy uses a combination of medications, orally or through an IV, to kill cancer cells.
• Radiation following surgery, you may need radiation, which uses strong beams of energy directed at the targeted area of your breast to kill cancer cells.
• Hormone therapy in some cases, invasive lobular carcinoma is responsive to hormone therapy, which blocks hormones in your body from stimulating the cancer cells inside.

Your doctor can test the cells in your breast to see if this treatment is an option for you.

Answers From The Community

• lynn1950

  Clementine, I had both lobular and ductal cancer. My oncologist told me that the chance of recurrence was greatest in the first three years after that and until 5 years there is a sharp drop off. He said that for my diagnosis, my chance of recurrence never drops to …for the life of me, I can’t remember! I’m pretty sure he didn’t say 0, but maybe he did.

  I believe these statistics were based on the size and type of tumors, and because the cancer had spread to more than two of my axillary lymph nodes.

  A little bit different take on lobular cancer.

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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.

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What If My Report Mentions Sentinel Lymph Node

In a sentinel lymph node biopsy, the surgeon finds and removes the first lymph node to which a tumor drains. This lymph node, known as the sentinel node, is the one most likely to contain cancer cells if they have started to spread. This procedure may be done during surgery to remove a breast cancer. It is a way to check for the spread of cancer to underarm lymph nodes without removing as many of them.

The sentinel lymph node is then checked to see if it contains cancer cells. If there is no cancer in the sentinel node, it’s very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed.

If a sentinel lymph node does contain cancer, your report will say that cancer was present in the lymph node. It may also say how large the deposit of cancer cells is. In some cases, if cancer is found in a sentinel lymph node, you may then also need additional treatment such as surgery to remove more underarm lymph nodes or radiation therapy to the underarm region. You should discuss this with your doctor.

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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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.