What Is Lobular Carcinoma In Situ
Lobular carcinoma in situ is a rare condition that happens when you have abnormal cells in your lobules the glands that produce breast milk. These abnormal cells are in situ, meaning they havent spread to surrounding breast tissue.
Lobular carcinoma in situ isnt breast cancer. But its a marker or indication that you have greater risk for developing breast cancer than someone who doesnt have LCIS. If you have lobular carcinoma in situ, you are 10 times more likely to develop breast cancer than someone who doesnt have LCIS.
Prophylactic Treatment With Anti
Hormonal therapy medicines have been shown to reduce breast cancer risk. LCIS is usually hormone receptor-positive, meaning that estrogen and/or progesterone fuels the growth of the abnormal cells. Pre-menopausal women are often recommended Novaldex, a medicine that blocks estrogen from attaching to the cells and signaling them to grow. Tamoxifen works to reduce the risk of an invasive breast cancer from developing in the future. The Breast Cancer Prevention Trial found that women with LCIS who took tamoxifen for 5 years reduced their risk of invasive breast cancer by 46%.
Does Lcis Need To Be Treated
LCIS is not the same as invasive breast cancer. LCIS does not need to be treated if there are no other abnormal changes to the breast. However, having LCIS increases the risk of developing breast cancer.If a woman has LCIS, its important that she has regular check-ups, including:
- a physical examination of both breasts by a doctor once a year
- a mammogram/ultrasound of both breasts once a year.
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Understanding Your Pathology Report: Lobular 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.
Proposed Mechanisms For The Development Of Invasive Breast Cancer
Although the natural course of the intraductal process is unknown, DCIS is considered to be a non-obligate precursor of invasive breast cancer. Four evolutionary models have been proposed to describe the progression of DCIS into invasive breast cancer .
Overview of models showing four different theories of progression from ductal carcinoma in situ to invasive breast cancer
The first model is the independent lineage model. On the basis of mathematical simulations of the observed frequencies of the histological grade of DCIS and the histological grade of invasive disease in the same biopsy sample, Sontag et al. proposed that in situ and invasive cell populations arise from different cell lineages and develop in parallel and independently of each other. In support of this theory, Narod et al. state that small clusters of cancer cells with metastatic ability spread concomitantly through various routes to different organs and can therefore give rise to DCIS, invasive breast cancer and metastatic deposits simultaneously. Recent studies elucidating molecular differences between DCIS and invasive breast cancer further support the relevance of this model.
These putative models illustrate the potential complexity of the invasion process in DCIS and indicate that indolent lesions might become invasive via a combination of more than one of the proposed mechanisms.
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What If My Lobular Carcinoma In Situ Is Described As Pleomorphic Or With Necrosis
Pleomorphic means that the LCIS cells look more atypical under the microscope than the usual case of LCIS. Necrosis means that some of the LCIS cells are dead. LCIS with either of these features may be more likely to grow faster and to spread, and is linked to an even higher risk of invasive cancer. LCIS with either of these features may be treated differently than most cases of LCIS.
Lobular Carcinoma In Situ
Lobular carcinoma in situ is a type of breast change that is sometimes seen when a breast biopsy is done. In LCIS, cells that look like cancer cells are growing in the lining of the milk-producing glands of the breast , but they dont invade through the wall of the lobules.
LCIS is not considered to be cancer, and it typically does not spread beyond the lobule if it isnt treated. But having LCIS does increase your risk of developing an invasive breast cancer in either breast later on, so close follow-up is important.
LCIS and another type of breast change are types of lobular neoplasia. These are benign conditions, but they both increase your risk of breast cancer.
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Immunohistochemistry And Molecular Biology
Classic LCIS is almost always negative for E-cadherin, and most cases are negative for high-molecular-weight CK5/6. LCIS with morphologic features that overlap with DCIS often predictably stains for E-cadherin. Classic LCIS is positive for ER in more than 95% of cases and is usually positive for PR. Classic LCIS cells are usually negative for p53 and HER-2, except for the pleomorphic variant, which begins to show cytologic and immunophenotypic features of high-grade DCIS. The idea that LCIS is only a marker for breast carcinoma should be discouraged molecular, immunophenotypic, and morphologic data indicate that LCIS is a direct precursor of invasive lobular carcinoma.80 For example, loss of heterozygosity at loci frequently observed in invasive lobular carcinoma has also been reported in LCIS , and it has been demonstrated that truncated mutations of the E-cadherin gene identified in invasive lobular carcinoma were also present in the adjacent LCISboth of which provide direct evidence that LCIS is a precursor lesion. In addition, the lobular neoplasia cells found in LCIS adjacent to invasive lobular carcinoma are usually cytologically identical to the invasive tumor cells. That the two resemble each other cytogenetically should come as no surprise, because it has long been known that phenotype recapulates genotype.
Amy E. McCart Reed, … Sunil R. Lakhani, in, 2019
How Do I Take Care Of Myself If I Have Lobular Carcinoma In Situ
Theres a lot you can do to take care of yourself if you have LCIS:
- Ask your healthcare provider what you can do to reduce your risk of developing breast cancer, such as maintaining a healthy weight.
