What is Invasive Lobular Carcinoma?
Invasive lobular carcinoma is a cancerous development commencing at the lobules of the breast. Lobules of the breast are milk-carrying ducts, which are extending throughout the breast tissue.
The invasive nature of this carcinoma has a tendency to spread from lobules to adjoin lymph nodes, breast tissues, and distant organs. It is one of the most common types of breast cancer.
Alternatively, Invasive lobular carcinoma is also termed as infiltrating lobular carcinoma1,2.
The incidence of Invasive Lobular Carcinoma is high and hold the second position in respect of all types of breast cancer. The development of this carcinoma may occur at any age, but the prevalence is more after 50 years of age.
The incidence rate showed that two-third of the invasive lobular carcinoma develops in a female with 55 years or more older age1,2.
The classic form of Invasive Lobular Carcinoma develops in a single-file pattern and invade stroma. The stroma is surrounded around the lobules and contains ligaments and fatty tissues.
Stroma is also adjoined with blood vessels and lymph nodes. Apart from classic Invasive Lobular Carcinoma, there are other subtypes of Invasive Lobular Carcinoma is present, which include:
In this sub-type of Invasive Lobular Carcinoma, the malignant cells develop on large sheets and tiny stroma is present in between the cell arrangement.
The cluster of cancer cells grouped together. In one cluster, 20 or more than this can grow into a series.
In this subtype, a fusion of “single-file” classic pattern with tiny tubules malignant cellular growth combined together.
Further additional subtypes of Invasive Lobular Carcinoma include:
The size of the cancer cells in this subtype is larger than the classic ILC type of cancer cells. The nuclei of these cells are different from each other.
Signet ring cell
In this type of Invasive Lobular Carcinoma, the malignant tumor growth has mucus filled cells with a one-sided nucleus. The position of the nucleus is at one side because mucus pushes the nucleus. This specific look of the cancerous tumor growth is termed as signet ring cells2.
At the initial stage, the Invasive Lobular Carcinoma is asymptomatic, But in advance stage, it provides following symptoms:
- Certain breast area become thicken
- Part of breast become inflamed or provide excessive fullness feeling
- Skin texture of the breast gradually alter, including thickening or dimpling
- The recent development of the inverted nipple1,3.
The exact cause of the invasive lobular carcinoma is unknown. Clinician explains that the commencement of the invasive lobular carcinoma involves single or multiple lobules (milk- glands of the breast) because of altered DNA mutation.
The abnormal mutation causes unwanted, rapid cell growth. The invasive nature of the lobular carcinoma spread to adjoin breast tissue by following star-like fashion. However, at initial stage it does not provide lump formation1.
The physical examination is the basis of diagnosis of the invasive lobular carcinoma. Abnormal findings or doubtful symptomatic discussion require further laboratory-based tests, including
- A mammogram, in this tests X-ray image of the breasts are taken for further investigation.
- A breast ultrasound, similar to abdominal ultrasound, breast ultrasound is performed by collecting wave producing images. But this test is performed after 35 years of age.
- A biopsy – Abnormal mass growth reported in mammogram and ultrasound require biopsy. A small tissue sample collected from the mass and examine under a microscope for checking malignancy of the collected tissue3,4.
Invasive Lobular Carcinoma Stages
When diagnosing breast cancer, staging becomes an important thing. When we talk of staging, it is process used to find out how much the cancer has advanced or spread and where it’s located. The details on staging also help plan for the cancer treatment and come up with a prognosis.
Staging provides a way of ensuring that a cancer patient gets the best possible treatment. In a majority of cancers, staging is based on these three main factors:2
- The size of the tumor as well as its growth into the areas around it (T)
- The spread of the cancer to lymph nodes close to it (N)
- The spread of the cancer to other areas of the body – distance areas from its original location (M)
When the TNM are established, the stage can be assigned to the cancer. That said, here are the different stages of invasive lobular carcinoma:
In this stage, it indicates that the cancer cells have not yet gone deeper into the fatty tissue that surrounds the breast. They are still contained in the breast lobule. In this stage, the lobular carcinoma is said to be in situ, which is a non-invasive breast cancer. With stage 0 of the breast cancer, it simply means that it hasn’t spread to distant sites or lymph nodes.
