Historical types of breast cancer
Histologically, the broad concept of breast cancer includes many different clinical entities and their identification is very important before surgery, as the treatment is different for each one. Histological identification, as it is called, can only be achieved preoperatively by biopsy by cut needle under ultrasound guidance and not by older methods such as fine needle aspiration (also known as FNA). We will list the main histological types of breast cancer and general information about their modern treatment approach.
1. Non-invasive porogenic carcinoma in situ
(DCIS – Ductal Carcinoma In Situ)
It is the most common type of in situ carcinoma (non-infiltrating). DCIS is often suspected by mammography and not palpable. Sometimes it may also constitute a palpable breast lump. It is a mild form of porogenic cancer and is a precursor stage of invasive breast cancer, as we will see below. The cancer cells have not escaped the basement membrane, so there may not be metastases to lymph nodes or other organs. It is, therefore, localised disease in the breast.
DCIS of the breast is treated surgically in principle. If it is located in a single part of the breast, DCIS is removed by wide lumpectomy at healthy margins. Especially if it is large in extent, it requires mastoplasty to achieve an excellent aesthetic result. Sometimes it is spread over a large part of the breast, in which case the indicated surgical treatment is mastectomy, preferably with reconstruction.
DCIS of the breast has histological classifications of aggressiveness. The more aggressive types will require postoperative breast radiotherapy. Also, the histological report will show whether DCIS is hormone-dependent. In this case, postoperative administration of hormone therapy will be discussed. Additional treatments are aimed at reducing the chance of local recurrence of DCIS in the breast.
2. Infiltrative porous non-specialized breast cancer
(IDC – Invasive Ductal Cancer NOS)
Represents about 75% of all breast cancers, making it by far the most common histological type of breast cancer. Originating from breast ductal cells, Treatment begins with preoperative diagnosis with guided breast biopsy for complete histological analysis by a pathologist anatomist. This shows us the degree of aggressiveness (Grade of breast cancer), receptors (hormonal receptors and HER-2 expression). The breast surgeon will investigate any multifocality, lymph node expansion and distant metastases prior to surgery.
After a full investigation of the condition, the surgeon is able to discuss the truly best surgical approach with the patient. Depending on the size of the tumor, we will choose the most appropriate procedure: wide lumpectomy with mastopexy or mastectomy with or without reconstruction. Any surgery for breast cancer removal includes an axillary sentinel lymph node biopsy. In the case of multiple infiltrated lymph nodes in the axilla, lymph node cleansing will also be needed.
In invasive porogenic breast cancer, depending on the stage and severity, radiotherapy to the breast and chest, chemotherapy, targeted molecular therapy and hormone therapy if the tumour is hormone-dependent are applied. Most commonly these treatments are given after surgery. However, there are cases in which chemotherapy must be given before surgery. This newer treatment protocol is called pre-operative chemotherapy for breast cancer (neo-adjuvant chemotherapy). The modern breast surgeon must be experienced in the use of such protocols. He ensures that patients who need it see an Oncologist pre-operatively.
3. Non-invasive lobular carcinoma in situ
(LCIS – Lobular Carcinoma In Situ)
LCIS is not considered a type of breast cancer, but it is among the risk factors if detected on biopsy. The risk of developing cancer during a woman’s lifetime is high, about 30-40%. Recall that the average risk in the female population is about 12%.
It usually does not indicate surgery, but lifelong close monitoring and screening. Surgery for LCIS is required when percutaneous biopsy finds LCIS to be pleomorphic, if it constitutes a palpable lump or if it is accompanied by suspicious detachments. In cases of very extensive LCIS, hormone therapy may be discussed if it is hormone-dependent.
Rarely, the woman may request bilateral prophylactic mastectomy with immediate reconstruction to reduce the risk of breast cancer in the future. At the Breast Care Clinic, such cases are treated with great care and with the involvement of a Health Psychologist to counsel women before any surgical intervention.
4. Infiltrative lobular carcinoma of the breast
(ILC – Invasive Lobular Carcinoma)
Lobular breast cancer is the second most common breast cancer, accounting for approximately 10% of all invasive breast carcinomas. It originates from cells in the lobules of the breast, where milk is produced.
It is a challenging type of cancer to diagnose and treat. It underscores the value of thorough screening and preoperative diagnosis in the most compelling way: Often lobular breast cancer is multifocal and sometimes a tumour coexists in the other breast. A biopsy should be performed preoperatively to establish the diagnosis and thoroughly investigate the extension of the tumour. It is also quite often invisible on mastography, seen on breast ultrasound and palpable on clinical examination as diffuse sclerosis.
