Sunday, June 9, 2013


There are several types of breast cancer, but some of them are quite rare. In some cases a
single breast tumor can be a combination of these types or be a mixture of invasive and in
situ cancer.

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast
About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.
When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from tissue samples) will look for areas of dead or dying cancer cells, called tumor necrosis, within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive. The term comedocarcinoma is often used to describe DCIS with large areas of necrosis. The pathologist will also note how abnormal the cells appear, especially the part of cells where DNA is found (the nucleus). Lobular carcinoma in situ

This is not a true cancer or pre-cancer, and is discussed in the section “What are the risk
factors for breast cancer?”
Invasive (or infiltrating) ductal carcinoma
This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma
(IDC) starts in a milk duct of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 of 10
invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC,
it can spread (metastasize) to other parts of the body. About 1 invasive breast cancer in
10 is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than
invasive ductal carcinoma.

Less common types of breast cancer

Inflammatory breast cancer: 

This uncommon type of invasive breast cancer accountsfor about 1% to 3% of all breast cancers. Usually there is no single lump or tumor.Instead, inflammatory breast cancer (IBC) makes the skin on the breast look red and feel warm. It also may give the breast skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or
infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may
become larger or firmer, tender, or itchy.
In its early stages, inflammatory breast cancer is often mistaken for an infection in the
breast (called mastitis) and treated as an infection with antibiotics. If the symptoms are
caused by cancer, they will not improve, and a biopsy will find cancer cells. Because
there is no actual lump, it might not show up on a mammogram, which can make it even
harder to find it early. This type of breast cancer tends to have a higher chance of
spreading and a worse outlook (prognosis) than typical invasive ductal or lobular cancer.

Triple-negative breast cancer: 

This term is used to describe breast cancers (usually invasive ductal carcinomas) whose cells lack estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on their surfaces. (See the section, "How is breast cancer diagnosed?" for more detail on these receptors.) Breast cancers with these characteristics tend to occur more often in younger women and in African-American women. Triple-negative breast cancers tend to grow and spread more quickly than most other types of breast cancer. Because the tumor cells lack these certain receptors, neither hormone therapy nor drugs that target HER2 are effective treatments (but chemotherapy can still be useful if needed).

Paget disease of the nipple: 

This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple.
It is rare, accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching. 
Paget disease is almost always associated with either ductal carcinoma in situ (DCIS) or
infiltrating ductal carcinoma.
 Treatment often requires mastectomy. If no lump can be felt in the breast tissue, and the biopsy shows DCIS but no invasive cancer, the outlook (prognosis) is excellent. If invasive cancer is present, the prognosis is not as good, and the cancer will need to be staged and treated like any other invasive cancer.

Phyllodes tumor: 

This very rare breast tumor develops in the stroma (connective tissue)
of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other
names for these tumors include phylloides tumor and cystosarcoma phyllodes. These
tumors are usually benign but on rare occasions may be malignant.
Benign phyllodes tumors are treated by removing the tumor along with a margin of
normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a
wider margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but
these cancers might not respond as well to the other treatments used for more common
breast cancers. When a malignant phyllodes tumor has spread, it can be treated with the
chemotherapy given for soft-tissue sarcomas.


 This form of cancer starts in cells that line blood vessels or lymph
vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication
of previous radiation treatments. This is an extremely rare complication of breast
radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can
also occur in the arms of women who develop lymphedema as a result of lymph node
surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see
the section, "How is breast cancer treated?") These cancers tend to grow and spread
quickly. Treatment is generally the same as for other sarcomas.

Special types of invasive breast carcinoma

There are some special types of breast cancer that are sub-types of invasive carcinoma.
These are often named after features seen when they are viewed under the microscope,
like the ways the cells are arranged.
Some of these may have a better prognosis than standard infiltrating ductal carcinoma.
These include:

  •  Adenoid cystic (or adenocystic) carcinoma
  •  Low-grade adenosquamous carcinoma (this is a type of metaplastic carcinoma)
  •  Medullary carcinoma
  •  Mucinous (or colloid) carcinoma
  •  Papillary carcinoma
  •  Tubular carcinoma

Some sub-types have the same or maybe worse prognosis than standard infiltrating ductal carcinoma. These include:

  •  Metaplastic carcinoma (most types, including spindle cell and squamous)
  •  Micropapillary carcinoma
  •  Mixed carcinoma (has features of both invasive ductal and lobular)
  • In general, all of these sub-types are still treated like standard infiltrating ductal carcinoma.

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