What Are The Symptoms Of Invasive Ductal Carcinoma
Like other breast cancers, IDC may present as a lump that you or your doctor can feel on a breast exam. But in many cases, at first, there may be no symptoms, Wright says.
That is why it is important to have screening mammograms to detect breast cancers such as invasive ductal carcinoma. A mammogram may detect a lump that is too small for you to feel, or suspicious calcifications in the breast, either of which will lead to further testing.
According to Wright, the following are possible signs of invasive ductal carcinoma and other breast cancers. If you notice any of these, you should contact your doctor right away for further evaluation:
- Lump in the breast
- Nipple discharge, other than breast milk
- Scaly or flaky skin on the nipple or an ulceration on the skin of the breast or nipple. These can be signs of Pagets disease, a different kind of breast cancer that can occur along with IDC.
- Lumps in the underarm area
- Changes in the appearance of the nipple or breast that are different from your normal monthly changes
Phenotypic Expression Of Homologous Recombination Deficiency
HRD biomarkersCells become deficient in HR through loss of BRCA function or loss of function of any other protein/factor involved in the process. Assays for HRD have focussed on the detection of underlying driver mutations , BARD1, Blooms syndrome gene product , BRIP1, FANCA/C/D2/E/F/G/L, MRE11A, nibrin , PALB2, phosphatase and tensin homolog , RAD50, RAD51, RAD51B and Werner syndrome helicase ), epigenetic changes such as BRCA promoter methylation, or the resultant mutational landscape of deficient HR ) . Head-to-head comparisons of the different HRD assays have not yet been done, and so it is not clear which assay is superior. However, the two most clinically validated HRD assays are the Myriad Genetics myChoice HRD Plus assay and the Foundation Medicines FoundationFocus companion diagnostic xBRCA LOH assay. The Myriad myChoice assay measures telomeric allelic imbalance, large-scale transition and LOH. FoundationFocus CDxBRCA LOH is an assay that uses next-generation sequencing for the qualitative detection of BRCA1 and BRCA2 sequence alterations and LOH.
HRD and tissue-specific tumour developmentAn unanswered question in BRCA-related cancer biology is why HR defects are associated with cancer development both in terms of tissue specificity and histology .
Our Approach To Breast Cancer
UCSF offers the highest quality breast cancer care in a respectful and supportive environment. We focus on effective and less toxic therapies, patient education and research that may lead to even better prevention and treatment strategies. Our team of surgeons, oncologists, radiologists, psychologists and nutritionists work together to heal the whole person, both physically and emotionally.
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Breast Cancer Important Information
Circa 2005
Breast cancer is the most common type of cancer among women in the United States, affecting one in every eight women at some point in their lives . It accounts for one out of every three cancer diagnoses in women. About 200,000 womenand 1,500 menare diagnosed with breast cancer in the U.S. each year. It was the leading cause of cancer deaths for women from the 1950s through the mid-1980s, until rising rates of lung cancer deaths among women overshadowed it, and it is still the leading cause of cancer deaths for women aged 40 to 49.
The number of breast cancer diagnoses in the United States has increased in recent years because mammography has allowed earlier detection, but at the same time the number of deaths due to breast cancer has been declining. Between 1989 and 1995 death rates declined by 1.4 percent per year, and they declined by 3.2 percent per year after that.
If detected early, breast cancer is one of the most treatable cancers. When breast cancer is confined to the breast, the five-year survival rate is 97 percent. If cancer has invaded the area around the breast, however, the rate drops to 78 percent, and with distant metastases to only 23 percent.
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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Lobular Carcinoma In Situ
Lobular carcinoma in situ , which is not considered a malignancy, arises from the lobule at the terminal end of the duct and shows a rather diffuse distribution throughout the breast, which explains its presentation as a nonpalpable mass in most cases . Over the past 25 years, LCIS incidence has doubled and is currently 2.8 per 100,000 women. The peak incidence is in women aged 40-50 years.
A study by Tran-Thanh et al found that the prolactin receptor gene is a potentially important target in the pathogenesis and progression of lobular neoplasia. Because this gene was found to be potentially less important in ductal carcinomas, the conclusion is that lobular and ductal carcinomas may evolve along separate pathways
What Is Estrogen Receptorpositive Breast Cancer And Progesterone Receptorpositive Breast Cancer
Cells from your breast cancer can be tested for receptors on two hormones that can fuel cancer growth: estrogen and progesterone. Receptors are special proteins on cells that attach to certain substances, such as estrogen and progesterone, much like a key entering a lock. Breast cancer can contain receptors for one of these hormones, both, or neither.
