Diagnosis:
Core-needle biopsy of large left breast mass: pathology consistent with invasive ductal carcinoma (infiltrating breast carcinoma), tubules observed in 85% of sample, 3-5 cell divisions in high-power observation with mild pleomorphism, tumor positive for estrogen and progesterone receptors.
Ultrasound of left breast and axilla: four cystic lesions in the left breast, solid-appearing, non-cystic mass consistent with cancer in upper outer quadrant, ill-defined mass with abnormal vascularity, the mass measures the same as with the mammogram (2,1x3x3.1 cm), there is some suggestion of skin thickening and mild tissue edema.
Ultrasound of liver: clear
Bone scan: no definitive evidence of bone metastasis, positive for mild degenerative changes consistent with degenerative joint disease.
Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that began growing in a milk duct and has invaded the fibrous or fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses.
As with any breast cancer, there may be no signs or symptoms
Make an appointment to have a breast lump evaluated if:
The lump feels firm or fixed
The lump doesn't go away after four to six weeks
You notice skin changes on your breast, such as redness, crusting, dimpling or puckering
You have discharge, possibly bloody, from your nipple
Your nipple is turned inward and isn't normally positioned that way
You can feel a lump in your armpit and it seems to be getting bigger
Thickening of the breast skin
Swelling in one breast
New pain in one particular location of a breast
Changes in the appearance of the nipple or breast that are different from the normal monthly changes a woman experiences
Now that you know the patient has IDC – what’s next?
Clinical course: The oncologist met with the patient and together they decided on breast conservation therapy/lumpectomy with sentinel lymph node biopsy, radiation and chemotherapy. The nodes were negative and surgical margins were clear. After radiation treatment, the patient was placed on tamoxifen. She will have follow-up appointments every 3-4 months for the first two years and then every 6 months for the next three years, then annually.
For more information on options for treating IDC, check out https://www.breastcancer.org/symptoms/types/idc/treatment
Treatments for invasive ductal carcinoma (IDC) include surgery, chemotherapy, radiation therapy, hormonal therapy, and targeted therapy.
Surgery is used to treat IDC not only to remove the breast tumor itself, but also to confirm whether or not cancer is in the lymph nodes. Surgery is considered a local treatment because it treats just the tumor and surrounding area. A lumpectomy removes only the tumor (the “lump”) and some of the normal tissue that surrounds it.
In a Sentinel lymph node biopsy, the surgeon looks for the very first lymph node — the “sentinel node” — that filters fluid draining away from the area of the breast that contains the cancer. If cancer cells are breaking away from the tumor and traveling away from your breast through the lymph system, the sentinel lymph node is more likely than other lymph nodes to contain cancer. The surgeon uses a special radioactive substance or dye to identify that first node and the couple of nodes where it drains. These nodes are then removed and sent for examination by a pathologist. If the lymph nodes are cancer-free, no further surgery is necessary. If cancer is found, then more lymph nodes in the armpit need to be removed, either now or at a later date.
Radiation therapy is most often recommended after surgeries that conserve healthy breast tissue, such as lumpectomy and partial mastectomy.
If the IDC is larger than 1 centimeter in diameter and/or has spread to the lymph nodes, chemotherapy is usually recommended or, at the very least, seriously considered. When chemotherapy is given after surgery, it is called “adjuvant therapy.” In cases where the tumor is large, or breast cancer cells have traveled to many lymph nodes or other parts of the body, chemotherapy may be given before surgery to shrink the cancer. This approach is called “neoadjuvant therapy.” In either case, chemotherapy will be given in cycles, usually with a day (or days) of treatment followed by a period of “off” days. The exact schedule can vary depending on the medication or medications used. An entire course of chemotherapy usually takes about 3 to 6 months.
Hormonal therapy for IDC is recommended if the cancer tested positive for hormone receptors, Hormonal therapy, also called anti-estrogen therapy or endocrine therapy, works by lowering the amount of estrogen in the body or blocking the estrogen from signaling breast cancer cells to grow. For small tumors, it’s common for hormonal therapy (adjuvant treatment) to be given after other treatments. Tamoxifen acts like estrogen and attaches to the receptors on the breast cancer cells, taking the place of real estrogen. As a result, the cells don’t receive the signal to grow. Tamoxifen can be used to treat both pre- and postmenopausal women. Other examples of SERMs are Evista (chemical name: raloxifene) and Fareston (chemical name: toremifene).
References
Breast lumps https://www.mayoclinic.org/symptoms/breast-lumps/basics/causes/sym-20050619
Invasive ductal carcinoma https://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/invasive_ductal_carcinoma.html
Risk factors for Breast Cancer at a Young Age https://www.CDC.gov/cancer/breast/young_women/bringyourbrave/breast_cancer_young_women/risk_factors.htm?s_cid=byb_sem_013
Treatment for IDC https://www.breastcancer.org/symptoms/types/idc/treatment
