Breast Investigators

Source: BreastCancer.org

LCIS – Lobular Carcinonoma In Situ

Lobular carcinoma in situ (LCIS) is an area (or areas) of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later on in life. Lobular means that the abnormal cells start growing in the lobules, the milk-producing glands at the end of breast ducts. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. In situ or “in its original place” means that the abnormal growth remains inside the lobule and does not spread to surrounding tissues. People diagnosed with LCIS tend to have more than one lobule affected.

Despite the fact that its name includes the term “carcinoma,” LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term “lobular neoplasia” instead of “lobular carcinoma.” A neoplasia is a collection of abnormal cells.

LCIS is usually diagnosed before menopause, most often between the ages of 40 and 50. Less than 10% of women diagnosed with LCIS have already gone through menopause. LCIS is extremely uncommon in men.

LCIS is viewed as an uncommon condition, but we don’t know exactly how many people are affected. That’s because LCIS does not cause symptoms and usually does not show up on a mammogram. It tends to be diagnosed as a result of a biopsy performed on the breast for some other reason

It is difficult to detect LCIS on your own. Doctors usually find LCIS through an abnormal mammogram and a biopsy.

Symptoms of LCIS

LCIS usually does not cause any signs or symptoms, such as a lump or other visible changes to the breast. LCIS may not always show up on a screening mammogram. One reason is that LCIS often lacks microcalcifications, the tiny specks of calcium that form within other types of breast cancer cells. On a mammogram, microcalcifications show up as white specks. It’s believed that many cases of LCIS simply go undiagnosed, and they may never cause any problems.

Diagnosing LCIS

LCIS is usually diagnosed after a biopsy is done on the breast for some other reason, such as an abnormal finding on a mammogram or a suspicious breast lump. These biopsy procedures may include the following:

• Fine needle aspiration biopsy: A very small, hollow needle is inserted into the breast. A sample of cells is removed and examined under the microscope. This method leaves no scars.
• Core needle biopsy: A larger needle is inserted to remove several bigger samples of tissue from the area that looks suspicious. In order to get the core needle through the skin, the surgeon must make a tiny incision. This leaves a very tiny scar that is barely visible after a few weeks.
• Incisional biopsy: Incisional biopsy removes a small piece of tissue for examination.
• Excisional biopsy: Excisional biopsy attempts to remove the entire suspicious lump of tissue from the breast.

To the pathologist looking at the sample under the microscope, LCIS can look very much like ductal carcinoma in situ, or DCIS (cancer that is limited to the breast duct) — especially low-grade, solid DCIS.
Unlike LCIS, DCIS is considered to be cancer and does require treatment with surgery and often radiation therapy. So you may want to ask why the pathologist has determined that you have LCIS rather than DCIS. You might also want to seek a second opinion from a pathologist at a different hospital.

In more than half of cases, LCIS is “multifocal,” meaning that multiple lobules have areas of abnormal cell growth inside them. In about one-third of women with LCIS, the other breast is affected as well.

Even though LCIS is not really breast cancer, you may hear your doctor describe it as “Stage 0.” The breast cancer staging system is used to describe how far cancer has spread beyond the site of the original tumor. Both LCIS and DCIS are considered Stage 0, the earliest stage possible.

ILC – Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma (cancer that begins in the milk-carrying ducts and spreads beyond it). According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. About 10% of all invasive breast cancers are invasive lobular carcinomas. (About 80% are invasive ductal carcinomas.)

Invasivemeans that the cancer has “invaded” or spread to the surrounding breast tissues. Lobular means that the cancer began in the milk-producing lobules, which empty out into the ducts that carry milk to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. All together, “invasive lobular carcinoma” refers to cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast. Over time, invasive lobular carcinoma can spread to the lymph nodes and possibly to other areas of the body.

Although invasive lobular carcinoma can affect women at any age, it is more common as women grow older. According to the American Cancer Society, about two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. ILC tends to occur later in life than invasive ductal carcinoma — the early 60s as opposed to the mid- to late 50s.

Some research has suggested that the use of hormone replacement therapy during and after menopause can increase the risk of ILC.

Signs and Symptoms of ILC

At first, invasive lobular carcinoma may not cause any symptoms. Sometimes, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing. Invasive lobular carcinomas tend to be more difficult to see on mammograms than invasive ductal carcinomas are. That’s because instead of forming a lump, the cancer cells more typically spread to the surrounding connective tissue (stroma) in a line formation.

In other cases, the first sign of ILC is a thickening or hardening in the breast that can be felt, rather than a distinct lump. Other possible symptoms include an area of fullness or swelling, a change in the texture of the skin, or the nipple turning inward.

According to the American Cancer Society, any of the following unusual changes in the breast can be a first sign of breast cancer, including invasive lobular carcinoma:

• swelling of all or part of the breast
• skin irritation or dimpling
• breast pain
• nipple pain
• redness, scaliness, or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area