Invasive Lobular Carcinoma – Diagnosis and Treatment
Diagosis
Checking the Breasts Manually
A health care worker begins by asking about any symptoms and changes. Then, they look at both breasts for anything unusual, including differences in skin appearance or a nipple that looks different than before.
Next, they carefully feel both breasts with their hands. This helps them detect any lumps, hard areas, or swelling. The examiner also gently presses along the collarbone and in the armpit to check for enlarged lymph nodes that might signal the spread of cancer cells.
X-ray Imaging of Breast Tissue
A mammogram uses low-dose X-rays to take detailed photos of the breast’s inside. This is a common tool for finding breast cancer, and doctors often order it as the first imaging test.
Mammograms are split into two types: screening and diagnostic. A screening mammogram looks for changes in women who have no symptoms. If a lump or other concern is found, doctors perform a diagnostic mammogram to get clearer, close-up images.
Not every case of invasive lobular carcinoma is easy to spot with a mammogram because this cancer type can be harder to see on X-ray images. Still, this test often helps reveal abnormal tissue, especially when both breasts are compared side by side in a follow-up exam.
Sound Wave Pictures of the Breast
Breast ultrasound makes images using sound waves. It helps doctors check a lump’s nature—if it is solid (possibly cancer) or filled with liquid (often a harmless cyst). Doctors use an ultrasound tool that glides over the skin to look inside the breast and nearby lymph nodes.
Although some invasive lobular carcinoma cases might get missed on ultrasound, the test remains an important step if mammogram images are unclear or if the doctor needs extra information.
Magnetic Resonance Imaging for Detail
A breast MRI provides a very detailed look at breast tissue by using strong magnets and radio waves. This test helps doctors spot areas of cancer that might not show up on other imaging methods, especially when invasive lobular carcinoma is difficult to detect.
At the start of the test, medical staff inject dye through a vein. The dye highlights blood flow and helps cancer cells show up more clearly on the images.
Doctors sometimes use MRI to double-check both breasts when one has cancer, as this cancer can appear in more than one area. MRI also helps in planning surgery or other treatments by showing the full size and location of cancer.
Collecting a Tissue Sample from the Breast
A doctor or nurse performs a biopsy to remove a small sample of tissue from the breast. This test is the only way to confirm if a lump or spot is cancer.
The medical professional inserts a thin, hollow needle through the skin into the lump or concerning area, usually while using images from mammogram, ultrasound, or MRI for guidance. Once in position, the needle removes a tiny piece of tissue.
During the procedure, the team usually leaves a small marker behind where the sample was taken. This marker helps the medical team locate the exact area for future tests or treatments. A table below shows some ways tissue can be collected:
| Method | Description |
|---|---|
| Core needle biopsy | Removes a small tube of tissue |
| Fine needle aspiration | Uses a very thin needle for fluids or cells |
| Surgical biopsy | Removes a bigger piece or the whole lump |
Lab Analysis of Breast Tissue
After the biopsy, a pathologist studies the collected tissue in a lab. This doctor checks under a microscope for cancer cells. The tests reveal if the cells are normal or cancerous, whether the cancer is invasive lobular carcinoma, and how quickly the tumor might be growing.
Special tests on the tissue look for hormone receptors. These are proteins that let hormones, like estrogen and progesterone, attach to cancer cells and help them grow. Doctors check these hormone receptors to decide which treatments may work best.
Other tests may check for the HER2 protein, which can make cancer grow faster. The results of all these tests give the health care team details for a treatment plan that matches the patient’s specific type of breast cancer.
Figuring Out How Far Cancer Has Spread
Once physicians diagnose invasive lobular carcinoma, they determine how far the cancer has spread, called staging. Staging helps guide treatment and gives clues about the outlook for recovery.
Doctors may order additional blood work, like counts of red and white blood cells, and tests to see how well the liver and kidneys are working. Imaging tests such as bone scans, CT scans, PET scans, and MRIs can check for cancer in other parts of the body, especially if there are signs the cancer may have traveled away from the breast.
In some cases, doctors perform a sentinel lymph node biopsy. This procedure checks if the cancer cells have reached the lymph nodes near the breast. Cancer that is only in the breast and has not spread is a lower stage. If it has reached lymph nodes or other organs, the stage number is higher.
Breast cancer stages run from 0 to 4:
- Stage 0: Cancer is only in the breast ducts and hasn’t spread.
- Stage 1–3: Cancer is present in breast tissue and possibly the nearby lymph nodes.
- Stage 4: Cancer has spread to other parts of the body (metastasis).
The exact tests used depend on each person’s situation. Physicians select the most appropriate tests to check for cancer’s size, spread, and specific traits, which helps make an effective care plan.
Treatment
Surgical Options for Breast Cancer
Surgeons usually start managing invasive lobular carcinoma with surgery. The main goal is to remove the cancer from the breast and, when necessary, some surrounding tissue or lymph nodes.
Breast Tissue Removal
- Breast-Sparing Operation: Known as lumpectomy or partial mastectomy, this surgery removes only the tumor and a small amount of normal tissue around it, keeping most of the breast intact. This option is often followed by radiation treatment to lower the risk of cancer coming back.
