Every woman with a type of breast cancer has a unique experience. The various types of Breast Cancers have been identified and further classified into categories of major and rare types of breast cancer to help better understand the disease. The doctor will find out what type of breast cancer the female has in order to plan the required and suitable treatment for her.
Breast Cancer Classification
Doctors classify breast cancer mainly as per the:
- Location: the part of the breast where cancer started.
- Spread: If cancer has spread, then, where (parts of the female, generally surrounding the breast and chest area) cancer has spread.
There is another term “Recurrent Breast Cancer”, which means that cancer has reappeared after treatment.
Symptoms of Breast Cancer
Types of Breast Cancers
Breast cancer is also classified into different types based as per how the cells look under a microscope. Most breast cancers are categorized as “carcinomas”, a type of cancer that begins in the linings of most organs.
1. Ductal carcinoma in situ
Ductal carcinoma in situ (DCIS) is a major type of Breast Cancer, characterized by the cancerous cells which are confined to the lining of the milk ducts. These cancerous cells have not spread through the duct walls into surrounding breast tissue. If ductal carcinoma in situ lesions is left untreated, over time cancer cells may break through the duct and spread to nearby tissue, becoming an invasive breast cancer.
As per various Statistics, DCIS is the most common type of noninvasive breast cancer among females, with about 60,000 new cases diagnosed each year. On a rough approximation, one in every five new breast cancer cases is of the type “ductal carcinoma in situ”.
DCIS is divided into several sub-categories, mainly as per the appearance of the tumor. These sub-categories include micropapillary, papillary, solid, cribriform and comedo.
Females with ductal carcinoma in situ are generally at a higher risk for getting their cancer again after treatment, with the chance of a recurrence less than 30 percent. Most recurrences are seen within the five to 10 years after the initial diagnosis of the disease and may be invasive or noninvasive. DCIS also brings a heightened risk for developing new breast cancer, of the same or a different type, in the other breast. A recurrence of ductal carcinoma in situ requires special attention and additional treatment.
The type of treatment option selected for a patient may affect the likelihood of recurrence. Treating ductal carcinoma in situ with breast-conserving surgery, a type of lumpectomy without radiation therapy has a 25 percent to 35 percent chance of recurrence. Adding radiation therapy along with the treatment decreases the recurrence risk to 15 percent. With the best treatment and care, the long-term survival rate for females with ductal carcinoma in situ is nearly 100 percent.
2. Invasive ductal carcinoma
Invasive ductal carcinoma (IDC) originates in the milk ducts and spreads till the fatty tissue of the breast, which is outside the duct. IDC is a common type of breast cancer with approximately 80 percent of breast cancer cases to be of invasive breast cancers.
Treatment options for Invasive ductal carcinoma: Surgery is generally the first treatment suggested for invasive ductal breast cancer. The aim of the treatment is to remove cancer from the breast completely, with lumpectomy or mastectomy. The type of surgery recommended depends on various factors such as the origin and the location of the tumor, the size of cancer and if more than one part in the breast has been affected. For females with ductal carcinoma, a long-term and systemic treatment with tamoxifen is suggested to prevent a recurrence.
There are four types of “invasive ductal carcinoma”. These types of Cancers are less common. They are briefed below:
- Medullary ductal carcinoma: This type of cancer is rare and counts for only 3 to 5 percent of breast cancers. This is also called “medullary” as under a microscope, it resembles the medulla, a part of the human brain. Medullary carcinoma can occur to a female of any age. But it mostly affects women in their late 40s and early 50s. Diagnosis and Treatment- This type of cancer is more common in females who have the “BRCA1 gene mutation”. Medullary tumors are generally “triple-negative,” which means that they test negative for estrogen and progesterone receptors and also for the HER2 protein. There are fewer chances of having lymph nodes in this cancer. It is also more responsive to treatment and may have a better prognosis as compared to the more common types of invasive ductal cancers. Surgery is mostly the first-line treatment for medullary ductal carcinoma. A lumpectomy or mastectomy is generally performed. But it widely depends on the location of the tumor. Chemotherapy and radiation therapy may also be added to the treatment.
