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Overview and Ductal Carcinoma
The first step in educating yourself about breast cancer is to learn about the
different forms of the disease. There are many different types of breast cancer,
but the vast majority (over 80%) begins in either the milk ducts or the lobular
(milk-producing) tissue. These two types are called ductal carcinoma and lobular
carcinoma. Either type, if diagnosed early enough, may be called “in situ”,
which means that the cancer has not yet reached the stage where it will invade
nearby tissue or lymph nodes and therefore is highly curable. The prognosis
(outcome) for the invasive version of either type depends on many factors, such
as the stage of the cancer, your age, and your general health.
The other types of breast cancer are less common, sometimes called “special
types”, and each has its own specific prognosis.
Ductal Carcinomas
Ductal carcinoma is the most common form of breast cancer. It develops in the
ducts that carry the milk from the lobules (milk glands) to the nipple. Ductal
carcinomas can be either in situ (DCIS) or invasive breast cancer (IDC).
Ductal Carcinoma In Situ (DCIS)
Ductal carcinoma in situ or DCIS is a non-spreading form of breast cancer. The
cells themselves have typical features of cancer, but they are limited to the
inside of the milk ducts within the breast. Inside the ducts, the cancer cells
divide and multiply, “spreading” up and down the ducts, but they do not invade
through the duct walls or move into the blood or lymphatic systems.
Depending on the amount of cancer that is present, and the number of ducts that
contain cancer cells, DCIS is described as either localized or diffuse.
Treatment options may differ depending on how DCIS is categorized.
If the cancer cells spread up the ducts all the way to the nipple(s), the
nipple(s) can appear crusted, scaly and red and cause burning, itching, or ooze
a bloody discharge. This condition is known as Paget’s disease of the nipple.
(see Paget’s below)
Mammography may or may not show microcalcifications (tiny calcium deposits) in
the ducts. DCIS is nearly 100% curable because the cancer is found and treated
at such an early stage. If DCIS is not detected, however, the cancer cells may
develop the ability to invade the duct walls and nearby tissues. The cancer
would then be viewed as invasive ductal carcinoma or IDC.
Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma accounts for 70 - 80% of breast cancers. Like DCIS,
the cancer begins in the milk ducts but IDC invades the fatty tissues of the
breast.
In most cases, breast cancer is slow-growing. Cancer may have been developing
for months or years before a lump can be felt. IDC cells, however, will
eventually move into nearby breast tissue, and then into the lymphatic channels
and travel to nearby lymph nodes (usually the nodes in the armpit area). For
those with IDC, it is common to have lymphatic nodes biopsied or removed so they
can be examined under a microscope to see if the cancer has spread. It is
important to detect and treat IDC before it has had time to metastasize (spread)
to the liver, lungs, bones, or other organs.
On mammography, the lump appears opaque with irregular borders and it is common
for microcalcifications to be seen. On manual exam, the lump feels hard and
immovable and the skin over that area (or over the nipple) may look puckered
(retracted). IDC has the ability to spread to other parts of the body
(metastasize) by traveling through the blood or lymph systems.
Paget's Disease of the Nipple
Paget’s disease of the breast is an eczema-like change in the skin of the
nipple, and 90% of women who have it have an underlying breast cancer. The
underlying breast cancer may be a DCIS or invasive breast cancer. This type of
breast cancer starts in the milk ducts and spreads to the skin of the nipple and
areola (the dark circle around the nipple). Approximately 50% of those who have
Paget’s disease will have a palpable (able to be felt with the hand) lump in
their breast when they are diagnosed.
Paget's disease is an uncommon form of breast cancer, occurring in only 1% - 2%
of all cases of breast cancer. It usually occurs in women in their fifties, but
it can occur at a later age. (It can affect men too but this is extremely rare.)
If no lump can be felt in the breast tissue and the biopsy shows the growth to
be in situ and not invasive, treatment for Paget's disease is very effective.
Lobular Carcinoma
Lobular carcinoma tumors grow in the milk-producing glands of the breast. It is
far less common than ductal carcinoma, only about 10% of all breast cancers, but
it can present itself in both breasts more often than other types of breast
cancer. Lobular carcinoma can be either in situ (LCIS) or invasive breast cancer
(ILC).
