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Medullary Breast Cancer

Medullary breast cancer, or Medullary breast carcinoma is a rare type of cancer that can occur at any age, but it is mostly found in younger women who have inherited distorted BRCA1 gene. This type of cancer can also occur in men, but it is quite rare. It also accounts for 3 to 5 percent of all diagnosed breast cancers.

Medullary breast cancer is invasive, which means it can spread to other areas of the body. Although each is different from the next, the prognosis is usually positive.

Medullary breast cancer comes in three types which are:

  1. Atypical Medullary breast cancer: This is when not all of the features of Medullary breast cancer are visible under a microscope.
  2. Classic Medullary breast cancer: Happens when all the features of Medullary breast cancer are visible under a microscope.
  3. Invasive ductal breast cancer: Has all the features of Medullary breast cancer.

Symptoms of Medullary Breast Cancer

During the early stages of Medullary breast cancer, there might be no symptoms present, but as it progresses, a noticeable lump develops. This lump can be fleshy and soft or firm to the touch. Most are usually small, not more than 2cm in size. This lump can easily be felt or seen during a routine mammogram or breast screening.

Some of the symptoms of Medullary breast cancer include:

  • Breast lump or thickening of tissue in the breast
  • Pain in the breast or armpit
  • Swelling of the breast
  • Redness of the breast
  • Breast tenderness

Diagnosis of Medullary Breast Cancer

Medullary breast cancer is diagnosed during a routine breast screening or mammogram after which you’ll be referred to a breast specialist for further examination. Other tests are also ordered to confirm the presence of breast cancer cells. These range of tests include:

  1. An ultrasound scan
  2. Mammogram
  3. Core Biopsy where a tissue sample is removed from breast for analysis
  4. Fine Needle Aspiration (FNA) whereby a fine needle and syringe are used to take samples of the cancer cells for examination.

Treatment of Medullary breast cancer

Based on the test results of the Medullary breast cancer, the breast doctor will customize the treatment plan according to the features of the breast cancer.

Surgery

The first form of treatment for Medullary breast cancer is surgery, which is used to remove the tumor. There are two types of surgeries that are done. These are:

1.      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.

2.      Mastectomy

This is the surgical removal of the entire breast including the nipple, 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

Before the surgery, the patient is always given the option of having a breast reconstruction. This can happen immediately (immediate breast reconstruction) after the tumor is removed, or at a later date (delayed breast reconstruction). After a mastectomy, some women may be unable to have a breast reconstruction procedure, at which point a prosthesis breast is recommended.

Lymph Node Removal

Although Medullary breast cancer is less likely to spread to the lymph nodes under the arm, the breast specialists might want to ensure it hasn’t spread there. This is done through a lymph node biopsy, where a small sample of the lymph nodes are removed and tested for cancer cells. If they are found to be affected by the cancer, then these lymph nodes are surgically removed – a procedure known as lymph node clearance – and radiotherapy treatment might be recommended.

Sentinel Lymph Node Biopsy

If tests before the surgery show that the lymph nodes are not affected by the cancer, then the sentinel lymph node biopsy is introduced. This identifies the most immediate lymph nodes that the cancer cells are most probable to spread to. If they are cancer-free, then no surgery is required. On the other hand, if they are affected by the cancer, then surgery is required, with the possibility of radiotherapy treatment.

Additional Treatments for Medullary Breast Cancer

After a lumpectomy or mastectomy, you may need additional treatments for Medullary breast cancer, known as adjuvant treatments. The goal is to give the best promising outcome, and to reduce the chances of the cancer returning. Each treatment recommended depends on the state of the breast cancer and differs from one case to the next. These treatments include:

  • Chemotherapy: If the Medullary breast cancer has spread to the lymph nodes, then the patient is offered the option of undergoing chemotherapy. Chemotherapy is an anti-cancer 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 spreading or returning. Its recommendation depends on different factors such as the grade and size of the tumor, estrogen receptor (ER) status, and human epidermal growth factor receptor 2 (HER2) status.
  • Radiation therapy: If you go through a lumpectomy, you may need radiation therapy to destroy any cancer cells and reduce the chances of it recurring on the same breast. It might be done for the chest wall as well, if the lymph nodes under the arm are also affected by the cancer.
  • Hormone therapy: This treatment is considered if the cancer cells have receptors that bind to estrogen. Administration of hormone therapy 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.
  • Bisphosphonates: Bisphosphonates are drugs that are given orally or intravenously to either slow down or prevent bone damage. When used for cancer treatment in post-menopausal women, they reduce the risk of the Medullary breast cancer

Triple Negative Breast Cancer

A triple negative breast cancer occurs when the breast cancer is estrogen receptive negative, HER2 negative, and progesterone receptive negative. This means that you may not be able to have Medullary breast cancer treatments such as hormone therapy and trastuzumab. However, the prognosis of Medullary breast cancer is usually positive.

Recovery After Medullary Breast Cancer

After the successful treatment of Medullary breast cancer, your doctor will keep a close watch on you. Follow-up appointments are required and should be followed as agreed with the breast doctor, where he/she will do tests for signs of recurrence. A mammogram and screening might be required every 6 to 12 months.

Next Steps

At King’s College Hospital London Dubai, our Breast Care Clinic caters to every type of breast cancer and breast conditions. If you are facing any kind of abnormal changes to your breast, regardless how small, get in touch for a consultation with one of our breast doctors. For more information on breast cancer and breast care, book an appointment below.

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