Invasive Lobular Carcinoma

Diagnosis

Diagnosis of invasive lobular carcinoma often begins with a clinical breast exam and a discussion of symptoms. Imaging tests are used to evaluate breast tissue, and a biopsy confirms whether cancer is present.

A clinical breast exam involves checking the breasts, nipples, collarbones and armpits for changes or lumps. Imaging tests provide more detail and may include:

• Mammogram

• Breast ultrasound

• Breast MRI

A breast biopsy removes a sample of tissue using a needle guided by imaging. The sample is tested in a lab to determine whether it contains cancer cells and to identify the type of cancer. Special tests may check for hormone receptors and other features that help guide treatment.

Staging tests help determine how far the cancer has spread. Depending on the situation, these may include:

• Blood tests

• Bone scan

• CT scan

• MRI

• PET scan

The stage ranges from 0 to 4, with higher stages indicating more advanced cancer.

Treatment

Treatment for invasive lobular carcinoma often begins with surgery. Additional treatments such as radiation, chemotherapy and hormone therapy may be used depending on the stage and characteristics of the cancer.

Surgery options include:

• Lumpectomy to remove the cancer and a margin of surrounding tissue

• Mastectomy to remove the entire breast

• Sentinel node biopsy to remove a few lymph nodes for testing

• Axillary lymph node dissection if cancer has spread to the nodes

• Risk-reducing mastectomy for those at high risk of cancer in the other breast

Breast reconstruction may be an option after mastectomy.

Hormone therapy is often used because most invasive lobular carcinomas are sensitive to estrogen or progesterone. Treatment options include medicines that block hormones, reduce hormone production or stop the ovaries from making hormones.

Radiation therapy uses high-energy beams to destroy any cancer cells left after surgery. It is commonly recommended after a lumpectomy.

Chemotherapy uses strong medicines to target cancer cells. It may be used before surgery to shrink the tumor or after surgery to reduce the risk of recurrence.

Targeted therapy focuses on specific features of cancer cells. Most invasive lobular carcinomas do not make extra HER2, so they may not respond to HER2-targeted treatments, but other targeted medicines may be considered depending on test results.

A treatment plan is customized based on the stage of the cancer, its growth rate and overall health considerations.