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Types

Types

December 14, 2021
Everett Bonner, MD
Everett Bonner, MD

Breast Surgery

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There are many different types of breast cancer. The most common is ductal carcinoma or invasive ductal carcinoma. We also have invasive lobular carcinoma. Invasive ductal carcinoma is the most common type. Usually about 80% of breast cancers are invasive ductal carcinoma. The next highest incidence is in lobular carcinoma. The real difference between the two is where those cells originate. As the name says, ductal carcinoma is within the milk ducts. Lobular carcinoma is within the lobules. Lobular carcinoma tends to have a better prognosis than ductal carcinoma. However, lobular carcinoma sometimes can be underestimated on standard mammograms or even ultrasound, and that’s why those patients end up having advanced imaging with MRI to evaluate the extent of lobular carcinoma. The other thing about lobular carcinoma, it does have a higher incidence of bilateral disease, which means cancer at the same time in the other breast. And that’s another indication for breast MRI to make sure that, is this lobular carcinoma not only in the breast that we know in the biopsy, is there something on the other side that was not diagnosed by mammogram or ultrasound? The other diagnosis you’ll see is ductal carcinoma in situ. That’s DCIS. When you hear that term, that’s non-invasive cancer cells that are within the duct. That is usually treated surgically and even radiographically or radiation therapy, the same way as breast cancer. And we also do hormonal therapy for those patients. The differences between DCIS or ductal carcinoma in situ and invasive ductal carcinoma, those patients usually do not get any type of chemotherapy. When we get to lobular carcinoma in situ, it’s treated a little bit different than DCIS. Lobular carcinoma in situ has now been sort of downgraded to more of a high-risk marker. So usually, you will find that you’ll see some calcifications or some type of abnormal finding on a mammogram, you’ll get your biopsy and it’s LCIS. Sometimes we go back and actually remove all the tissue around and make sure that’s the only diagnosis. And if that is your diagnosis, you’re now considered a high-risk patient. So you don’t end up having to go to radiation or any type of hormonal therapy with LCIS. We just know that makes you at a higher risk of breast cancer, and it’s a greater than 20% risk. So those patients will go onto high-risk monitoring, frequent mammograms, ultrasounds, and maybe even alternating your annual or semi-annual mammogram with an MRI.