Because of its multifocal nature, lobular cancer most often leads to mastectomies, with or without surgical breast reconstruction. Surgical management includes sentinel lymph node biopsy or complete axillary lymph node cleansing, depending on the indications. Radiotherapy, chemotherapy and hormone therapy are used depending on histological features and stage of the disease.
5. Medullary breast carcinoma
Subtype of invasive breast carcinoma
It is a relatively rare type of breast cancer accounting for 3-5% of all breast neoplasms. It is most commonly found in women of relatively young age 40-50%. Also, myeloid carcinoma is common in women with a mutation of the BRCA-1 gene. It is a cancer with relatively slow growth and less tendency to metastasize. It is diagnosed by directed cut needle breast biopsy.
6. Mucinous or colloid carcinoma of the breast (mucinous – colloid carcinoma)
Subtype of invasive breast carcinoma
Rare type of cancer (2-3% of all), found mainly in menopausal women around the age of 60-70 years. It is a cancer with a very good prognosis, which takes a long time to metastasize to the lymph nodes or other organs. For this reason, it has an excellent prognosis of up to 90% in 10 years. It is diagnosed by directed cut needle breast biopsy.
7. Tubular carcinoma of the breast
Subtype of infiltrating breast carcinoma
Another type of cancer with excellent prognosis and non-aggressive behaviour. It is often found on mammography and due to the implementation of prevention has become a more common finding in recent years, constituting perhaps more than 5% of all breast cancers. It rarely metastasizes and its progression in the breast is very slow. It has an excellent prognosis. Nevertheless, the breast surgeon should investigate the possibility of multifocal or tumor in the other breast. It is diagnosed by directed cut needle breast biopsy.
8. Papillary carcinoma of the breast (papillary carcinoma)
Subtype of invasive breast carcinoma
Particularly rare type constituting less than 1% of breast carcinomas. It is usually found in postmenopausal women. Very often coexists with It has a very good prognosis because it is not aggressive. It is diagnosed by directed cut needle breast biopsy.
9. Inflammatory breast cancer
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Inflammatory breast cancer is a rare (1%) and very aggressive brand of breast cancer. The cancer cells block the lymphatic vessels in the skin and give an appearance of inflammation in the breast. More specifically, the symptoms of inflammatory cancer are:
- Redness
- Swelling
- Redness
- Orange peel appearance
- Orange peel appearance
- Breast hardness
.
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Due to spread to the skin and general aggressiveness, inflammatory breast cancer at diagnosis is advanced stage. It has usually spread to the lymph nodes and staging tests should be performed to exclude the presence of metastases. It is usually diagnosed in young women. Patients are often obese.
Diagnosis is necessarily made preoperatively, with skin biopsy and directed breast biopsy with a cutting needle. This is very important because inflammatory cancer is treated with chemotherapy initially, followed by surgery
10. Paget’s disease of the nipple
Paget’s disease of the breast is the infiltration of the skin of the nipple and/or areola by cancer cells of the porogenic carcinoma type (types 1 and 2 on this page). It almost always coexists with one or more tumours within the breast. The coexisting tumours are of the porogenic type (in situ or invasive, types 1 and 2 on this page) Rarely found only in the skin, with no other tumour in the breast. Nipple skin shows symptoms of redness and scaling that should be differentiated from dermatitis and eczema of the nipple/papillary alopecia.
It is diagnosed by nipple skin / areola skin biopsy and directed cutaneous needle breast biopsy of all underlying breast tumors, if present. Proper preoperative diagnostic procedure is critical to follow correctly because unlike other breast cancers, surgical management of Paget’s disease of the breast must include removal of the nipple and nipple alveolus.
Purpose of information from the Breast Care Clinic
This page is intended to answer your questions such as:
- I don’t understand what it says in my breast biopsy answer…
- Is there only one type of breast cancer?
- Other than benign and malignant breast lumps, do we get any other information from the preoperative breast biopsy;
- So why did I have the breast biopsy before surgery? What will the information we get help with?
- What is non-invasive cancer? Does it have a better prognosis than invasive breast cancer;
- What is the difference between invasive and non-invasive breast cancer?
- What are the stages of breast cancer?
- What are the rare forms of breast cancer?
I don’t know what my breast cancer answer is in my biopsy report.
Note of the Breast Care Clinic of Patras:
By informing you, we want to protect you from sources of inaccurate information and dissemination on the internet. We also want to help you get informed before visiting our clinic. The breast surgeon Ioannis Haveles has written all the texts of the website of the Breast Care Clinic of Patras -frontidamastou.gr- and guarantees the scientific correctness of the information provided at the time of writing (2017). However, every woman is different and the treatment is individualized based on many elements. Do not jump to conclusions without asking your doctor. Talking to your qualified breast surgeon is not a substitute for reading informative texts, so address all your questions to your breast surgeon.
