Lobular Breast Cancer (Invasive Lobular Carcinoma)

What are the symptoms of lobular breast cancer?

Lobular breast cancer is a rare and aggressive type of breast cancer that affects the lobules, which are the milk-producing glands in the breast. The symptoms of lobular breast cancer can be similar to those of ductal breast cancer, but they may also have some distinct characteristics. Here are some common symptoms of lobular breast cancer:

1. Lump or thickening in the breast: Lobular breast cancer may cause a lump or thickening in the breast tissue, which can be felt during a self-examination or by a healthcare provider.
2. Changes in breast shape or size: Lobular breast cancer may cause changes in the shape or size of the breast, such as a lump that causes the breast to become misshapen.
3. Skin dimpling or puckering: Lobular breast cancer may cause skin dimpling or puckering, which is a common symptom of both ductal and lobular breast cancer.
4. Nipple discharge: In some cases, lobular breast cancer may cause nipple discharge, which can be bloody or clear.
5. Nipple retraction: Lobular breast cancer may also cause nipple retraction, where the nipple becomes pulled inward.
6. Breast asymmetry: Lobular breast cancer may cause asymmetry in the breasts, with one breast becoming larger than the other.
7. Pain or tenderness: Lobular breast cancer may cause pain or tenderness in the breast, although this is not always present.
8. Swelling: Lobular breast cancer may cause swelling in the arm or underarm area on the same side as the affected breast.

It’s important to note that these symptoms can also be caused by other conditions, such as benign tumors or non-cancerous conditions like fibroadenomas. If you experience any unusual changes in your breasts, it’s essential to consult a healthcare provider for an evaluation.

In addition to these symptoms, lobular breast cancer may also have some distinct features that can aid in diagnosis:

• Tumor size: Lobular breast cancers tend to be smaller than ductal breast cancers at diagnosis.
• Spread to lymph nodes: Lobular breast cancer is more likely to spread to lymph nodes under the arm (axillary lymph nodes) than ductal breast cancer.
• Hormone receptor status: Lobular breast cancers are often hormone receptor-negative, meaning they are less responsive to hormonal therapies like tamoxifen.

What are the causes of lobular breast cancer?

Lobular breast cancer is a rare type of breast cancer that affects the lobules, which are the milk-producing glands in the breast. The exact causes of lobular breast cancer are not fully understood, but there are several factors that can increase a woman’s risk of developing this type of cancer. Here are some of the known risk factors for lobular breast cancer:

1. Genetic mutations: Inherited genetic mutations in the TP53, CHEK2, and PALB2 genes can increase a woman’s risk of developing lobular breast cancer.
2. BRCA1 and BRCA2 mutations: Women with inherited mutations in the BRCA1 or BRCA2 genes have an increased risk of developing lobular breast cancer, as well as other types of breast and ovarian cancer.
3. Family history: Having a family history of lobular breast cancer or other types of breast cancer can increase a woman’s risk.
4. Age: Lobular breast cancer is more common in women over the age of 50.
5. Hormone replacement therapy: Long-term use of hormone replacement therapy (HRT) after menopause may increase the risk of developing lobular breast cancer.
6. Obesity: Being overweight or obese may increase the risk of developing lobular breast cancer.
7. Lack of physical activity: A sedentary lifestyle may increase the risk of developing lobular breast cancer.
8. Radiation therapy: Women who have had radiation therapy to the chest area (e.g., for Hodgkin lymphoma) may have an increased risk of developing lobular breast cancer.
9. Reproductive factors: Having fewer children or having them at an older age may increase the risk of developing lobular breast cancer.
10. Breast density: Women with dense breasts may be at a higher risk of developing lobular breast cancer, as it can be more difficult to detect on mammography.

It’s important to note that having one or more of these risk factors does not necessarily mean a woman will develop lobular breast cancer. However, women with multiple risk factors should discuss their individual risk with their healthcare provider and consider getting regular screenings and performing self-exams to detect any abnormalities early.

In terms of lifestyle factors, there is limited evidence on what specifically causes lobular breast cancer, but maintaining a healthy lifestyle through:

• A balanced diet
• Regular exercise
• Not smoking
• Limiting alcohol consumption
• Getting enough sleep

may help reduce the overall risk of developing breast cancer, including lobular breast cancer.

It’s essential for women to be aware of their individual risk factors and to work with their healthcare provider to develop a personalized prevention plan.

How is the diagnosis of lobular breast cancer made?

