What is invasive ductal carcinoma? Invasive ductal carcinoma, also known as IDC, infiltrating ductal carcinoma, carcinoma of no special type (NST), or not otherwise specified (NOS), is the most common invasive breast cancer, representing 65 to 85 percent of all cases. IDC starts in the breast’s milk ducts and invades surrounding breast tissue. If not treated at an early stage, IDC can move into other parts of the body through your bloodstream or lymphatic system.
Who is most likely to have IDC? Women have a greater likelihood of having breast cancer after they reach age 45. As a woman ages, breast cancer risk does not decline, with about 50 percent of IDC cases occurring after age 65. About 20 percent of women with breast cancer have a family history of the disease. Other factors increasing the risk of breast cancer include having no children or the first child after age 30, early menstruation, and consuming more than three alcoholic drinks a day.
What characterizes IDC? IDC is characterized by a hard lump with irregular borders. The IDC lump will feel harder, firmer, and more anchored than a benign breast lump. The skin over the affected area or the nipple may be retracted (pulled in). On a mammogram, IDC usually looks like a mass with spikes radiating from the edges; sometimes it appears as a smooth-edged lump or as calcifications in the tumor area.
How does the pathologist make a diagnosis? The pathologist examines biopsy specimens, along with other tests if necessary. If mammography shows suspicious findings, a biopsy may be recommended. A biopsy is the most widely used method for making a firm diagnosis of breast cancer. During a biopsy procedure, a primary care doctor removes cells or tissues from the suspicious area for the pathologist to examine more closely in the laboratory. In some cases a biopsy may be performed with surgery. The surgeon removes all or part of the tumor for the pathologist to examine.
Laboratory testing enables the pathologist to determine the type of cancer and whether it is invasive. The pathologist examines the tissue sample under a microscope and assigns a histologic type and a histologic tumor grade. Grade 1 cancers tend to grow the slowest, while Grade 3 tumors spread more aggressively. The pathologist also notes the size of the tumor, how close the cancer is to the edge of the tissue removed by the surgeon, and whether the tumor invaded blood or lymphatic vessels. These factors help pathologists determine the likelihood of the cancer remaining in or returning to the affected area.
What else does the pathologist look for? The biopsy sample is tested for the presence of estrogen and progesterone receptors. Women with cancers containing these receptors are more likely to respond positively to hormone therapy. Pathologists also may check for a protein called HER2/neu. Cancers with too much of this protein may respond to targeted therapy with Herceptin. Due to continual advances in research, other tests may be used as well.
After reviewing the results of the laboratory tests, your clinician may recommend additional tests to determine to what extent malignant cells may have spread to other parts of the body. Depending on your situation, these tests may include a chest x-ray; a bone scan; and imaging tests, including computed tomography (CT), magnetic resonance imaging (MRI), or PET (positron emission tomography). All these tests can detect signs that the cancer may have spread to other parts of the body.
With all necessary tests completed, the pathologist determines the cancer’s stage. Stage 1 IDC tumors are confined to the breast, and Stage 4 IDC tumors have spread beyond areas near the breast. Stages 2 and 3 describe conditions in between these two extremes.
How do doctors determine what surgery or treatment will be necessary? The pathologist consults with your primary care physician after reviewing the test results and determining the stage of your cancer. Together, using their combined experience and knowledge, they determine treatment options most appropriate for your condition.
What kinds of treatments are available for IDC? IDC is treated through one or more of the following: surgery, chemotherapy, hormonal therapy, and radiation therapy. It’s important to learn as much as you can about these treatment options and to make the decision that’s right for you.
Most women choose surgery. Advancements in surgical techniques have enabled about 70 percent of women to choose breast-conserving surgical treatments like lumpectomy rather than mastectomy, where the entire breast and often some or all lymph nodes near the breast are removed. Mastectomy reduces the chances the cancer will return. Lumpectomy is an option when the cancer is in a relatively small part of one breast. How far your tumor has grown and advanced will determine if breast-conserving treatments are possible. If your breast cannot be conserved, breast reconstruction surgery may be a possibility after you recover from your initial operation to remove the cancer.
