Subtypes of invasive lobular carcinoma
There are several subtypes of invasive lobular carcinoma, often named for how the cells look under a microscope.
Classic ILC is the most generic form of invasive lobular carcinoma and is made up of small cancer cells that invade the stroma, the fatty tissue and ligaments that surround the breast ducts and lobules. Classic ILC cells tend to invade the stroma in a single-file pattern.
Solid ILC cells grow in large sheets with little stroma in between them.
Alveolar ILC cells grow in groups of twenty or more.
Tubulolobular ILC cells grow in a single-file pattern, but some of the cells also form small tube-like structures.
Pleomorphic ILC cells look different from classic ILC cells. The cells are larger and the cells’ nuclei — the core of each cell that contains its genetic material — look different from each other. Pleomorphic ILC also may be composed of signet ring cells, cells that are filled with mucus that pushes the nucleus to one side.
Invasive lobular carcinoma (ILC) is the second most common type of breast cancer, after invasive ductal carcinoma (IDC). About 10% of all breast cancers are invasive lobular carcinomas, according to the American Cancer Society.
Invasive means the cancer has spread into surrounding breast tissues. Lobular means the cancer started in the lobules, the glands in the breast that produce milk. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs, such as breast tissue.
Staging invasive lobular carcinoma
The stage of invasive lobular carcinoma is determined by the cancer’s characteristics, such as how large it is and whether it has hormone receptors. The stage of the cancer helps you and your doctor:
figure out your prognosis, which is the outcome of the disease.
decide on the best treatment options for you.
determine if certain clinical trials may be a good option for you.
The stage of invasive lobular carcinoma is described as a number on a scale of I through IV. Stages I, II, and III describe early-stage cancers and stage IV describes cancers that have spread outside the breast to other parts of the body, such as the bones or liver.
Once a diagnosis of invasive lobular carcinoma has been made, your doctor will do more testing to collect information on the characteristics of the cancer. These tests, as well as the results of your biopsy, make up the parts of your pathology report.
Information commonly collected as part of a pathology report include:
size of the breast cancer
Nottingham grade of the cancer
tumor necrosis
tumor margins
lymphovascular invasion
lymph node status
hormone receptor status
HER2 status
rate of cell growth (Ki-67 levels)
Lobular Carcinoma Diagnosis and Symptoms
How is lobular carcinoma diagnosed?
The diffuse growth pattern of lobular carcinoma can make diagnosis particularly challenging. In addition, these breast cancers are also more likely to be multi-focal (occurring in more than one location) or bi-lateral (occurring in both breasts), which complicates accurate screening, detection, and treatment.
Mammography and ultrasound—standard breast imaging tools—are less dependable for early detection of lobular breast cancer or recurrent disease. This can lead to later detection and a more advanced stage at diagnosis. Current research shows that MRI may be better able to detect lobular carcinoma than mammography, and new techniques are being developed, with several in clinical trials now.
Where does lobular breast cancer spread?
Lobular breast cancer can have a unique pattern of metastasis—spreading to distant sites of the body—compared to invasive ductal breast cancer. Both may metastasize to the bones, lungs, brain, and liver, though less frequently in lobular carcinoma. Unlike invasive ductal carcinoma, invasive lobular carcinoma tends to also spread to the ovaries, gastrointestinal tissues, and the peritoneum (the tissue surrounding the abdomen). Lobular breast cancer can recur and metastasize many years after diagnosis and treatment, so it is important to be aware of metastatic symptoms.
What are lobular breast cancer symptoms?
The most common lobular breast cancer symptoms are:
Hardened or thickened area inside the breast or underarm
Dimpling, dent, or puckering of the skin of a breast.
Change the size or shape of a breast.
Changes to the nipple, including inversion or pulling to one side.
A new area of fullness or swelling in the breast.
Metastatic lobular breast cancer symptoms include:
Unexplained and persistent bone pain, especially in the back, ribs, or thighs
Unusual pelvic bleeding
Abdominal pain, distention and/or bloating.
Difficulty eating or digesting food.
Unexplained weight loss
Unexplained shortness of breath or painful breathing
Frequent headaches, dizziness, or impaired cognitive function
Swelling or lumps in the chest, armpit, neck, or groin
Changes in skin color, lasting rash, or firm nodules on the skin
New difficulty seeing
Lobular Carcinoma Treatment
Breast cancers are typically treated with a multidisciplinary approach involving surgery, radiation, and systemic therapies. Because of its diffuse and multi-focal nature, lobular carcinoma is difficult to detect both by imaging and during surgery. This characteristic also makes breast-conserving surgery more challenging. Unfortunately, up to 65 percent of people with lobular breast cancer require a second surgery.
Most of these cancers are hormone receptor (HR)–positive, so endocrine (anti-hormone) therapies are typically administered for lobular breast cancer treatment. Most commonly, the anti-estrogen therapy tamoxifen is recommended for premenopausal women while an aromatase inhibitor such as letrozole or anastrozole is given to postmenopausal women. Although lobular breast cancer responds to hormone therapies, tumors can become resistant to treatment.
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