The diagnosis of lobular breast cancer typically involves a combination of clinical evaluation, imaging tests, and biopsy. Here are the steps involved in diagnosing lobular breast cancer:

1. Clinical evaluation: A healthcare provider will perform a physical exam to assess the breasts, including checking for any lumps, swelling, or other abnormalities.
2. Mammography: A mammogram is a type of X-ray that produces images of the breast tissue. It can help detect abnormalities, such as calcifications or masses.
3. Breast ultrasound: An ultrasound uses sound waves to produce images of the breast tissue. It can help evaluate the size and location of a lump and determine if it is solid or cystic.
4. Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic field and radio waves to produce detailed images of the breast tissue. It may be used to evaluate the extent of the cancer and determine if it has spread to other parts of the body.
5. Breast Magnetic Resonance Imaging (MRI) with contrast: This is a type of MRI that uses a contrast agent to highlight any abnormalities in the breast tissue.
6. Breast Biopsy: A biopsy involves removing a sample of breast tissue for examination under a microscope. There are different types of biopsies, including:
   • Fine-needle aspiration biopsy (FNAB): A small sample of cells is removed using a thin needle.
   • Core biopsy: A larger sample of tissue is removed using a larger needle.
   • Surgical biopsy: A surgical procedure is performed to remove a sample of tissue for examination.
7. Pathology report: The biopsy sample is examined by a pathologist who will look for signs of cancer, including abnormal cell growth and invasion.
8. Staging: Once cancer is confirmed, the disease is staged based on the extent of the cancer and whether it has spread to other parts of the body.

Lobular breast cancer can be challenging to diagnose because it often presents as multiple small tumors or diffuse involvement throughout the breast tissue, rather than as a single large lump. This can make it difficult to detect on mammography or ultrasound.

To improve diagnostic accuracy, healthcare providers may use advanced imaging techniques, such as:

1. Contrast-enhanced mammography
2. Digital breast tomosynthesis (DBT)
3. Automated whole-breast ultrasound (AWBUS)
4. Contrast-enhanced MRI

In addition, healthcare providers may use computer-aided detection (CAD) software to help analyze images and identify abnormalities.

It’s essential for women to work closely with their healthcare provider to develop an individualized diagnostic plan and ensure that they receive accurate diagnosis and treatment for lobular breast cancer.

What is the treatment for lobular breast cancer?

The treatment for lobular breast cancer depends on the stage and characteristics of the cancer, as well as the individual’s overall health and preferences. The goal of treatment is to remove the cancer and prevent it from coming back. Here are some common treatments for lobular breast cancer:

1. Surgery: The most common treatment for lobular breast cancer is surgery, which may involve:
   • Lumpectomy: Removing the tumor and some surrounding tissue
   • Mastectomy: Removing the entire breast
   • Axillary lymph node dissection (ALND): Removing lymph nodes under the arm to check for cancer spread
   • Sentinel lymph node biopsy (SLNB): Removing the sentinel lymph node (the first node that drains the tumor) to check for cancer spread
2. Radiation therapy: Radiation therapy may be used after surgery to kill any remaining cancer cells and reduce the risk of recurrence. It can be external beam radiation therapy (EBRT) or brachytherapy.
3. Chemotherapy: Chemotherapy may be used before or after surgery to shrink the tumor and reduce the risk of recurrence. It can be used alone or in combination with other treatments.
4. Hormone therapy: Hormone therapy may be used to block the production of estrogen or progesterone, which can help slow down the growth of hormone-sensitive tumors.
5. Targeted therapy: Targeted therapy uses medications that target specific genes or proteins involved in the growth and spread of cancer cells.
6. Biological therapy: Biological therapy uses medications that stimulate or suppress the immune system to help fight cancer.

Some specific treatment options for lobular breast cancer include:

1. Neoadjuvant chemotherapy: Chemotherapy given before surgery to shrink the tumor
2. Adjuvant chemotherapy: Chemotherapy given after surgery to reduce the risk of recurrence
3. Hormone receptor-positive tumors: Treatment with aromatase inhibitors (e.g., anastrozole) or selective estrogen receptor modulators (e.g., tamoxifen)
4. HER2-positive tumors: Treatment with trastuzumab (Herceptin) and pertuzumab (Perjeta)

It’s essential to work with a healthcare team, including a surgeon, medical oncologist, radiation oncologist, and genetic counselor, to develop a personalized treatment plan.

In addition to these treatments, women with lobular breast cancer may also receive:

1. Supportive care: Medications to manage symptoms such as pain, nausea, and fatigue
2. Breast reconstruction: Surgery to rebuild the breast after a mastectomy
3. Lymphedema management: Treatment to manage swelling in the arm or hand due to lymph node removal
4. Rehabilitation: Physical therapy and exercise programs to improve range of motion and strength after surgery

It’s important to note that every woman’s experience with lobular breast cancer is unique, and treatment plans will vary depending on individual circumstances.