Most women with invasive breast cancer will be offered chemotherapy and/or hormonal therapy. These treatments deliver drugs or hormones throughout the body and reduce the risk of the cancer spreading further or coming back. Radiation therapy is used to rid the body of any microscopic remnants of the cancer in the area where the original tumor was found and removed.
Clinical trials of new treatments for IDC may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature but may be a potential option for advanced cancers. Some trials may involve biologic therapy, which uses the natural defenses of the immune system to fight cancer.
For more information, visit the American Cancer Society, Y-ME National Breast Cancer Organization, or Cancer.Net websites.
What kinds of questions should I ask my doctors? Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:
Please describe the type of cancer I have and what treatment options are available.
What stage is the cancer in?
What are the chances for full remission?
What treatment options do you recommend? Why do you believe these are the best treatments?
What are the pros and cons of these treatment options?
What are the side effects?
Should I receive a second opinion?
Is your medical team experienced in treating the type of cancer I have?
Can you provide me with information about the physicians and others on the medical team?
If I want a second opinion, will you provide me with the names of physicians or institutions that you recommend?
DEFINITION OF TERMS
Invasive, infiltrating: Capable of spreading to other parts of the breast or body.
Ductal: Relating to the breast’s milk ducts, the parts of the breast through which milk flows.
Carcinoma: A type of cancerous, or malignant, tumor.
Calcification: Calcium deposits in the breast can be associated with ductal carcinoma in situ. Clusters of these deposits may indicate cancer.
Pathologist: A physician who examines tissues and fluids to diagnose disease to assist in making treatment decisions.
Lymphatic: Relating to lymph glands, especially those near the breast.
What is invasive lobular carcinoma (ILC)? Invasive lobular carcinoma, also known as infiltrating lobular carcinoma, is a type of breast cancer that starts in a lobule and spreads to surrounding breast tissue. If not treated at an early stage, ILC also can move into other parts of the body, such as the uterus or ovaries. ILC is the second most common type of invasive breast cancer, accounting for 10 to 15 percent of all breast cancer cases.
Who is most likely to have ILC? Women between the ages of 45 and 56 are most likely to have ILC. About 20 percent of women with breast cancer have a family history of the disease. Other factors increasing the risk of having breast cancer include having no children or the first child after age 30, early menstruation, and consuming three or more alcoholic drinks a day.
What characterizes ILC? ILC is characterized by a general thickening of an area of the breast, usually the section above the nipple and toward the arm. You may not be able to feel a breast lump or hard mass. Instead, an area of breast tissue may only feel differently than the rest of your breast. ILC also is less likely to appear on a mammogram. When it does appear, it may show as a mass with fine spikes radiating from the edges or appear as an asymmetry compared to the other breast.
How does the pathologist make a diagnosis? The pathologist examines a biopsy specimen along with other tests if necessary. A biopsy is the most widely used method for detecting ILC breast cancer. During a biopsy procedure, the surgeon removes cells or tissues from the suspicious area for the pathologist to examine more closely in the laboratory. In some cases, a biopsy may be performed with surgery. The surgeon removes all or part of the tumor for the pathologist to examine.
Laboratory testing enables the pathologist to determine the type of cancer and whether or not it is invasive. The pathologist examines the tissue sample under a microscope and assigns a histologic type and histologic tumor grade to it. Grade 1 cancers tend to grow the slowest, while Grade 3 tumors spread more aggressively. The pathologist also notes the size of the tumor, how close the cancer is to the edge of the tissue removed by the surgeon, and whether the tumor invaded blood or lymphatic vessels. These factors help pathologists determine the likelihood of the cancer remaining in or returning to the affected area.
