Invasive Lobular Carcinoma What You Need to Know

Written by: Dr. Syeda Jannat Shayyan

Breast cancer remains one of the most common cancers worldwide, with millions of new cases diagnosed every year. One lesser-known but important type of breast cancer is Invasive Lobular Carcinoma (ILC). This article will dive deep into what you need to know about ILC, from its causes and symptoms to diagnosis, treatment, and survival rates. Understanding ILC is vital not only for those at risk but for anyone who wants to learn more about breast cancer.

What is Invasive Lobular Carcinoma?

Invasive Lobular Carcinoma (ILC) is a type of breast cancer that starts in the milk producing glands (lobules) of the breast and then spreads to surrounding tissues. Unlike other forms of breast cancer, such as Invasive Ductal Carcinoma (IDC), ILC tends to grow in a distinct pattern. The cells spread in a single-file line, which often makes ILC harder to detect through imaging techniques like mammograms.

ILC accounts for about 10-15% of all breast cancer diagnoses, making it the second most common type of invasive breast cancer. While it shares similarities with IDC, there are key differences in its behavior, symptoms, and how it is treated.

Understanding Breast Cancer Types

To better understand Invasive Lobular Carcinoma, it’s crucial to have a basic grasp of how breast cancer is categorized. Breast cancers are classified based on where they start in the breast tissue:

• Ductal carcinoma: Begins in the ducts that carry milk from the lobules to the nipple. Invasive Ductal Carcinoma (IDC) is the most common form of breast cancer.
• Lobular carcinoma: Originates in the lobules, which are responsible for milk production. Invasive Lobular Carcinoma falls into this category.

Both ductal and lobular carcinomas can be non-invasive (contained within the ducts or lobules) or invasive (spreading into surrounding breast tissue). Invasive cancers are the most concerning because they can metastasize to other parts of the body.

Symptoms of Invasive Lobular Carcinoma

One of the challenges in diagnosing ILC is that its symptoms can be subtle, making it less likely to be detected early. Unlike other types of breast cancer that might present as a lump, ILC often grows in sheets or lines of cells, which can feel different or be harder to notice. However, some common symptoms of ILC include:

• Thickening or hardening of a part of the breast rather than a distinct lump.
• Change in breast texture, making one breast feel firmer or fuller than the other.
• Changes in breast shape that may include dimpling or an asymmetrical appearance.
• Nipple inversion or turning inward.
• Swelling in one part of the breast or in the whole breast.
• Unexplained breast pain that does not seem related to menstruation or injury.

Because ILC can be difficult to detect through regular mammograms, it’s crucial to be aware of these more subtle symptoms and report any changes to a healthcare professional promptly.

Causes and Risk Factors

Like other types of breast cancer, the exact cause of Invasive Lobular Carcinoma remains unclear. However, several risk factors have been identified:

1. Age

The risk of developing ILC increases with age. Most women diagnosed with this type of breast cancer are over the age of 55.

2. Hormonal Replacement Therapy (HRT)

Women who have undergone hormone replacement therapy for an extended period, especially with a combination of estrogen and progesterone, have a higher risk of developing ILC.

3. Family History and Genetics

Having a family history of breast cancer, especially in first-degree relatives, increases the risk of ILC. Genetic mutations, such as BRCA1 and BRCA2, are also linked to a higher likelihood of developing both lobular and ductal carcinomas.

4. Previous Breast Cancer

If a woman has had breast cancer in the past, she is at a higher risk of developing ILC.

5. Radiation Exposure

Previous exposure to radiation therapy, particularly in the chest area, can elevate the risk of developing breast cancer later in life.

6. Obesity and Alcohol Consumption

There is a clear correlation between obesity and increased breast cancer risk, including ILC. Excessive alcohol consumption is another known risk factor.

How Invasive Lobular Carcinoma is Diagnosed

Because Invasive Lobular Carcinoma grows differently from other forms of breast cancer, it is often more challenging to diagnose. Regular mammograms may miss ILC, as the cancer tends to spread in strands of cells rather than forming a distinct lump. However, a combination of diagnostic tools can help detect ILC:

1. Mammograms

Although not always effective for ILC, mammograms are still a primary screening tool for breast cancer. Advanced imaging techniques, such as 3D mammograms, may improve detection rates.