- Breast cancer with receptors for estrogen is called estrogen receptor positive, or ER positive.
- Breast cancer with no receptors for estrogen is called estrogen receptor negative, or ER negative.
- Breast cancer with receptors for progesterone is called progesterone receptor positive, or PR positive.
- Breast cancer with no receptors for progesterone is called progesterone receptor negative, or PR negative.
If your cancer is ER positive, PR positive, or positive for both estrogen and progesterone receptors, your treatment may include a hormone therapy a drug or drugs that keep these hormones from plugging into their receptors. The idea is to cut off the cancers access to the fuel that would otherwise power its growth, much like putting a child safety cap on an electrical outlet.
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Breast Cancer During Pregnancy
Women can be diagnosed with breast cancer during pregnancy. Our breast cancer specialists can help achieve healthy outcomes for pregnant women with breast cancer and their babies. Our team includes some of the most recognized and respected breast cancer oncologists and maternal-fetal specialists in the nation.
How Is Breast Cancer Treated
If the tests find cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis.
The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells, and the stage, or extent, of the disease. Your doctor will usually consider your age and general health as well as your feelings about the treatment options.
Breast cancer treatments are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments. Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy are systemic treatments. A patient may have just one form of treatment or a combination, depending on her individual diagnosis.
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Breast Cancer Cell Lines
Part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with cell lines derived from breast cancers. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low . Indeed, attempts to culture breast cancer cell lines from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available breast cancer cell lines issued from metastatic tumors, mainly from pleural effusions. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, MDA-MB-231 and SK-BR-3, account for more than two-thirds of all abstracts reporting studies on mentioned breast cancer cell lines, as concluded from a Medline-based survey.
Metabolic markers
Brca Proteins In Homologous Recombination
HR is distinguished by its error-free repair of DSBs and is the predominant and promoted DSB repair process in the S/G2 phases of the cell cycle. The steps of HR have been reviewed in other articles , but we will present a brief, somewhat simplified overview of HR in mammalian cells here, highlighting the roles of BRCA1 and BRCA2.
Initially, ATM and ATM and RAD3-related recognise the DSB and phosphorylate downstream targets. BRCA1, along with BARD1 and BRIP1, act as a scaffold to organise other proteins, including the Mre11-Rad50-Nbs1 complex and C-terminal binding protein interacting protein , which then facilitate end resection . Antagonising mediators, such as 53BP1 and RIF1, may inhibit end resection at DSBs , shuttling the DSB into the NHEJ repair process instead. The end resection is extensive, in contrast to the less extensive end resection that can lead to the MMEJ pathway. Phosphorylated replication protein A binds to the resected end, protecting it and also facilitating the next stepRad51 loading .
BRCA2 and BRCA1 also function in another critical process: the protection of stalled replication forks. More specifically, BRCA1 and components of the Fanconi anaemia pathway may cooperate with BRCA2 in preventing nascent DNA degradation at stalled replication forks . Some studies have shown that this process of fork stabilisation may be independent of HR . Broadly speaking, emerging data point to a complex interplay of HR factors in fork remodelling and stability .
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Enhancing Healthcare Team Outcomes
After the treatment of breast cancer, long-term follow-up is necessary. There is a risk of local and distant relapse, and hence an interprofessional team approach is necessary. The women need regular mammograms and a pelvic exam. Also, women with risk factors for osteoporosis need a bone density exam and monitoring for tumor markers for metastatic disease. For those who are about to undergo radiation therapy, a baseline echo and cardiac evaluation are necessary. Even though many types of integrative therapies have been developed to help women with breast cancer, evidence for the majority of these treatments is weak or lacking.
Outcomes
Over the past four decades, the survival rates of most breast cancer patients have improved. Of note is that the presence of breast cancer has gradually slowed down over the past decade, which may be due to earlier detection and improved treatments. The prognosis for patients with breast cancer is highly dependent on the status of axillary lymph nodes. The higher the number of positive lymph nodes, the worse the outcome. In general, hormone-responsive tumors tend to have a better outcome. In breast cancer survivors, adverse cardiac events are common this is partly due to the cardiotoxic drugs to treat cancer and the presence of traditional risk factors for heart disease. The onus is on the healthcare provider to reduce the modifiable risk factors and lower the risk of adverse cardiac events. [Level 5)
Invasive Breast Cancer: Invasive Ductal Carcinoma And Invasive Lobular Carcinoma
Invasive ductal carcinoma and invasive lobular carcinoma are the most common types of invasive breast cancer. Invasive means cancer has spread from the original site through the bloodstream and lymph nodes to other areas, like nearby breast tissue, lymph nodes, or elsewhere.