What else does the pathologist look for? The biopsy sample is tested for the presence of estrogen and progesterone receptors. Women with cancers containing these receptors are more likely to respond positively to hormone therapy. Pathologists also may check for a protein called HER2/neu. Cancers with too much of this protein may respond to targeted therapy with Herceptin. Invasive lobular cancers are almost always negative for HER2/neu. Due to continual advances in research, other tests may be used as well.
After reviewing the results of the laboratory tests, your clinician may recommend additional tests to determine to what extent malignant cells may have spread to other parts of the body. Depending on your situation, these tests may include a chest x-ray; a bone scan; and imaging tests including computed tomography (CT), magnetic resonance imaging (MRI), or PET (positron emission tomography). All these tests can detect signs that the cancer may have spread to other parts of the body.
With all necessary tests completed, pathologists determine the cancer’s stage. Stage 1 ILC tumors are confined to the breast, and Stage 4 ILC tumors have spread beyond areas near the breast. Stages 2 and 3 describe conditions between these two extremes.
How do doctors determine what surgery or treatment will be necessary? The pathologist consults with your primary care physician after reviewing the test results and determining the stage of your cancer. Together, using their combined experience and knowledge, they determine treatment options most appropriate for your condition.
What kinds of treatments are available for ILC? ILC is treated through one or more of the following: surgery, chemotherapy, hormonal therapy, and radiation therapy. It’s important to learn as much as you can about your treatment options and to make the decision that’s right for you.
Most women choose surgery. Advancements in surgical techniques have enabled about 70 percent of women to choose breast-conserving surgical treatments like lumpectomy rather than mastectomy, where the entire breast and often some or all lymph nodes near the breast are removed. Mastectomy reduces the chances the cancer will return. Lumpectomy is an option when the cancer is in a relatively small part of one breast. How far your tumor has grown and advanced will determine if breast-conserving treatments are possible. If your breast cannot be conserved, breast reconstruction surgery may be a possibility after you recover from your initial operation to remove the cancer.
Most women with invasive breast cancer will be offered chemotherapy and/or hormonal therapy. These treatments deliver drugs or hormones throughout the body and reduce the risk of the cancer spreading further or coming back. Radiation therapy is used to rid the body of any microscopic remnants of the cancer in the area where the original tumor was found and removed.
Clinical trials of new treatments for ILC may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature but may be the best option for advanced cancers.
For more information, visit the American Cancer Society, Y-ME National Breast Cancer Organization, or Cancer.Net websites.
What kinds of questions should I ask my doctors? Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:
Please describe the type of cancer I have and what treatment options are available.
What stage is the cancer?
What are the chances for full remission?
What treatment options do you recommend? Why do you believe these are the best treatments?
What are the pros and cons of these treatment options?
What are the side effects?
Should I receive a second opinion?
Is your medical team experienced in treating the type of cancer I have?
DEFINITION OF TERMS
Invasive, Infiltrating: Capable of spreading to other parts of the breast or body.
Lobular: Relating to the breast lobule, the part of the breast that produces milk in a woman who has been recently pregnant or who is breast feeding.
Carcinoma: A type of cancerous, or malignant, tumor.
Malignant: Cancerous and capable of spreading.
Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.
Lymphatic: Relating to lymph glands, especially those located near the breast.
What is ductal carcinoma in situ (DCIS)? Ductal carcinoma in situ is the earliest possible and most treatable diagnosis of breast cancer. Some experts consider it to be “pre-malignant.” The most common form of non-invasive breast cancer, DCIS accounts for about 25 percent of all breast cancers. Sometimes, DCIS is seen in association with an invasive form of breast cancer.
The diagnosis of DCIS is increasing because more women are receiving regular mammograms – and because of advancements in mammography technology, which can now find small areas of calcification in the breast. If untreated, about 30 percent of women with DCIS will develop invasive breast cancer within 10 years of the initial diagnosis.
