Infiltrating or invasive Lobular Carcinoma of the Breast
Lobular carcinoma originates in the breast ‘lobules‘ (where the milk is produced) and is much less common than ductal carcinoma. Invasive lobular carcinoma comprises about 10% of all breast cancers, but the incidence rate is thought to be increasing, especially among postmenopausal women.
I just want to let you know that we have created a newer version of this page, with more up-to-date information on infiltrating lobular carcinomas. However, this page is still pretty good for research.
In cytological appearance, the ‘classic‘ presentation of infiltrating lobular carcinoma shows relatively uniform cells with grade I cytologist features.
Upon infiltration the cellular pattern often appears as rows of cells scattered randomly, but no more than one or two cells wide. Sometimes it forms in ‘target-like‘ or concentric patterns around ducts.
There are several ‘subtypes’ of lobular carcinoma
Common sub-types of infiltrating lobular carcinoma include the pleomorphic variant (with larger, more atypical nuclei), the alveolar variant (with rounded groups of cells), the solid variant (with groups of tubercular “rods” of malignant cells less than 2 cells thick), and the signet ring variant (which forms ‘ringlets‘ but with a ‘wall’ only one or 2 cells thick).
Infiltrating lobular carcinoma famous for being hard to diagnose
Infiltrating lobular carcinoma can be hard to spot on a mammogram, sometimes impossible.
It typically does not create a substantial reaction in connective tissues, nor destroy other anatomic structures. It is also uncommon for Lobular carcinoma to form a distinct, palpable mass. Instead, it usually constitutes as a somewhat vague thickening of the breast tissue.
IF it is noticed on a mammogram, lobular carcinoma does look a lot like ductal carcinoma. It often shows as a vaguely defined mass with fine spikes radiating from the edges (a ‘spiculated‘ pattern).
Lobular carcinoma is also slightly more likely than ductal carcinoma to be multifocal or bilateral, but in terms of survival rates there is virtually no difference between the two.
Treatment of infiltrating lobular cancer
Confirmed cases of infiltrating are most often treated by mastectomy, and this occurs slightly more frequently than with ductal carcinoma. However, if clear surgical margins can be obtained then breast conserving surgery has proven to be a good option.
Invasive lobular carcinoma also tends to be hormone receptor positive, so adjuvant endocrine therapies are a little more common. For some reason, many infiltrating lobular carcinomas are less responsive to endocrine therapy than expected, but this has not proven to have any consistent bearing on survival rates.
Reminder, this small page on the topic is old, and particularly the treatment information is inadequate and old. This page on treatments targeted at hormone sensitive tumors is much newer. But all my pages about ‘treatment’ are out-of-date sooner-or-later, so finding current treatment should “talk to an oncologist”.
Here are some common Q&A…
- What does infiltrating lobular carcinoma look like? It doesn’t typically form a lump as most women expect with breast cancer. Instead, it often causes a thickening of the tissue or fullness in one part of the breast.
- What are the symptoms of infiltrating lobular carcinoma? At it’s earliest stages, it may cause no signs nor symptoms. As it grows larger, it may cause an area of thickening in part of the breast, a new area of fullness o swelling in the breast, a change in the texture or appearance of the skin over the breast (such as dimpling or thickening), or an inverted nipple.
- When should I see a doctor? Make an appointment with your doctor if you are experiencing any signs or symptoms that worry you. Your doctor may recommend beginning screening mammograms or other tests at an earlier stage.
- What causes infiltrating lobular carcinoma? It’s not clear on what causes this.
- How does infiltrating lobular carcinoma form? It begins to form when cells in one or more milk-producing glands of the breast develop mutations in their DNA. The mutations tell the cells to divide and grow rapidly. The cancer cells can spread to other areas of the body. Infiltrating lobular carcinoma (or invasive lobular carcinoma) tends to invade surrounding breast tissue in a web-like manner. The affected area may have a different feel from surrounding breast tissue, but it is unlikely to feel like a lump.
- What are the known risk factors of infiltrating lobular carcinoma? Some factors that may increase your risk of infiltrating lobular carcinoma may include being female, older age, lobular carcinoma in situ (LCIS), post-menopausal hormone use, and/or inherited genetic cancer syndromes.
- Are there any known complications? Cancer in the other breast, as well as cancer that spreads to other areas of the body are some complications people may have.
- What are the tests & diagnosis? Mammogram, ultrasound, MRI, and/or removing a sample of tissue for further testing.
- What is the infiltrating lobular carcinoma treatment? Surgery, chemotherapy, radiation therapy, and hormone therapy.
- Are there any alternative medicines? No alternative medicine treatments can cure breast cancer. Instead, complementary and alternative treatments are most helpful for coping with the side effects of cancer and cancer treatment. Options may include hypnosis, meditation, relaxation exercises, and/or yoga. While none of these alternative treatments is proven to help control hot flashes, although some preliminary evidence shows some breast cancer survivors have found them very helpful.
- What could I do for coping and support? A diagnosis of breast cancer may be one of the most difficult situations you’ll ever face. It can set of a rollercoaster of emotions, shock and fear to anger, anxiety or depression. With time you’ll find your own way of coping with your feelings. Until then, you may find comfort if you learn enough aout your cancer to make treatment decisions, seek support from your family and friends, connect with other cancer survivors, and take care of yourself (get enough sleep, choose a diet full of fruits and vegetables, staying physically active, and take time to relax).
- How can I prevent infiltrating lobular carcinoma? To reduce the risk of breast cancer, consider trying to discuss the benefits and risks of hormone therapy with your doctor, drink alcohol in moderation if at all, exercise most days of the week, and maintain a healthy weight.
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- Smith, DB., Howell, A., Wagstaff, J., Infiltrating lobular carcinoma of the breast: Response to endocrine therapy and survival. European Journal of Cancer and Clinical Oncology (July 1987) Volume 23, Issue 7, Pages 979-982