vInvasive Lobular Carcinoma – Breast Cancer

Also known as Invasive Lobular Carcinoma (ILC), this type of breast cancer accounts for a small percentage of all breast cancers and makes up about 10 per cent of all invasive breast cancers. It is classified as a ‘Special Type’ breast cancer because it falls under the rare cancers and develops in different ways that affect their outlook. In Invasive Lobular Carcinoma, the cancer cells start developing in the milk ducts or globules, then progresses to other parts of the breast tissue. It’s also more likely to be found in both breasts.

Symptoms of Invasive Lobular Carcinoma

During the early stages, Invasive Lobular Carcinoma may not show any signs or symptoms. It is more likely to be found during a routine breast screening. It can also be difficult to see during a mammogram. But as it progresses, it can present itself through symptoms such as:

1. Thickening or hardening of an area on the breast
2. A change in the texture of the breast such as dimpling or puckering
3. Pulled-in (inverted) nipple

Diagnosis of Invasive Lobular Carcinoma

Without any symptoms present, Invasive Lobular Carcinoma can be hard to diagnose. During a visit to the breast clinic, tests are ordered to confirm the presence of breast cancer cells, and to check how much of it has affected the breast. These tests include:

1. An ultrasound scan of the breast and under the arm (axilla)
2. Breast X-ray (mammogram)
3. Core biopsy (a small sample of breast tissue is taken for examination)
4. MRI – Since ILC is more difficult to locate and measure, an MRI might be required

Treatment of Invasive Lobular Carcinoma

The first treatment for removing the Invasive Lobular Carcinoma is surgery. Based on the test results, the doctor will customize the treatment plan. Before the surgery, the surgeon has to consider:

• The aggressiveness of the cancer
• Stage of the cancer
• Tumor size and location
• Age and overall health
• History of breast cancer in the family
• Gene mutation test results

There are two types of surgery when it comes to treating Invasive Lobular Carcinoma. These are:

Breast-conserving surgery (BCS)

Also known as a lumpectomy, the surgeon removes the cancer cells, as well as a minimal amount of healthy breast tissue surrounding the tumor. After the lumpectomy, radiation therapy is recommended to reduce the chances of the cancer returning.

Mastectomy

This is the surgical removal of the entire breast, and it would be recommended if:

1. The area of the cancer is large
2. The cancer cells are in multiple areas of the breast
3. There is a gene mutation which increases the likelihood of breast cancer
4. There’s a history of breast cancer in the family
5. The patient cannot stand radiation

If one undergoes a mastectomy, radiation therapy may not be required, and depending on each case, the patient might undergo a breast reconstruction surgery immediately after (immediate reconstruction), or at a later date (delayed reconstruction).

Surgery to the Lymph Nodes

In order to check if the cancer has spread to the axilla (lymph nodes under the arm), the surgeon might suggest a surgical procedure to remove some of the glands under the arm for a biopsy. If the results show the presence of cancer cells, then radiotherapy might be done on the remaining lymph nodes, or sometimes the removal of all the lymph nodes might be recommended.

Additional Treatments for Invasive Lobular Carcinoma

After the lumpectomy or mastectomy, you may need additional treatments, known as adjuvant treatments. The goal is to give the best promising outcome. These treatments include:

• Chemotherapy: This is a drug therapy that is done before surgery to reduce the size of the tumor with the aim of making it operable. The treatment is also given after surgery to minimize the chances of the cancer returning.
• Radiation therapy: As mentioned, if you go through a lumpectomy, you may need radiation therapy to destroy any cancer cells and reduce the chances of it recurring. This is done on an outpatient basis for a duration of 4 to 6 weeks.
• Hormone therapy: This is considered if the cancer cells test positive for hormone receptors, which reduces the chance of the cancer returning or progressing further.
• Targeted therapy: If the breast cancer cells have human epidermal growth factor receptor 2 gene (HER2), treatment drugs to specifically target it may be given.

Recovery After Invasive Lobular Carcinoma Treatment

After the breast cancer treatment, your doctor will keep a close watch on you. This is because there is a risk of the cancer recurring or moving on to the other breast (especially in Invasive Lobular Carcinoma cases). Follow-up appointments are required every few months (or as scheduled by your doctor) where the specialist will test for signs of recurrence. A mammogram and screening might be required every 6 to 12 months (usually after a lumpectomy).