Who is most likely to have DCIS? Because of how DCIS is detected, it can be found in women earlier than age 45, which is the age breast cancer becomes more common. However, as a woman ages, breast cancer risk does not decline; therefore, DCIS can be found at any age. About 20 percent of women with breast cancer have a family history of the disease.
Other factors increasing the risk of having breast cancer include having no children or the first child after age 30, early menstruation, and consuming three or more alcoholic drinks a day.
What characterizes DCIS? DCIS is characterized by pre–cancerous or early–stage cell abnormalities in the breast ducts. On a mammogram, DCIS appears as areas of calcification.
How does the pathologist make a diagnosis? The pathologist examines biopsy specimens, along with other tests if necessary. If mammography shows suspicious findings, a biopsy may be recommended. A biopsy is the most widely used method for making a firm diagnosis of breast cancer. During a biopsy procedure, a primary care physician removes cells or tissues from the suspicious area for the pathologist to examine more closely in the laboratory. In some cases a biopsy may be performed with surgery.
To make a firm diagnosis of DCIS, the pathologist will investigate whether the malignancy has invaded tissue surrounding the ducts. A diagnosis of DCIS means the tumor remains only in its original place—“in situ.”
What else does the pathologist look for? The biopsy sample is tested for the presence of estrogen receptors. Women with DCIS containing this receptor are more likely to respond positively to hormone therapy. Due to continual advances in research, other tests may be used as well.
With all necessary tests completed, pathologists determine the cancer’s stage. All DCIS tumors are Stage “Tis”, which means the tumor is “in situ” and has not spread. The cure rate for stage “Tis” tumors is close to 100 percent if standard forms of treatment are followed.
How do doctors determine what surgery or treatment will be necessary? The pathologist consults with your primary care physician after reviewing the test results. Together, using their combined experience and knowledge, they determine treatment options most appropriate for your condition.
What kinds of treatments are available for DCIS? DCIS is treated through surgery, which is sometimes supplemented by radiation therapy. It’s important to learn as much as you can about your treatment options and to make the decision that’s right for you. Because having DCIS is not an emergency situation, you can take your time making your choices.
Advancements in surgical techniques have enabled about 70 percent of women to choose breast-conserving surgical treatments like lumpectomy rather than mastectomy, where the entire breast is removed. If you have DCIS, which is confined to one area of one breast, you are likely to be a good candidate for lumpectomy. If your breast cannot be conserved, breast reconstruction surgery may be a possibility after you recover from your initial operation to remove the cancer.
Radiation therapy is often used after lumpectomy and sometimes after mastectomy to rid the body of any microscopic remnants of the cancer in the area where the original tumor was found and removed.
For more information, visit the American Cancer Society, Y-ME National Breast Cancer Organization, or Cancer.Net websites.
What kinds of questions should I ask my doctors? Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:
Please describe the type of cancer I have and what treatment options are available.
What are the chances for full remission?
What treatment options do you recommend? Why do you believe these are the best treatments?
What are the pros and cons of these treatment options?
What are the side effects?
Should I receive a second opinion?
Is your medical team experienced in treating the type of cancer I have?
Can you provide me with information about the physicians and others on the medical team?
DEFINITION OF TERMS
Ductal: Relating to the breast’s milk ducts, the parts of the breast through which milk flows.
Carcinoma: A type of cancerous, or malignant, tumor.
In Situ: In its original place.
Non-invasive: Not spreading beyond the inside of the breast duct.
Calcification: Calcium deposits in the breast sometimes are associated with ductal carcinoma in situ. Clusters of these deposits may indicate cancer.
Malignant: Cancerous and capable of spreading.
Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.