- Complete Breast Removal: Mastectomy involves taking out all of the breast tissue. Sometimes, the skin or even the nipple might be preserved, depending on the specific case and patient choice. Newer techniques like skin-sparing or nipple-sparing mastectomy are making recovery outcomes better in terms of how the chest looks.
Lymph Node Procedures
- Sample Node Removal: Surgeons perform sentinel node biopsy to take out a few key lymph nodes and check if cancer has spread. If these first nodes are free of cancer, further node removal is usually not needed.
- More Extensive Node Removal: Axillary lymph node dissection removes several lymph nodes from the underarm, usually for patients whose cancer has been found in the sentinel nodes.
Risk-Reducing Surgery
Some patients choose to remove the healthy breast to lower the risk of new cancer, especially those with a strong family history or certain genetic conditions.
Possible complications:
- Pain, bleeding, and infection can happen with any surgical procedure.
- Arm swelling (lymphedema) may occur if lymph nodes are removed.
- Reconstructive surgery using implants or your own tissue can help restore breast shape. Consulting with a reconstruction specialist before breast surgery is beneficial.
Medicines to Block Hormones
Many invasive lobular cancers rely on hormones like estrogen or progesterone to grow. Blocking these hormones or stopping their production can help treat the cancer and limit its return.
Types of Hormone Blockers
- Estrogen Receptor Modulators: These drugs attach to cancer cells and keep hormones from feeding tumor growth.
- Aromatase Inhibitors: These are commonly used for women past menopause. They stop the body from making estrogen.
- Stopping Ovarian Function: Medicines or surgery can halt hormone production from the ovaries.
Treatment Timing
- Hormone therapy often follows surgery to lower the chance of cancer returning.
- Sometimes, it is used before surgery to shrink tumors.
- It can also help control cancer that has spread.
Possible Side Effects
- Hot flashes, night sweats, and vaginal dryness are common.
- Some experience bone thinning or blood clots.
- Side effects vary by drug and treatment length.
Targeted High-Energy Radiation
Radiation therapy uses precise beams of energy to attack cancer cells. The most usual method directs external beams at the cancer site after surgery. Brachytherapy, which uses sources placed inside the body, is less common for this type of cancer.
Purpose of Treatment
- Destroys leftover cancer cells after breast surgery.
- Reduces the risk of the tumor returning locally.
Common Side Effects
- Fatigue and a skin reaction, similar to a sunburn, where treatment was aimed.
- Sometimes, swelling or a firmer feel in the breast.
- Rare but serious risks include possible long-term damage to other organs nearby, such as the heart or lungs.
Doctors carefully plan each treatment to deliver the right dose while protecting healthy tissue as much as possible.
Drugs That Kill Cancer Cells: Systemic Chemotherapy
Chemotherapy uses strong anti-cancer medicines that travel throughout the body to target cancer cells no matter where they are. Oncologists often use it after surgery for invasive lobular carcinoma to eliminate any cancer that might be left.
How It’s Given
- Infusions through a vein are the most common way.
- Some chemotherapy drugs are pills you swallow.
When Is Chemotherapy Used
- After Surgery: To reduce the chance cancer may come back.
- Before Surgery: To shrink large tumors or make breast-conserving operations possible.
- Advanced Cancer: For cancer that has spread beyond the breast and lymph nodes, chemotherapy may help slow disease progression.
Common Side Effects
- Tiredness, nausea, hair loss, and increased risk of infections.
- Most physical side effects usually fade after treatment stops.
There are many kinds of chemotherapy medications. Doctors usually select a mix of drugs that research shows will give the best results for each patient’s individual case.
Medicines That Target Cancer Cells
Targeted treatments focus on specific features of cancer cells. For breast cancer, some drugs are designed to home in on the HER2 protein, which appears in high amounts in certain cancers. However, most invasive lobular carcinomas do not overproduce HER2, so these drugs may not be as helpful.
Types of Targeted Therapies
- HER2-Targeting Drugs: Used if the cancer makes a lot of HER2 protein. They do not work on tumors that are HER2-negative.
- Other Targets: Some treatments may block specific proteins or signals that cancer cells use to grow.
Combination With Other Treatments
- Sometimes, targeted drugs are paired with hormone therapy for added benefit.
- Targeted treatments can be given for advanced cancer or if other standard treatments do not work.
Potential Side Effects
- Skin rashes, diarrhea, or other organ-specific effects, depending on the exact drug.
- Usually less likely to cause hair loss or widespread effects than standard chemotherapy.
Doctors test the tumor tissue to check which, if any, targeted drugs are likely to be useful.
Nontraditional Approaches
Ways to Manage Sudden Warm Spells
Sudden feelings of warmth, often called hot flashes, commonly affect people during menopause and after hormone therapy for breast cancer. Patients may feel sweaty or uncomfortable even if the room is cool. People sometimes try nontraditional methods to manage these episodes, especially when standard treatments do not help enough.
