Invasive Lobular Carcinoma: Symptoms, Causes, Treatment

What are the symptoms of invasive lobular carcinoma?

Invasive lobular carcinoma (ILC) is a type of breast cancer that begins in the lobules (milk-producing glands) and then invades nearby tissues. The symptoms of ILC can be subtle and may include:

1. Thickening or hardening in an area of the breast.
2. A change in the texture or appearance of the breast, such as dimpling or puckering of the skin.
3. A new area of fullness or swelling in the breast.
4. A new lump or mass in the breast, which might feel different from the surrounding tissue.
5. Nipple changes, such as inversion (turning inward) or discharge.
6. Pain in the breast or nipple area, though this is less common.
7. Changes in the skin over the breast, such as redness or an orange-peel texture.
8. Swelling in the arm on the side of the affected breast.

It’s important to note that ILC often does not form a distinct lump, making it more challenging to detect through physical examination or even routine mammography. Therefore, any unusual changes in the breast should be evaluated by a healthcare professional for accurate diagnosis and appropriate management.

What are the causes of invasive lobular carcinoma?

The exact causes of invasive lobular carcinoma (ILC) are not fully understood, but several factors are known to increase the risk of developing this type of breast cancer. These risk factors include:

1. Age: The risk of breast cancer increases with age, with most cases occurring in women over 50.
2. Gender: Being female is the primary risk factor, although men can also develop breast cancer, including ILC.
3. Family history: A family history of breast cancer, particularly in a mother, sister, or daughter, can increase the risk.
4. Genetic mutations: Inherited mutations in genes such as BRCA1 and BRCA2 can significantly increase the risk of breast cancer.
5. Personal history of breast cancer: Having breast cancer in one breast increases the risk of developing it in the other breast.
6. Hormone replacement therapy (HRT): Long-term use of HRT, especially combined estrogen and progesterone therapy, has been linked to an increased risk of breast cancer.
7. Reproductive history: Factors such as early menstruation (before age 12), late menopause (after age 55), having children later in life or not at all, and not breastfeeding can influence risk.
8. Radiation exposure: Previous radiation treatment to the chest area, particularly during adolescence or young adulthood, can increase the risk.
9. Alcohol consumption: Regular alcohol consumption is associated with an increased risk of breast cancer.
10. Obesity: Being overweight or obese, particularly after menopause, can increase the risk due to higher levels of estrogen produced by fat tissue.
11. Dense breast tissue: Women with dense breast tissue may have a higher risk of breast cancer and may also find it more challenging to detect tumors through mammograms.

While these factors can increase the risk of developing ILC, having one or more of these risk factors does not mean a person will definitely develop the disease. Conversely, some people with no known risk factors can still develop ILC.

How is the diagnosis of invasive lobular carcinoma made?

The diagnosis of invasive lobular carcinoma (ILC) is typically made through a combination of clinical examination, imaging studies, and histopathological examination of a biopsy sample. Here are the steps involved in the diagnosis of ILC:

1. Clinical evaluation: A patient with suspected breast cancer undergoes a clinical breast exam (CBE) and a mammogram to identify any abnormalities in the breast tissue.
2. Imaging studies: Additional imaging studies such as ultrasound, magnetic resonance imaging (MRI), or positron emission tomography (PET) may be performed to confirm the presence of a mass or abnormality in the breast tissue.
3. Biopsy: A biopsy is performed to obtain a tissue sample from the suspected tumor site. There are several types of biopsies that can be performed, including:
   • Fine-needle aspiration biopsy (FNAB): A thin needle is inserted into the breast tissue to collect a sample of cells.
   • Core needle biopsy (CNB): A larger needle is inserted into the breast tissue to collect a larger sample of tissue.
   • Excisional biopsy: The entire tumor is surgically removed, and a pathologist examines the tissue.
4. Pathological examination: The biopsy sample is sent to a pathologist for examination. The pathologist examines the tissue under a microscope and performs various tests to determine the type of cancer, including:
   • Histochemical staining: Special stains are applied to the tissue to highlight specific features, such as estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2).
   • Immunohistochemistry (IHC): Antibodies are used to detect specific proteins on the surface of cancer cells.
   • Molecular testing: Genetic testing may be performed to identify specific genetic mutations, such as BRCA1 or BRCA2 mutations.
5. Histopathological evaluation: The pathologist examines the tissue sample and provides a diagnosis based on the following criteria:
   • Invasive ductal carcinoma: The tumor invades the ducts or lobules of the breast tissue.
   • Invasive lobular carcinoma: The tumor invades the lobules of the breast tissue.
   • Histological grade: The tumor is graded based on its growth pattern, nuclear atypia, and mitotic rate.
6. Staging: Once a diagnosis of ILC is confirmed, further staging is performed to determine the extent of the disease. This includes:
   • Clinical staging: The patient’s symptoms, medical history, and physical examination are used to determine the stage.
   • Imaging staging: Imaging studies such as mammography, ultrasound, MRI, or CT scans are used to evaluate lymph node involvement and distant metastases.

The diagnosis of ILC is typically made by a multidisciplinary team of healthcare providers, including surgeons, radiologists, pathologists, and oncologists.

What is the treatment for invasive lobular carcinoma?

The treatment for invasive lobular carcinoma (ILC) is typically a combination of surgery, radiation therapy, and hormone therapy, depending on the stage and characteristics of the tumor. Here are some common treatment options:

1. Surgery: The primary treatment for ILC is surgery to remove the tumor and affected breast tissue. The type of surgery may vary depending on the size and location of the tumor, as well as the patient’s overall health. Common surgical options include:
   • Lumpectomy: Removal of the tumor and a small amount of surrounding tissue.
   • Mastectomy: Removal of the entire breast.
   • Bilateral mastectomy: Removal of both breasts.
2. Lymph node removal: In addition to removing the tumor, the surgeon may also remove lymph nodes from the armpit (axillary lymph nodes) to determine if they contain cancer cells.
3. Radiation therapy: Radiation therapy is often used in combination with surgery to kill any remaining cancer cells. It may be administered after surgery (adjuvant radiation) or before surgery (neoadjuvant radiation).
4. Hormone therapy: Hormone therapy is often used to treat ILC because it is sensitive to estrogen and progesterone hormones. Hormone therapy may be used alone or in combination with other treatments.
5. Targeted therapy: Targeted therapy is a type of treatment that targets specific molecules on the surface of cancer cells to stop their growth and spread. Examples of targeted therapies for ILC include:
   • Trastuzumab (Herceptin): Targets HER2-positive ILC.
   • Pertuzumab (Perjeta): Targets HER2-positive ILC.
   • Palbociclib (Ibrance): Targets CDK4/6-positive ILC.
6. Chemotherapy: Chemotherapy may be used in combination with other treatments or as a single agent to kill cancer cells. The choice of chemotherapy depends on the stage and characteristics of the tumor, as well as the patient’s overall health.
7. Biomarker testing: Biomarker testing is used to identify specific genetic mutations or protein expressions that can help guide treatment decisions.

The specific treatment plan for ILC will depend on various factors, including:

• Tumor size and location
• Lymph node involvement
• ER, PR, and HER2 status
• Grade and histological type
• Patient age and overall health

It’s essential to work with a multidisciplinary team of healthcare providers, including oncologists, surgeons, radiologists, and pathologists, to develop a personalized treatment plan for ILC.