What is lobular carcinoma in situ (LCIS)? Lobular carcinoma in situ, also known as lobular neoplasia, is not technically a cancer or a carcinoma. The alternate name for this condition—lobular neoplasia—is more technically accurate, since LCIS is only a “marker” of cancer in most women. In women who develop invasive lobular carcinoma, LCIS is a direct precursor. An LCIS diagnosis means there is abnormal cell growth that increases your chances for developing breast cancer later in life. According to the National Cancer Institute, about 25 percent of women with LCIS develop invasive breast cancer within 25 years of the initial diagnosis. While having LCIS increases the chances of someday having breast cancer, most women with LCIS do not develop breast cancer. Due to improvements in breast cancer screening, the diagnosis of LCIS is increasing.
Who is most likely to have LCIS? LCIS is more common in pre-menopausal women; however, LCIS can be found at any age. About 20 percent of women with breast cancer have a family history of the disease. Other factors increasing the risk of having breast cancer include having no children or the first child after age 30, early menstruation, and consuming three or more alcoholic drinks a day.
What characterizes LCIS? LCIS is characterized by the appearance of abnormal cells in the milk-producing lobules of the breast. LCIS rarely shows on a mammogram; instead, it is usually discovered by chance as part of a biopsy sample for a breast lump, which a pathologist examines.
How does the pathologist make a diagnosis? The pathologist examines biopsy specimens along with other tests if necessary. A biopsy is the most widely used method for detecting breast cancer. During a biopsy procedure, the primary care doctor removes cells or tissues from the suspicious area for the pathologist to examine more closely in the laboratory. In some cases, a biopsy may be performed with surgery.
The pathologist also will note the size and location of the cell abnormalities. To make a firm diagnosis of LCIS, the pathologist will investigate whether the abnormal cells have invaded outside lobules into the surrounding tissue. A diagnosis of LCIS means the cell abnormalities remain only in their original place—“in situ.”
What else does the pathologist look for? The biopsy sample is at this time not tested any further. All LCIS tumors are stage 0, which means the tumor is not cancerous. The cure rate for stage 0 tumors is close to 100 percent if standard forms of treatment are followed.
How do doctors determine what surgery or treatment will be necessary? The pathologist consults with your primary care physician after reviewing the test results. Together, using their combined experience and knowledge, they determine treatment options most appropriate for your condition.
What kinds of treatments are available for LCIS? Most women with LCIS do not receive immediate treatment; instead, they are closely monitored through regular clinical breast exams and mammography. In addition, they are encouraged to do self-exams each month and to report unusual lumps or changes to a physician.
Some women with LCIS, usually those with a strong family history of breast cancer, choose the preventive removal of both breasts, a procedure known as prophylactic mastectomy, often followed with breast reconstruction. This treatment significantly reduces the risk of breast cancer.
Another option is to consider taking the drug tamoxifen, which was proved to reduce the risk of breast cancer in a recent clinical trial conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP). A second NSABP clinical trial, known as the STAR (Study of Tamoxifen and Raloxifene) trial, is now underway to compare the effectiveness of tamoxifen with raloxifene, a promising new anti-cancer drug. If you are interested, ask your physician about these drug therapy options.
For more information, visit the American Cancer Society, Y-ME National Breast Cancer Organization, or Cancer.Net websites.
What kinds of questions should I ask my doctors? Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:
Please describe the type of condition I have and what kind of preventive measures I can take
Is any type of treatment recommended at this stage?
What are the pros and cons of these treatment options?
What are the side effects?
Should I receive a second opinion?
Is your medical team experienced in treating the condition I have?
Can you provide me with information about the physicians and others on the medical team?
DEFINITION OF TERMS
Lobular: Relating to the breast lobule, the part of the breast that produces milk in a woman who has been recently pregnant or who is breast-feeding.
Carcinoma: A type of cancerous, or malignant, tumor.
Neoplasia: Any new and abnormal cell growth.
In Situ: In its original place.
Non-invasive: Not yet spreading to other parts of the breast or body.
Malignant: Cancerous and capable of spreading.
Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.