- Mucinous ductal carcinoma: This type of breast cancer is not very common and accounts for less than 2 percent of breast cancer cases. It is also called colloid carcinoma. Upon Microscopic evaluations, it can be seen that the cancer cells in this disease are surrounded by mucus. Like the other types of invasive ductal cancers, mucinous ductal carcinoma starts in the milk ducts of the breast and then spreads to the tissues around the duct. Diagnosis and Treatment- This cancer affects women after their menopause. Mucinous cells are found positive for estrogen and/or progesterone receptors and negative for the HER2 receptor. Surgery is generally recommended for the treatment of mucinous ductal carcinoma. Lumpectomy or mastectomy can be performed, depending on the extent, size and location of the tumor. Other treatments or therapies like Radiation therapy, Hormonal therapy, and Chemotherapy, may also be required in the treatment prospects. Most mucinous carcinomas tests are negative for protein receptor HER2. For that reason, they are not generally treated with trastuzumab, also known as Herceptin.
- Papillary ductal carcinoma: This type of cancer is rare, with less than 1 percent of invasive breast cancers. In most cases, this type of cancer is diagnosed in older and postmenopausal females. Under a microscope, these cells look like tiny fingers or papules. Diagnosis and Treatment- This type of breast cancers are mostly small, and have a positive test result for the estrogen and progesterone receptors. Papillary Cancers are also negative for the HER2 receptor. Most papillary cancers are invasive in nature and have a similar treatment like invasive ductal carcinoma. Surgery is the first-line treatment for papillary breast cancers. Depending on the size and location of the tumor, lumpectomy or mastectomy can be performed. After the surgery, adjuvant therapies including radiation, chemotherapy and/or hormone therapy may be required for the patient.
- Tubular ductal carcinoma: This is another rare type of cancers. This type of cancer is seen in less than 2 percent of breast cancer diagnoses. Similar to the other types of invasive ductal cancers, tubular breast cancer originates in the milk ducts and then spreads to the tissues around the milk duct. Tubular ductal carcinoma cells make up tube-shaped structures. Tubular ductal carcinoma is more common in females above the age of 50. Diagnosis and Treatment- Tubular breast cancers test positive for estrogen and/or progesterone receptors and is negative for the HER2 protein receptor. Treatment options for tubular ductal carcinoma are decided to keep in mind the aggressiveness and stage of cancer. Treatment often consists of a lumpectomy or mastectomy surgery, along with adjuvant therapy including chemotherapy, radiation or hormone therapy.
3. Lobular Carcinoma
Lobular carcinoma originates in the lobes or lobules, the glands that make breast milk. These lobules are connected to the ducts that carry breast milk to the nipples.
- Lobular carcinoma in situ (LCIS) – This cancer originates in the lobules and does not spread through the wall of the lobules to the surrounding breast tissue or other parts of the body. These abnormal cells rarely become invasive cancer and their presence shows an increased risk of developing breast cancer later. About 25 percent of females with LCIS may develop breast cancer at some point in their lifetime. This breast cancer may occur either in the breast or may appear in the lobules or in the ducts. Diagnosis and Treatment- As LCIS is not actually cancer, cancer treatment may not be recommended. If a female is diagnosed with lobular carcinoma, she is suggested to discuss and take frequent breast cancer screening with her doctor. Increasing surveillance and diagnosis may help detect any breast cancer in its earliest, most treatable stages.
- Invasive lobular carcinoma (ILC) – It originates in the lobules and then invades the nearby tissue and can spread to distant parts of the body. This breast cancer is common and accounts for about 1 out of every 10 invasive breast cancer cases. Treatment and Diagnosis- Treatment options suitable for invasive lobular carcinoma includes localized options such as surgery followed by radiation therapy which treats the tumor and the surrounding areas. Systemic treatments like chemotherapy and hormonal or other targeted therapies which travel throughout the body to destroy cancer cells which may have spread from the original tumor are also required for patients with this type of cancer.