Invasive ductal carcinoma is the most common type of breast canceraccounting for roughly 70 to 80 percent of all cases. IDC starts in a milk duct and grows into other parts of the breast. With time, it may spread further, or metastasize, to other parts of the body.
Invasive lobular carcinoma is the second most common type, accounting for roughly 5 to 10 percent of all breast cancers. ILC starts in lobules and then spreads into the nearby breast tissue. Like IDC, it may metastasize and spread to other parts of the body. This cancer is harder to detect on mammograms than IDC and one in five women with ILC have both breasts affected.
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Mucinous Carcinoma Of The Breast
Mucinous carcinoma, also known as colloid carcinoma, is a rare form of invasive ductal carcinoma . About 2 percent of breast cancers are pure mucinous carcinoma, while up to 7 percent of breast cancers have some component of mucinous carcinoma cells.
With this type of cancer, the tumor consists of abnormal cells that appear to float in pools of mucus when looked at under a microscope.
Its typically a less aggressive type of cancer that has a lower probability of spreading to the axillary lymph nodes than some other types of IDC.
Mucinous carcinoma tends to be more common in post-menopausal women, with the average age at diagnosis being around 60 to 70 years of age.
Are Your Cancer Cells Fueled By Hormones
Some breast cancers are sensitive to your body’s naturally occurring female hormones — estrogen and progesterone. The breast cancer cells have receptors on the outside of their walls that can catch specific hormones that circulate through your body.
Knowing your breast cancer is sensitive to hormones gives your doctor a better idea of how best to treat the cancer or prevent cancer from recurring.
Hormone status of breast cancers includes:
- Estrogen receptor positive. The cells of this type of breast cancer have receptors that allow them to use the hormone estrogen to grow. Treatment with anti-estrogen hormone therapy can block the growth of the cancer cells.
- Progesterone receptor positive. This type of breast cancer is sensitive to progesterone, and the cells have receptors that allow them to use this hormone to grow. Treatment with endocrine therapy blocks the growth of the cancer cells.
- Hormone receptor negative. This type of cancer doesn’t have hormone receptors, so it won’t be affected by endocrine treatments aimed at blocking hormones in the body.
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What To Know About Breast Cancer Symptoms
The symptoms of breast cancer can vary widely and some types of breast cancer may not have any noticeable symptoms.
Sometimes a lump may be too small to be felt or to cause any changes to your breast or surrounding area. In these cases, cancerous cells are often first detected through screening techniques like a mammogram.
When there are symptoms, they can include:
- a lump or thickening of breast tissue that you can feel with your fingers
- breast swelling or changes to your breast size or shape
- changes to the skin on your breast, such as dimpling, redness, or skin irritation
- the nipple turning inward or nipple pain
- a lump in your underarm area
- nipple discharge other than breast milk
Its important to be familiar with how your breasts usually look and feel. This will help you notice any changes and to follow up with your healthcare professional promptly if anything looks or feels different.
Noninvasive breast cancer develops in the cells of a duct or lobule and remains in that location. Its also referred to as in situ which means in the original place.
There are two types of noninvasive breast cancer:
- ductal carcinoma in situ
- lobular carcinoma in situ
Lets take a closer look at each type.
How Is Breast Cancer Diagnosed
During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following:
- Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different than benign lumps.
- Digital mammography: An X-ray test of the breast can give important information about a breast lump. This is an X-ray image of the breast and is digitally recorded into a computer rather than on a film. This is generally the standard of care .
- Ultrasonography: This test uses sound waves to detect the character of a breast lump whether it is a fluid-filled cyst or a solid mass . This may be performed along with the mammogram.
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles.
After the sample is removed, it is sent to a lab for testing. A pathologist a doctor who specializes in diagnosing abnormal tissue changes views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is and whether it has spread beyond the ducts or lobules .
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Common Categories Of Breast Cancer
Understanding the ins and outs of breast cancer can be difficult especially when there are so many different types. We encourage you to speak with your cancer care team at Willamette Valley Cancer Institute and Research Center so they can address any questions or concerns you may have.
Certain breast cancers are more common than others. Types of common breast cancers include: