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Where Does Lobular Breast Cancer Spread

Learn More About Lobular Breast Cancer And What Bcrf Is Doing To Accelerate Lifesaving Research

Metastatic Lobular Carcinoma Treatment Options

Invasive lobular carcinoma, also referred to as invasive lobular breast cancer or simply lobular carcinoma/breast cancer, is the second most common type of breast cancer after invasive ductal carcinoma . The location where the cancer originates distinguishes ductal vs. lobular breast cancer: Invasive ductal carcinoma begins in milk ducts whereas invasive lobular carcinoma begins in lobules .

Lobular breast cancer represents 10 to 15 percent of all invasive breast cancers. Over the past two decades, incidence rates of lobular carcinoma have increased. An estimated 43,700 cases of invasive lobular breast cancer were diagnosed in 2021. Despite its prevalence, our understanding of the unique biology of this breast cancer subtype is still emerging.

Lobular carcinoma is treatable but has unique biology that affects symptoms, diagnosis, and therapeutic strategies. BCRF is working to better understand these challenges and advance lobular breast cancer researchand in just the last few years, say advocates and researchers like BCRF investigator Dr. Steffi Oesterreich, weve made terrific progress.

What is invasive lobular carcinoma?

Invasive breast cancers are those that have broken out of the areas where they originated and infiltrated surrounding breast tissue. The most common type of invasive breast cancer is invasive ductal carcinoma, followed by invasive lobular carcinoma.

Lobular Carcinoma Diagnosis and Symptoms
How is lobular carcinoma diagnosed?

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.

Whats New In Ilc Research

While there are challenges to lobular research â itâs a less common cancer so there are fewer sample sizes and cell lines â studies now underway may lead to answers about the cancerâs origins, changes to current treatment and potential therapies.

In September 2015, results from the Breast International Group 1-98 study presented key findings regarding the hormonal treatment of ILC patients: An aromatase inhibitor worked better for ILC patients than tamoxifen. As a result, a new national study, run through the Translational Breast Cancer Research Consortium and led by U Pitt lobular expert Dr. Rachel Jankowitz , is comparing three endocrine therapies â fulvestrant, tamoxifen and the AI anastrozole â to see which one works best.

âThe hypothesis of this trial,â said Davidson, who helped create the TBCRC back in 2005, âis that tamoxifen will be the least effective drug and that the AI and fulvestrant might actually be better drugs in this setting. It may lead us to think more carefully about how we treat these women in the future.â

There is also a body of work looking at potential molecular targets for ILC.

âWeâre testing these samples comprehensively for expression differences and associations with hormonal replacement therapies ,â said Porter. âIf we look at the gene expression and mutations and relate them to HRT categories, we might start to see differences that could lead to the identification of novel prevention and therapeutic targets.â

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Invasive Lobular Carcinoma Grades

Its important to understand the difference between the stage and the grade numbers assigned during a cancer diagnosis. The cancers stage refers to its size and how much it has spread. Grade is a measure of the cancerous cells appearance and predicted tendency to spread.

Specifically, grade refers to how similar or different your cancer cells are to a normal cell. This grade will be noted after your cancer cells have been examined under a microscope. This will require a biopsy. Youll probably see an assigned grade of 1, 2, or 3.

The lowest grade 1 refers to cancer cells that resemble normal breast cells, are slow-growing, and least likely to spread. Grade 2 cells look less like normal cells and are growing a bit faster. Grade 3 cells look much different and will likely grow and spread the fastest.

The grade number assigned to your cancer will help your doctor decide on the best course of treatment for you and gauge your prognosis.

Guidelines For Elective Surgical Options

Factsheet: ILC

Women with BRCA1 or BRCA2 mutations face a significant risk of breast and ovarian cancer. Prophylactic removal of the fallopian tubes and ovaries is recommended by about age 40. Many women with BRCA1 or BRCA2 mutations will also elect to have their breasts removed. Nipple-sparing mastectomy is an effective option for these women.

Making the decision to have an elective preventive double mastectomy and removal of the ovaries is personal and should be based on many life factors. You must balance where you are in your childbearing years, what your future choices may be, and whether you would prefer to follow a rigorous screening schedule instead of making such a life-altering choice.

Whatever your decision, we encourage you to make an informed choice. If you do elect to have a preventive double mastectomy, our breast specialists will guide you in the appropriate breast surgery reconstruction to help restore your body image after treatment.

If you are interested in discussing ovary removal surgery , we will refer you to one of our gynecological oncologists.

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How Is Invasive Lobular Carcinoma Diagnosed

In most cases, invasive lobular carcinoma is detected during a routine mammogram or by physical exam. During this exam, your healthcare provider will feel for lumps, bumps, skin thickening or other abnormalities in your breast. They may also order other tests, including:

  • Ultrasound. This imaging test uses sound waves to capture pictures of your breast tissue. Ultrasound may be used as a standalone test or in combination with mammography.
  • Magnetic resonance imaging . Your healthcare provider may request an MRI, which uses radio waves and magnets to take detailed pictures inside your body.
  • Biopsy. In order to confirm that the cancer is present, your healthcare provider may take a small sample of breast tissue and send it to a pathology lab for analysis.

Patient Engagement And Collaboration

Encouraged by lobularâs moment in the sun, Pate and other ILC advocates formed the Lobular Breast Cancer Alliance after the Pittsburgh symposium to advance research and educate patients and others about the disease.

âA group of us stayed in touch after the symposium and put ideas together, and it basically evolved into the LBCA,â she said. âNow we have a steering committee of patient advocates around the country and a scientific advisory board of top lobular researchers, including two at Fred Hutch .â

So far, the group has developed a white paper, launched a website, presented a poster at the San Antonio Breast Cancer Symposium, organized a series of educational webinars and established a partnership with the Metastatic Breast Cancer Project â a genomic research initiative out of Dana Farber Cancer Institute and the Broad Institute of MIT and Harvard â to help identify lobular patients and expedite their tumor analysis.

âThe sheer lack of tumor material to study is a problem,â said Pate. âWeâre trying to bridge that.â

Other goals of the LBCA : advancing lobular-specific and inclusive clinical trials and studies, linking ILC patients with research opportunities, and working with existing breast cancer organizations to better address the needs of lobular patients, hundreds of whom have shared stories of misleading mammograms and delayed diagnoses on two closed Facebook groups launched by early– and late-stage ILC patients.

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What Is The Prognosis For Invasive Lobular Carcinoma

Your doctor can give you an idea of what to expect based on individual characteristics of the cancer cells, the stage of the cancer and other factors, Tran says. Early-stage breast cancers carry a higher survival rate than advanced stages. In general, with modern treatments, the prognosis of lobular carcinoma is similar to ductal carcinoma.

Breast Health Services

Johns Hopkins breast health services include preventive and noncancerous surgical treatment, risk assessment, diagnostic screenings and treatment for breast cancer.

How Is Lobular Breast Cancer Different From Other Breast Cancers

Lobular Carcinoma In Situ Systemic Therapy Options

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.

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Breast Mri And Biopsy

Magnetic resonance imaging uses magnetic radio waves rather than radioactive waves and helps collect detailed images of the breast. Breast MRIs are often used to guide a biopsy of the area in concern.

Breast biopsies consist of taking a small sample of tissue by making a small incision and using a needle to collect samples. A biopsy is needed to make a definitive diagnosis of lobular breast cancer.

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 of the cancer cells, 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.

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What Is Synthetic Lethality

Our cells have thousands of different genes coding for proteins that work together to keep cells healthy. When one or more of these genes stop working properly it doesnt have to mean the cell can no longer survive there are often other proteins that can step in as a backup. In fact, in cancer our genes are often damaged, dysfunctional or lost altogether, but instead of dying the cells grow and spread far more than they should.

While faulty genes can give cancer cells a survival advantage, these mutations also make cells vulnerable to further damage. When two genes have a synthetic lethal interaction it means that the simultaneous loss of both of them will cause the cell to die. If just one is lost or damaged, the cell can stay alive, but as soon as the other gene in the pair is broken or blocked, the cell is no longer able to survive. When either gene is removed, the pathways that rely on them are disrupted, and when both are removed at once, there is no longer a backup to step in.

Synthetic lethality therefore presents opportunities to develop new cancer treatments. If a gene thats often damaged in certain tumour cells has a synthetic lethal partner gene, creating a drug that blocks the actions of the other gene will destroy the cancer cell, without killing healthy cells.

Treatment Options For Breast Cancer

Progression of Invasive Lobular Cancer

Surgery is the most common treatment option for breast cancer.Depending on the size and extent of the tumour, the surgeon may opt to do lumpectomy or mastectomy. Radiation and/or chemotherapy are typically recommended after surgery to prevent cancer recurrence and to kill any remaining cancerous cells. Hormone therapy is recommended for hormone receptor positive breast cancers.

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What Is Lobular Breast Cancer

Lobular breast cancer is a type of breast cancer that begins in the milk-producing glands of the breast. It is the second most common type of breast cancer, accounting for about 10% to 15% of all invasive breast cancers. Cancer of the breast ducts is the most common type of invasive breast cancer, accounting for 65% to 85% of all invasive breast cancers.

What Is Invasive Lobular Carcinoma

Invasive lobular carcinoma is breast cancer that begins in one of the glands that make milk, called lobules, and spreads to other parts of the breast. Itâs the second most common form of breast cancer after invasive ductal carcinoma, which begins in a milk duct.

Itâs different from lobular carcinoma in situ . Thatâs another type of abnormal cell growth in the breast that stays inside the lobules.

ILC is more likely to be found in both breasts than other types of breast cancer. It can also spread to other areas of your body.

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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.

How Is Lobular Breast Cancer Treated

Lobular Carcinoma In Situ, What Is It?

Once a lobular breast cancer is found, treatment consists of surgery followed by radiation and/or chemotherapy. Depending on the size of the tumor, surgical options include removing the tumor and some normal tissue around it or a part of or the whole breast including some lymph nodes and muscle tissue. If a breast MRI was not done before, it may be done prior to surgery to make sure the planned surgery will be able to remove all the cancer.

Following surgery, you may need radiation therapy to kill any cancer cells left at the site of the tumor and/or chemotherapy to kill cancer that may have spread to the lymph nodes under the arm and beyond the breast area.

Most patients will need to take daily doses of anti-estrogen medications for 5 to 10 years after surgery to continue to treat the cancer. These medications include tamoxifen and aromatase inhibitors, such as letrozole , exemestane and anastrozole .

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A New Lethal Weapon Against Lobular Breast Cancer

In some exciting new research, Breast Cancer Now scientists led by Professor Chris Lord at the Breast Cancer Now Toby Robins Research Centre in the Institute of Cancer Research in London have uncovered a key weakness which could bring new hope for people with lobular breast cancer.

Whats more, they found that this weakness can be exploited through something called synthetic lethality. Sound scary? It is to tumours, as this weakness is proving to be an efficient way to eliminate specific cancer cells without harming healthy cells. But what is this lethal weapon and how does it work?

How Quickly Breast Cancer Spreads

Metastasis, the spread of breast cancer to other parts of the body, is responsible for the majority of breast cancer deaths. This makes it important to know how fast a breast cancer spreads.

Breast cancer usually spreads first to lymph nodes under the arm. This is called lymph node-positive breast cancer. Breast cancer is considered early-stage and potentially curable even with the involvement of lymph nodes.

When a cancer spreads to regions such as the bones, brain, lungs, or liver, it is considered stage IV or metastatic breast cancer. This means it is no longer curable.

Most breast cancers have the potential to spread. Carcinoma in situ or stage 0 breast cancer is considered non-invasive because of its limited spread. It is potentially 100% curable with surgery.

All other stages of breast cancer are considered invasive and have the potential to spread. Spread to lymph nodes, even when early stage, is very important because it indicates the cancer’s potential to spread beyond the breasts.

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What Are The Stages Of Breast Cancer

Breast cancers are staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade and three is a high grade cancer that is more likely to grow rapidly and spread. In addition, breast cancer may be staged as noted below.

The four stages of breast cancer are:

  • Stage I: The tumor is relatively small and localized to the original site with possible spread to the sentinel lymph nodes.
  • Stage II: The tumor has grown and spread to a few nearby lymph nodes.
  • Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
  • Stage IV: The cancer has spread to distant parts of the body such as bone, brain, lungs or liver.

Other staging systems state there are 5 stages with Stage 0 representing non-invasive cancer cells. Another classification that is highly detailed is the TNM system, based on tumor size, lymph node involvement and metastatic spread.

Diagnosis Of Lobular Cancer

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Diagnosis of ILC by physical exam can be challenging as patients often present with limited clinical signs and do not always have a palpable breast lump signs may be frequently vague such as skin thickening or dimpling. Measuring the extent of ILC can be difficult as traditional screening methods such as mammography and ultrasound have a low sensitivity for detecting ILC compared to other invasive breast tumors. This difficulty can be largely attributed to the diffuse infiltrative growth pattern of ILC .

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