Lobular Carcinoma In Situ (LCIS)
Lobular carcinoma in situ (also called lobular neoplasia) is a precancerous
growth that begins in the milk-producing glands of the breast and does not
penetrate through the wall of the lobule(s). Most researchers believe it does
not usually become an invasive breast cancer. Women who develop LCIS, however,
have a higher risk of developing invasive breast cancer in the same or opposite
breast in the future.
Invasive Lobular Carcinoma (ILC)
Invasive lobular carcinoma begins in the milk-producing glands and then moves
into the fatty tissue of the breast. Like invasive ductal carcinoma, ILC has the
ability to metastasize and spread to other parts of the body. About 5%-10% of
breast cancers are invasive lobular carcinomas. It occurs most frequently in
women between the ages of 45 and 56.
Invasive lobular carcinoma can be more difficult to detect by mammogram. Instead
of a distinct lump with firm borders (like IDC), it normally presents as a
diffuse swelling or thickening in the upper outer quadrant (the part of your
breast nearer your armpit). Compared to ductal carcinoma, however, lobular
carcinoma is associated with a better prognosis.
In about 30% of cases, ILC is found in the opposite breast as well. It is also
often found in other parts of the same breast (called multicentric ILC) and is
more likely to spread to the uterus and ovaries (ductal carcinomas tend to
spread to the bones, liver, and lungs). Most tumors are positive for estrogen
and progesterone receptors and so they will respond well to hormonal therapy.
Less Common Types of Breast Cancer
Inflammatory Breast Cancer (IBC)
Inflammatory Breast Cancer (IBC) is a very aggressive type of invasive breast
cancer. Some sources say it accounts for less than 1% of all breast cancers but
newer estimates figure it to be more like 5%. In IBC, cancer cells block the
normal flow of lymph within the breast, causing the skin to appear thick and
pitted like the outside of an orange (a symptom called “peau d’orange”). The
affected breast(s) may feel warm to the touch and look red. Misdiagnosis can
contribute to the poor prognosis – it can be confused with an infection or
inflammatory skin condition and often occurs without the typical "lump" most
people associate with breast cancer - by delaying proper diagnosis and
treatment. Medullary Carcinoma. The tumor in medullary carcinoma is usually a
soft, well-defined lump. The well-defined border of the tumor helps prevent the
rapid spread of the cancer. Because it is less likely to spread to the lymph
nodes, treatment is often more effective against this cancer type than others,
leading to a better outcome (prognosis).
Tubular Carcinoma
Tubular carcinoma is rare, accounting for only 3%-4% of all breast cancers. The
tumors are usually small, but due to advances in screening techniques, more
tubular carcinomas have been detected in recent years. Treatment is more
effective for this type of invasive cancer than other forms – with a prognosis
of about 80% survival at 5 years.
Mucinous Carcinoma
Mucinous carcinoma, another rare type of invasive breast cancer, also has a good
prognosis because it does not easily spread to the lymph nodes. The cancer is
formed by mucus-producing cancer cells that spread the disease to surrounding
breast tissue. More common in older women, mucinous carcinoma accounts for about
2% of all breast cancers.
Cribriform Carcinoma
This type of invasive breast cancer accounts for only 3% of all breast cancers
and has a good prognosis after treatment.
Papillary Carcinoma
Papillary carcinomas account for about 2% of all breast cancers and have a
better prognosis than ductal carcinoma.
Phyllodes Tumor
This rare type of breast tumor forms in the connective tissue (stroma) of the
breast, unlike the carcinomas that develop in the ducts or lobules. These tumors
are usually benign, but in rare cases can be malignant. Malignant phyllodes
tumors account for less than 1% of all breast cancers and are responsible for
less than 10 breast cancer deaths per year.
Phyllodes tumors do not respond to hormonal therapy and are less likely to
respond to other standard breast cancer therapies like chemotherapy and
radiation. They are treated surgically by removing the tumor and some of the
surrounding healthy tissue or by removing the entire breast (mastectomy).
Source :
http://www.breastcancer.about.com/od/diagnosis/a/brcatypes1.htm