If the cancer has grown about 2cm, which is equivalent of ¾ inches or less of that, across the tissue, but it has not metastasized to distance sites or the nearby lymph nodes, it is said to be in stage 1.
In this stage, the tumor has grown to about 2cm or it is less than that across. It also has begun having micrometastases within the axillary lymph nodes. The cancer has started attacking the lymph nodes, however, it is in small attacks. It has grown across by greater than 0.2 mm or it has invaded more than 200 cells however its extent of attack does not go beyond 2mm. Also, in this stage, the cancer has not moved to attack distant sites.
While in this stage the cancer hasn’t yet spread to reach distant sites, it exhibits one of the following characteristics:
- The tumor is about 2cm, or let’s say, it’s less across, it has also spread to up to three axillary lymph nodes. In the lymph nodes, it has grown more than 2mm across.
- There is growth of the tumor by 2cm or maybe less across, there are also tiny amounts occurring within the internal mammary lymph nodes
- The tumor has grown by 2cm or probably less across, it has spread to up to three lymph nodes found under the arm. It has also spread to internal mammary lymph nodes.
- Or, the tumor has grown by more than 2cm across but less than 5cm, however, it has not spread to attack the lymph nodes.
In this phase of the cancer growth, it has not reached distance sites, however, one of these situations apply:
- The tumor has grown more than 2cm but less than 5cm across. Also, it has spread to up to three axillary lymph nodes. There are also tiny amounts within the internal mammary lymph nodes.
- The tumor is more than 5cm across, however, it hasn’t spread to chest skin or wall. It also has not attacked lymph nodes.
The cancer has not reached distance sites, however, the following situations apply:
- The tumor has not grown more than 5cm across, it has however attacked about four or up to nine axillary lymph nodes. The cancer has also caused the internal mammary lymph nodes to enlarge.
- The tumor is more than 5cm across, however, it has not grown into the chest skin or wall. The cancer has however attacked up to nine axillary nodes. It has also attacked the internal mammary nodes.
In this stage, the tumor has extended to reach the chest skin or wall, however, it has not yet reached distant sites. On top of that, the tumor exhibits the following features:
- It hasn’t attacked the lymph nodes
- The tumor has attacked up to three axillary lymph nodes. And, there are little amounts present within internal mammary lymph nodes.
- The cancer has invaded up to nine axillary lymph nodes. Alternatively, it has caused the internal mammary lymph nodes to enlarge.
In this stage, the tumor is said to be of any size but it’s has not yet attacked distant sites. That said, the tumor exhibits one of these features:
- It has spread to attack up to 10 or more of the axillary lymph nodes
- It has spread to invade the lymph nodes found under the collar bone or clavicle
- It has invaded the lymph nodes found above the clavicle
- It has invaded more than four of the axillary lymph nodes. In addition, there are tiny amounts present within the internal mammary lymph nodes.
In this stage, the cancer is of any size, it has or has not invaded the nearby lymph nodes. The cancer has invaded distant organs or it has attacked lymph nodes found far from the individual’s breast. The cancer tends to spread to areas such as the lungs, brain, liver, or bones.
Breast Cancer Cell Grades
When looking at how cancer has advanced, it is important to ensure that you don’t confuse grading with staging. Usually the stage of the cancer is based on the size and the distance it has spread from the original location in a breast.
When talking of cancer cell grade, it is kind of a “score” used to show how the various cancer cells appear and their growth patterns in relation to normal, healthy breast cells. A pathologist gives a report that rates the cancer using a scale of 1 to 3.1
This is also referred to as low grade or well differentiated. In this grade, the cells look somewhat different from the normal cells. The cancer cells grow in a slow, but well-organized pattern. Again, with this grade, there are no many cells that are dividing to form new cancerous cells.