Popular strategies include:
| Method | Main Benefit |
|---|---|
| Acupuncture | May lower discomfort |
| Hypnosis | Can reduce stress |
| Meditation | Promotes calmness |
| Tai chi/Yoga | Enhances relaxation |
- Acupuncture: Practitioners insert thin needles to try to relieve symptoms.
- Hypnosis: Guided sessions may help reduce stress linked to hot flashes.
- Meditation: Breathing exercises help the body relax and may make hot flashes less stressful.
- Relaxation Methods: Deep breathing and other calming practices might be useful.
- Tai Chi or Yoga: Gentle activity combined with focused breathing promotes relaxation.
Some people say they feel better after using these alternative practices. Anyone interested should discuss their choices with a healthcare provider. Calcium supplements support bone health during treatment, but they do not treat hot flashes.
Coping and Finding Support
Gathering Information to Guide Your Care Choices
Many people find that understanding their condition helps them feel more in control. Ask your health care team about the kind of cancer you have, its stage, and whether it has any hormone receptors. If you prefer not to know all the details, you can say so.
- Write questions before appointments
- Take notes or bring someone with you
- Request brochures or website links from your doctor
Relying on Family and Friends for Support
Family and friends can make a big difference by helping with daily tasks, providing company, or listening when you need to talk.
Ways that loved ones can help include:
| Type of Help | Example |
|---|---|
| Emotional support | Listening or talking |
| Practical assistance | Cooking, cleaning, rides |
| Social connection | Spending time together |
Let them know what you need or what you are comfortable with.
Building Connections With Others Facing Cancer
Talking with others who have the same diagnosis can offer comfort, advice, and new ideas for coping. Cancer support groups meet both in-person and online.
Some benefits of joining a support group:
- Shared experiences
- Useful tips and resources
- A sense of community
Organizations like the American Cancer Society help people find local or virtual groups.
Sharing Emotions With Someone You Trust
Expressing feelings can lessen stress and help with problem-solving. You can talk with friends, family, counselors, or spiritual leaders. Healthcare teams often refer people to professionals trained to help those facing illness.
Quick Tips for Support
- Choose someone who listens well.
- Consider written journals as another outlet.
- Speak honestly about your worries and needs.
Practicing Self-Care During Treatment
Taking care of your body and mind is important during treatment. Maintain healthy routines, rest when you need to, and eat nutritious foods like fruits and vegetables.
Simple self-care ideas:
- Get enough sleep.
- Stay active if you can.
- Participate in favorite hobbies.
- Attend social events as you feel able.
Balancing rest and activity can help you preserve energy and boost your mood.
Getting Ready for Your Medical Visit
Steps to Take Before Your Appointment
Preparing for a medical appointment helps people feel more confident and organized and allows them to get the most out of their time with the healthcare team. Here are some practical things to do in advance:
- List all symptoms. Write down any problems, changes, or discomforts, even if they seem unrelated to breast cancer.
- Note personal details. Think about any recent major stress, significant life events, or other health changes.
- Document family medical history. Include all close relatives who have had cancer. Write down what type, when they were diagnosed, their age at the time, and the outcome.
- Record all medications: Make a list of every medicine, vitamin, or supplement you take.
- Keep all medical documents together: Save test results, diagnosis paperwork, and treatment notes in one folder or binder to bring to appointments.
- Bring a support person: Ask a friend or family member to come with you. They can support you and help remember important details.
- Prepare questions: Jot down questions and topics you want to discuss with your doctor.
Here is a quick example of how to organize important information:
| What to Bring | Examples |
|---|---|
| List of medications | Prescriptions, vitamins, supplements |
| Symptom notes | Changes in breast, pain, fatigue |
| Family cancer history | Type, age at diagnosis, outcome |
| Personal info | Recent stress, life changes |
| Medical records | Test results, doctor notes |
| Prepared questions | See list below |
Important Topics and Questions for Your Doctor
Time during a visit can be limited. To make the most of it, arrange your questions from the most important to the least important. Some good questions to consider asking include:
- Is my breast problem cancer, or could it be something else?
- What type and size is my breast cancer?
- What stage is my breast cancer?
- Are there more tests I will need?
- What can these tests tell you about my situation?
- What treatments are possible for me?
- What might be the side effects of these treatments?
- How might these treatments change my daily routine or ability to work?
- Do you have a treatment you think is best for my case?
- What makes you recommend a certain plan?
- What would you suggest to someone close to you in my place?
- How quickly should I decide about starting treatment?
- What are the risks if I decide not to treat it?
- How much will this care cost? Will my insurance cover it?
- Should I ask for a second opinion? Is that covered by insurance?
You may also want to request written materials or ask for recommendations on trusted resources to review at home. Feel free to ask for clarification if anything is unclear. It’s crucial to understand your diagnosis, treatment options, and next steps.
What Questions the Doctor May Ask You
Doctors need information to understand your condition and to plan the best care. Expect to answer questions such as:
- When did your symptoms start?
- Are these symptoms happening all the time, or do they come and go?
- How serious or uncomfortable are the symptoms?
- Does anything make your symptoms better?
- Does anything make your symptoms worse?
Be honest and detailed to help healthcare professionals plan the right care. Keep your documents and notes ready so you can give accurate answers.