- Find out what physical changes in your breasts might indicate your lobular carcinoma in situ has become invasive breast cancer.
- Examine your breasts monthly. You might notice changes that have nothing to do with LCIS but could be signs of other conditions.
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Surgery And Radiation Therapy
Currently, breast-conserving treatment for DCIS is frequently recommended. A mastectomy is advised if the DCIS is too extensive to allow breast conservation. According to Thompson et al., the recurrence rates with 5 years median follow-up are 0.8% after mastectomy, 4.1% after breast-conserving surgery followed by radiotherapy and 7.2% after breast-conserving surgery alone. According to Elshof et al., invasive recurrence rates are 1.9, 8.8 and 15.4%, respectively, after 10 years median follow-up. The 15-year cumulative incidence in the National Surgical Adjuvant Breast and Bowel Project 17 trial of patients with clear margins is 19.4% after breast-conserving surgery alone and 8.9% after breast-conserving surgery followed by radiotherapy. Four randomised clinical trials have been performed to investigate the role of radiotherapy in breast-conserving treatment for DCIS after complete local excision of the lesion. In a meta-analysis, these trials show a 50% reduction in the risk of local recurrences after radiotherapy. Radiotherapy was reported to be effective in reducing the risk of local recurrence in all analysed subgroups according to age, clinical presentation, grade and type of DCIS.
Below Are A Bunch Of Q& as
What is the meaning of lobular carcinoma in situ?
LCIS is an uncommon condition in which abnormal cells form in the lobules or milk glands in the breast. LCIS is not cancer, but having a diagnosis of LCIS indicates that you have an increase in the risk of developing breast cancer.
What are the symptoms of lobular carcinoma in situ?
LCIS does not cause any signs or symptoms. Rather, your doctor might discover incidentally that you have LCIS. For example, after a biopsy to asses a breast lump or an abnormal area, such as microcalcifications, on mammogram.
When should I see a doctor?
Make an appointment with your doctor if you notice any of the following including a:-
- change in your breast
- area of puckered or otherwise unusual skin
- thickened region underneath the skin
- nipple discharge
Ask your doctor how often you should have breast cancer screening and follow up. Most groups recommend routine screening beginning in your 40s. Talk with your doctor about what is right for you.
What causes lobular carcinoma in situ?
It is not yet clear what causes LCIS.
How does lobular carcinoma in situ start?
LCIS begins when cells in a milk-producing gland, known as a lobule, of a breast develop genetic mutations that cause the cells to appear abnormal. The abnormal cells remain in the lobule and do not extend into, or invade, nearby breast tissue.
What is the percentage of risk for developing lobular carcinoma in situ?
What are the risk factors for Lobular Carcinoma In-Situ?
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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 To Expect From Your Doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:
- Do you have a breast lump that you can feel?
- When did you first notice this lump?
- Has the lump grown or changed over time?
- Have you noticed any other unusual changes in your breast, such as discharge, swelling or pain?
- Have you gone through menopause?
- Are you using or have you used any medications or supplements to relieve the symptoms of menopause?
- Have you been diagnosed with any previous breast conditions, including noncancerous conditions?
- Have you been diagnosed with any other medical conditions?
- Do you have any family history of breast cancer?
- Have you or your close female relatives ever been tested for the BRCA gene mutations?
- Have you ever had radiation therapy?
- What is your typical daily diet, including alcohol intake?
- Are you physically active?
If your biopsy reveals LCIS, you’ll likely have a follow-up appointment with your doctor. Questions you may want to ask your doctor about LCIS include:
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What Questions Should I Ask My Healthcare Provider About My Lcis Diagnosis
Lobular carcinoma in situ is a rare disease that increases your risk for developing breast cancer. Understanding your risk and your options can help you feel more confident and in control of your situation. Start with asking the following questions:
- How does lobular carcinoma in situ happen?
- What is my risk for developing breast cancer?
- What are my treatment options?
- What are those treatments side effects?
- Is there anything I can do on my own to reduce my risk of developing breast cancer?
A note from Cleveland Clinic
Lobular carcinoma in situ isnt breast cancer. Being diagnosed with LCIS doesnt mean you will develop breast cancer. It does mean you live with an increased risk for developing breast cancer. You might feel frustrated and frightened because you dont have a clear idea what to expect. If that happens, ask your healthcare provider for help understanding what it means to live with LCIS. They will have insight into your individual situation, and they can make recommendations for programs and services that might be helpful.
Last reviewed by a Cleveland Clinic medical professional on 09/20/2021.
Lowering The Risk Of Breast Cancer
Some hormonal therapy drugs can reduce the risk of breast cancer developing in women with LCIS. Your doctor or specialist nurse may talk to you about taking a hormonal therapy if it is an option for you. It is not clear how much the reduction in risk outweighs the side effects of hormonal therapy drugs.