4. Inflammatory Breast Cancer
Inflammatory breast cancer is aggressive and fast-growing. In females with this form of cancer, the cancer cells penetrate into the skin and lymph vessels of the breast. But, in the majority of the cases, a breast lump or mass cannot be felt. This may also delay the diagnosis. Symptoms are generally noticeable when cancer spreads and blocks the lymph vessels. These symptoms include persistent itching, a rash, small irritation like an insect bite, redness, swelling, feeling warmth in the breast, nipple inversion and flattening, or dimpling of nipples.
5. Metastatic Breast Cancer
Metastatic cancer is stage 4 of the disease, during which cancer has spread to other parts of the body, most commonly the lungs, liver, bones, or brain. Cancer spread can occur when cancer cells invade the nearby healthy cells, cancer cells penetrate into the circulatory or lymph system, cancer cells migrate through circulation, cancer cells lodge in capillaries. This can also happen when new small tumors grow. Symptoms may vary based on how far cancer has spread in the patient. When cancer affects the bones, patients often experience severe and constant pain, swelling, and easily broken bones. The effect of metastasis to the brain can cause persistent, severe and worsening headaches or feelings a pressure over the head, vision disturbances, seizures, vomiting, nausea, and changes in behavior or personality.
Also Read: TNM Staging System for Breast Cancer
Symptoms of metastatic cancer to the liver include
- Itchy skin
- Abnormally high enzymes in the liver
- Abdominal pain
- Loss of appetite
At last, metastatic cancer to the lungs can cause chronic cough or inability to get a full breath, abnormal chest scans such as X-Rays, and severe chest pain.
What is Breast Reconstruction?
If you choose to have a mastectomy (complete removal of one or both breasts, partially or completely), you may also decide to undergo reconstruction of your breast, most females do. Breasts are a strong factor in a woman’s sexual personality. Most females prefer to get breast reconstruction after their cancer treatment if they have undergone a mastectomy. Breast Reconstruction is less of a requirement and more of a personal choice. Undergoing a breast reconstruction surgery is a safe, yet big procedure, especially after fighting cancer. Females are suggested to look at the wide aspects of the procedure, pros, and cons, possible side effects, risk factors, etc.before making a decision. Also, talk to your doctor openly, preferably the one who is aware of your previous medical history.
Types of Breast Reconstructions
In the basic surgery, a plastic surgeon restores the size and shape of the female’s breast following a mastectomy. There are several ways to carry out this procedure:
- Using a breast implant to substitute for the natural breast tissues
- Using a “flap” of your own tissue
- Combination of breast implants and flaps of tissues
After restoring the breast’s natural shape, the surgeon can also restore the nipple and areola in another procedure after that. This is generally done after 3-6 months of augmentation surgery. This procedure uses the female’s own tissues for the nipple. Also, the doctors can tint the areola safely, with tattoo dye. Some new procedures such as nipple-sparing mastectomies can make the nipple reconstruction unnecessary.
It is essential to understand that mastectomy may result in loss of sensation and functioning of the breasts in all aspects. Breast reconstruction cannot completely restore those factors.
Treatments for Breast Cancer
Breast cancer is a hostile disease which occurs when the cells in the breast begin to grow out of control. The exact causes of the disease remain unknown, but the development of this disease has been linked to acquired or inherited gene mutations. Females with this disease often experience symptoms such as breast lumps or masses, swelling in one part or whole of the breast, irritation or dimpling, pain in breast or nipple, nipple retraction, nipple discharge other than breast milk, or redness, scaliness, or thickening of the nipple or breast skin, etc.
After proper diagnosis of the disease, talk to your doctor and know more about the type and category of your disease. The doctor will introduce you to new terminology with multiple treatment and surgical options. It is essential for the patient to learn how to best select and communicate with the doctor and healthcare team.
Cancer is a very aggressive disease. Sometimes, even after trying all possible options, the patient may not be saved.
Along with the treatment, a strong will-power, love, physical, mental and emotional support of family and loved ones and a will to fight, survive and recover plays an essential role in the treatment and recovery journey of the patient.