About Invasive Lobular Carcinoma (ILC)

Overview

Invasive lobular carcinoma (ILC) is a common type of breast cancer that starts in the milk-producing glands of the breast. It is also known as infiltrating lobular carcinoma or lobular breast cancer. Unlike other types of breast cancer, ILC does not typically form lumps that can be easily felt. Instead, it grows and spreads in a different manner, starting in the breast lobules and moving into the surrounding breast tissue. From there, it can spread to lymph nodes and other organs in the body. ILC accounts for about 10% of all invasive breast cancers and is more commonly diagnosed in women in their early 60s. It may not produce any symptoms, making it more challenging to detect through mammograms alone. Early diagnosis and treatment are crucial for improving long-term outcomes for individuals with ILC.

Causes and Risk Factors

The root causes of invasive lobular carcinoma (ILC) are not fully understood, but there are some factors that have been identified as potential contributors. These include:

Genetic mutations: ILC has been associated with specific genetic mutations, such as alterations in the E-cadherin gene (CDH1), which is involved in cell adhesion and tissue integrity.
Hormonal factors: Hormones, particularly estrogen and progesterone, play a role in the development of ILC. Women with a history of hormone replacement therapy or early menarche (onset of menstruation) and late menopause are at a higher risk.
Lobular neoplasia: Lobular neoplasia is a precursor lesion to ILC and can increase the risk of developing invasive cancer.

Non-modifiable risk factors for ILC cannot be changed or controlled. These include:

Gender: Women are at a much higher risk of developing ILC compared to men.
Age: The risk of ILC increases with age, particularly after menopause.

Modifiable risk factors for ILC can be influenced or changed. These include:

Obesity: Being overweight or obese increases the risk of developing ILC.
Alcohol consumption: Regular and excessive alcohol consumption has been associated with an increased risk of developing ILC.
Hormone replacement therapy: Long-term use of hormone replacement therapy, especially combined estrogen-progestin therapy, can increase the risk of ILC.

It's important to note that while these factors have been identified as potential contributors to the development of ILC, individual cases may vary. It's always best to consult with a healthcare professional for personalized advice and guidance.

Symptoms

In the early stages of invasive lobular carcinoma (ILC), it may not cause any symptoms. However, as the condition progresses or becomes more severe, the following symptoms may occur:

Early symptoms:

Thickening or hardening of breast tissue instead of a distinct lump
An area of fullness or swelling in the breast
Change in the texture of the breasts' skin
Nipple turning inward

Later stage/progression/higher severity symptoms:

Metastasis (spread) to other parts of the body
Spread to nearby lymph nodes and other tissues
Swelling of the breast
Thickening of breast skin
Scaly skin on the nipple or breast
Skin irritation or peau d'orange (orange peel-like appearance)
Nipple retraction
Nipple discharge (other than breast milk)
Persistent breast or nipple pain

It's important to note that ILC is often not associated with a noticeable lump, making it difficult to detect through self-examination. Regular screening mammograms can help in early detection. If you experience any concerning symptoms, it's crucial to consult with your healthcare professional for proper evaluation and diagnosis.

Diagnosis

To diagnose invasive lobular carcinoma (ILC), the following examinations, tests, and procedures are commonly performed:

Clinical examinations: A physical examination of the breasts and lymph nodes is conducted by a healthcare professional.
Breast imaging: Mammography and ultrasound are commonly used to detect breast abnormalities. However, ILC can be difficult to detect using these methods due to its infiltrative growth pattern.
Biopsy: A Tru-cut biopsy is often performed to obtain tissue samples for pathological examination. This helps confirm the presence of ILC.

To determine the stage or severity of ILC, additional examinations, tests, and procedures may be performed:

Magnetic resonance imaging (MRI): MRI is a valuable diagnostic tool for ILC as it provides detailed images of the breast tissue. It can help identify the extent of the tumor and evaluate its response to treatment.
Intraoperative frozen evaluation: In cases where conservative surgery is performed, an intraoperative frozen evaluation may be conducted to assess the surgical margins and determine if further excision is required.
Radiological and pathological response evaluation: For patients receiving neoadjuvant treatment (treatment before surgery), the compatibility between radiological and pathological treatment response is evaluated to assess the effectiveness of the treatment.

It's important to consult with your healthcare professional for personalized advice on which examinations, tests, and procedures are appropriate for your individual situation.

Treatment Options

The goals of treatment for invasive lobular carcinoma (ILC) are to remove or destroy the cancer cells, prevent the spread of the disease, and improve overall survival. Here are the different types of treatments and how they work to achieve these goals:

Surgical treatment: The main goal is to remove the tumor and surrounding tissue. This can be done through lumpectomy (removal of the tumor and a small margin of healthy tissue) or mastectomy (removal of the entire breast). Surgical treatment aims to achieve complete resection with negative margins, minimizing the risk of recurrence.
Radiation therapy: This treatment uses high-energy rays to kill cancer cells or shrink tumors. It is often recommended after surgery to destroy any remaining cancer cells and reduce the risk of local recurrence.
Endocrine therapy: Since most ILC tumors are estrogen receptor-positive, endocrine therapy is commonly used. Medications like tamoxifen or aromatase inhibitors block the effects of estrogen on cancer cells, reducing the risk of recurrence and improving survival.
Chemotherapy: In some cases, chemotherapy may be recommended to kill cancer cells that have spread beyond the breast. It is often used when ILC has spread to lymph nodes or distant organs.
Health behavior changes: Adopting a healthy lifestyle can support treatment outcomes. This includes maintaining a balanced diet, engaging in regular physical activity, managing stress, and avoiding tobacco and excessive alcohol consumption.

It's important to note that treatment plans may vary depending on individual factors such as tumor characteristics, stage of cancer, and overall health. Always consult with your healthcare professional for personalized advice.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.