You might have a pattern of breast cancer in your family. For example, there may be a number of family members who have been diagnosed with breast cancer. If this is the case, you may be referred to a genetics clinic to see a specialist. At the clinic, you have a risk assessment and genetic counselling.
Some women who are assessed as having a high risk of breast cancer, may think about having surgery to remove both breasts removed. This is to reduce the risk of breast cancer developing. It is called risk-reducing breast surgery.
Talk to your doctor or specialist nurse if you are worried about your family history or risk of developing breast cancer.
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Lcis And Breast Cancer Screening
There are special breast cancer screening guidelines for women with LCIS.
- Have a clinical breast exam every 6-12 months
- Have a mammogram every year, starting at age 30 may be considered)
- Talk with a health care provider about screening with breast MRI every year, starting at age 25
This medical care helps ensure if breast cancer does develop, its caught at an early stage when the chances of survival are highest.
Learn more about breast cancer screening recommendations for women at higher risk.
How Is Lobular Carcinoma In Situ Diagnosed
LCIS does not always show up on a mammogram or cause symptoms. Thats why its usually caught when you have a biopsy for some other reason. A biopsy is the only way to diagnose LCIS.
During a biopsy, the doctor uses a needle to extract a small sample of the suspicious tissue. A pathologist then examines the sample under a microscope to look for abnormal cells or cell overgrowth.
LCIS is not cancer, so active treatment may not be necessary. Its not life threatening, so you can take your time making treatment decisions. A few factors that can influence these decisions are:
- the cells are very abnormal
- there are areas of dead cells
- you have a personal or family history of breast cancer
- personal preference
Your doctor may recommend removing the abnormal tissue. Surgical options include breast excisional biopsy or breast conserving surgery to remove the abnormal area plus a margin of healthy tissue.
Another option is prophylactic mastectomy, which is surgical removal of the breast to lower the risk of breast cancer. Its not usually recommended for LCIS. Some women who have additional risk factors, such as BRCA gene mutations might be more inclined to choose this surgery.
LCIS increases breast cancer risk in both breasts, so both would be removed. Because theres no cancer, theres no need to remove lymph nodes under the armpits . Removal of the entire breast, including the skin, nipple, and areola, is called simple mastectomy.
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Tests For Colon Cancer
Post-menopausal women are often recommended tamoxifen or Evista , another medicine that blocks estrogens effects on breast tissue based on the results of the Study of Tamoxifen and Raloxifene which showed that raloxifene was as effective as tamoxifen in reducing the risk of invasive cancer in postmenopausal women with LCIS.
In 2013, the American Society of Clinical Oncology released new guidelines on using hormonal therapy medicines to reduce breast cancer risk in high-risk women. These guidelines recommend that doctors talk to high-risk postmenopausal women about using Aromasin to reduce risk.
Research presented at the 2013 San Antonio Breast Cancer Symposium showed that Arimidex can lower the risk of first-time, hormone-receptor-positive breast cancer in postmenopausal women at high risk who havent been diagnosed. Like Aromasin, Arimidex isnt approved by the FDA for this use, but doctors may consider it a good alternative to other hormonal therapies approved to reduce risk in high-risk women.
What Can I Do To Prevent Lobular Carcinoma In Situ
Unfortunately, researchers dont have enough information about LCIS to recommend ways to prevent it. But there are steps you can take to reduce their risk for developing breast cancer:
- Maintain a healthy weight.
- Exercise on a regular basis.
- Ask your healthcare provider about any risk you might have if you take hormone replacement medication or birth control medication.
- Find out if you have a family medical history that might increase your risk of developing breast cancer.
- If you expect to have children, plan on breastfeeding them.
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Outlook For Invasive Lobular Carcinoma
Cancer affects everyone differently. Your outlook may depend on things like how early youre diagnosed and how well your body responds to treatment.
In general, about 90% of all women with breast cancer live at least 5 years after diagnosis. While there isnt much information about specific types of breast cancer, these survival rates are tracked by stage at diagnosis or how far the cancer has spread:
- Localized : 98.9% live at least 5 years.
- Regional : 85.7% live at least 5 years.
- Distant : 28.1% live at least 5 years.
Breastcancer.org: Lobular carcinoma in situ , Invasive lobular carcinoma, Bone Scans, LCIS and Breast Cancer Risk, Treatments for LCIS, Test for Diagnosing ILC, and Systemic Treatments for ILC: Chemotherapy, Hormonal Therapy, Targeted Therapies, Signs and Symptoms of ILC, Local Treatments for ILC: Surgery and Radiation Therapy.
Breast Cancer Network of Strength: Lobular carcinoma in situ and Infiltrating lobular carcinoma.
National Cancer Institute: Lobular carcinoma in situ, Cancer Stat Facts: Female Breast Cancer.
American Cancer Society: What is breast cancer? and “Special Section: Breast Carcinoma in Situ,” Chemotherapy for Breast Cancer, Radiation for Breast Cancer.
College of American Pathologists: Lobular carcinoma in situ, “Invasive lobular carcinoma.