2. Ultrasound

Breast ultrasound can be used to detect areas of abnormal tissue that might not show up on a mammogram. This is particularly useful in cases of ILC.

3. Magnetic Resonance Imaging (MRI)

MRIs are often used in women who have dense breast tissue or who are at high risk for breast cancer. This imaging technique can provide a more detailed view of the breast tissue.

4. Biopsy

A biopsy involves taking a small sample of breast tissue to be examined under a microscope. This is the definitive way to diagnose ILC. There are different types of biopsies, including core needle biopsy and surgical biopsy.

Treatment Options for Invasive Lobular Carcinoma

Treatment for Invasive Lobular Carcinoma usually involves a combination of surgery, radiation, chemotherapy, and hormone therapy. The treatment plan is based on the stage of the cancer, its size, and whether it has spread to other parts of the body.

1. Surgery

The mainstay of treatment for ILC is surgery, which can be in the form of a lumpectomy (removal of the tumor and some surrounding tissue) or a mastectomy (removal of one or both breasts). The decision between a lumpectomy and mastectomy depends on the size of the tumor and its location.

2. Radiation Therapy

Radiation therapy is often recommended after surgery to kill any remaining cancer cells in the breast or nearby lymph nodes. This is especially common after a lumpectomy.

3. Chemotherapy

Chemotherapy may be used before surgery (neoadjuvant therapy) to shrink the tumor, or after surgery (adjuvant therapy) to kill any remaining cancer cells. Chemotherapy is usually recommended if the cancer has spread beyond the breast or if there is a high risk of recurrence.

4. Hormone Therapy

ILC is often hormone receptor-positive, meaning it grows in response to hormones like estrogen and progesterone. Hormone therapy, such as tamoxifen or aromatase inhibitors, can help prevent the cancer from returning by blocking the body’s natural hormones.

5. Targeted Therapy

For some women with ILC, targeted therapy may be an option. This involves medications designed to target specific molecules involved in cancer growth, such as HER2-positive breast cancer.

Prognosis and Survival Rates

The prognosis for Invasive Lobular Carcinoma depends on the stage at which it is diagnosed. Early-stage ILC has a good prognosis, with survival rates similar to those of Invasive Ductal Carcinoma. The 5-year survival rate for localized ILC is about 90%, meaning that 9 out of 10 women are still alive five years after diagnosis.

However, ILC can sometimes be more challenging to detect in its early stages, which can affect survival rates. When ILC is diagnosed at a more advanced stage or if it has spread to distant parts of the body (metastatic ILC), the prognosis becomes less favorable. Early detection and treatment are critical for improving outcomes.

Prevention and Early Detection

While it is not possible to entirely prevent breast cancer, there are several steps women can take to lower their risk:

• Regular screening: Mammograms and other imaging tests can help detect breast cancer early, even before symptoms appear.
• Healthy lifestyle: Maintaining a healthy weight, exercising regularly, limiting alcohol consumption, and eating a balanced diet can reduce breast cancer risk.
• Know your family history: If you have a family history of breast cancer, talk to your doctor about genetic testing and other preventative measures.
• Hormone replacement therapy caution: If you are considering HRT, discuss the risks and benefits with your healthcare provider, especially if you have other risk factors for breast cancer.

Conclusion

Invasive Lobular Carcinoma is a unique and complex type of breast cancer, accounting for a significant number of cases each year. While it may be harder to detect than other forms of breast cancer, advances in diagnostic tools and treatment options are helping to improve outcomes for women with ILC.

Awareness of ILC’s symptoms, understanding your personal risk factors, and following recommended screening guidelines can help with early detection and successful treatment. If you notice any changes in your breasts, even if they seem subtle, it’s essential to consult a healthcare professional.

By staying informed about breast cancer, including the less common types like Invasive Lobular Carcinoma, you can take proactive steps toward maintaining your breast health and ensuring early intervention if needed.

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