This is known as the moderate or intermediate grade. It is also called moderately differentiated. The cells don’t look like normal cells. In addition, they grow and divide quite faster than usual.
This is known as high grade or poorly differentiated. With this grade, the cells appear very different to the normal cells. Also, they are growing quickly and are disorganized. They have irregular patterns and there are so many cells dividing to form new cancerous cells.
When a person has low-grade cancer, it is something that is encouraging. However, it is important to realize that higher-grade cancers could be somewhat more vulnerable compared to low-grade cancers when it comes to treatments like chemotherapy or radiotherapy. This is because these treatments are designed to target fast-dividing cells.
Doctor prepare treatment plan depending upon the stage of the Invasive Lobular Carcinoma, invasive nature of the tumor, the size of the tumor, spreading of metastasizing and overall health of patients. There are several therapeutic approaches like a surgical intervention, chemotherapy, hormonal therapy etc.
Lumpectomy is a surgery in which local excision of the tumor occurs and in this surgery, most of the breast tissue remains same. During the local surgical intervention, along with tumor lining the associated normal breast tissue margin also removed. This method is followed to reduce the scope of the future tumor reoccurrence.
Mastectomy is a complete removal of the affected breast. In this case, along with lobules, fatty tissue, ducts, breast skin, including nipple and areola is completely removed due to spreading of the metastasize to all the breast parts.
Dissection of the axillary lymph node is conducted if additional lymph nodes present in the armpit also affected.
Chemotherapy can be prescribed as a pre or post-operative regimen. The aim of prescribing pre- operative chemotherapy is to shrinking of tumor size. In the case of post-operative chemotherapy prescription, the treatment goal is to kill the remaining malignant cells and to reduce the scope of recurrence.
In radiation therapy, using the beam of ray assist to kill the malignant cells. Radiation therapy can be applied after Lumpectomy and Mastectomy, in the case of spreading cancer in the larger area.
If hormonal imbalance is the basic etiology of the cancer development and patient response is positive in hormone therapy, then hormone therapy is prescribed to control the cancer progression1,3,4.
Early diagnosis and appropriate treatment plan can provide a good prognosis. Early diagnosis and immediate effective treatment plan can mostly provide complete recovery and low incidence of recurrence, though it also depends upon patient response. The treatment approaches usually have low complications5.
Invasive Lobular Carcinoma is slowly progressive and therefore spreading of the cancer is less than other types of cancer. The clinical report documented that minimum survival rate in case of Invasive Lobular Carcinoma and it extends up to 30 years. Almost 75 percent of affected women can survive at least 5 years after their diagnosis and 50 percent of Invasive Lobular Carcinoma patient can survive till 30 years after their diagnosis of cancer5.
- Invasive lobular carcinoma; Mayo clinic; http://www.mayoclinic.org/diseases-conditions/invasive-lobular-carcinoma/basics/treatment/con-20033968
- ILC — Invasive Lobular Carcinoma; BREASTCANCER.ORG; http://www.breastcancer.org/symptoms/types/ilc
- Invasive lobular breast cancer; CANCER RESEARCH UK; http://www.cancerresearchuk.org/about-cancer/breast-cancer/stages-types-grades/types/invasive-lobular-breast-cancer
- breast cancer care https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/diagnosed-breast-cancer/primary-breast-cancer/invasive-lobular-breast-cancer
- Lobular Breast Cancer: What Are the Prognosis and Survival Rates? http://www.healthline.com/health/breast-cancer/lobular-breast-cancer-prognosis-survival#overview1
- Cell Grades – http://www.breastcancer.org/symptoms/diagnosis/cell_grade
- Staging Invasive Lobular Carcinoma. https://www.pennmedicine.org/cancer/types-of-cancer/breast-cancer/types-of-breast-cancer/invasive-lobular-carcinoma/invasive-lobular-carcinoma-diagnosis/invasive-lobular-carcinoma-staging
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