Keywords: Invasive ductal carcinoma, arm lymphedema, lymphedema, breast cancer, Cyclooxygenase 2. Receptor, erbB-2. Breast neoplasms. Carcinoma, intraductal, noninfiltrating. Carcinoma, ductal, breast.
Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas. It is scancer that began growing in the duct and has invaded the fatty tissue of the breast outside of the duct.
Who is at Risk?
Women have a greater likelihood of having breast cancer after they reach age 45. As a woman ages, breast cancer risk does not decline, with about 50 percent of IDC cases occurring after age 65. Less than 10 percent of women with breast cancer have a family history of the disease. Other factors increasing the risk of breast cancer include having no children or the first child after age 30, early menstruation, and consuming more than three alcoholic drinks a day. (2)
Types of Ductal Carcinoma
Additional less commona types of invasivc ductal carcinoma include:
• Medullary Ductal Carcinoma – This type of cancer is rare and only three to five percent of breast cancers are diagnosed as medullary ductal carcinoma. The tumor usually shows up on a mammogram and it does not always feel like a lump; rather it can feel like a spongy change of breast tissue.
• Mucinous Ductal Carcinoma – This occurs when cancer cells within the breast produce mucous, which also contains breast cancer cells, and the cells and mucous combine to form a tumor. Pure mucinous ductal carcinoma carries a better prognosis than more common types of IDCs
• Papillary Ductal Carcinoma – This cancer looks like tiny fingers under the microscope. It is only in rare cases that this kind of cancer becomes invasive. Common among women age 50 and older, this kind of cancer is treated like DCIS, despite being an invasive cancer.
• Tubular Ductal Carcinoma – This is a rare diagnosis of IDC, making up only two percent of diagnoses of breast cancer. Tubular ductal carcinoma is more common in women older than 50 and are usually small, estrogen-receptor positive cancers, which means they respond to hormones. The name comes from how the cancer looks under the microscope; like hundreds of tiny tubes.(1)
The symptoms may be very identical to other types of breast cancer, and it is vital to remember that any lump or mass in the breast needs to be immediately reported to your physician and followed up with further testing to determine what it exactly is.
• The symptoms include: Lump in the breast • Thickening of the breast skin • Rash or redness of the breast • Swelling in one breast • New pain in one breast • Dimpling around the nipple or on the breast skin • Nipple pain or the nipple turning inward • Nipple discharge • Lumps in the underarm area • Changes in the appearance of the nipple or breast that are different from the normal monthly changes a woman experiences.
There are several steps in the diagnostic process for any breast cancer, including invasive ductal carcinoma. These include: digital mammography (mammogram), ulstrasound, MRI, PET Scan, CT Scan, Staging workup, Biopsy, Pathology report (diagnostic report from the pathologist).
In diagnosing the cancer several tests may be used and they are:
There are several possible complications to invasive ductal carcinoma. They are: Lymphedema – Due to damage from either biopsy surgery, damage from radiation therapy or chemotherapy, the lymph system becomes unable to move the fluids in the affected areas. This leads to fluid accumulation in the interstititial tissues and thus results in swelling. For breast cancer patients this is almost always the arms (either or both, depending upon the breast cancer sites).
For lymphedema a referral is required to a certified lymphedema therapist for a complete evaluation and treatment workup. The protocol treatment consists of complete decongestive therapy with the subsequent wearing of compression garments to help control the swelling.
Bleeding is another possible complication as is hermatoma formation, cosmetic disfiguration and brachial plexus injuries, that is a possiblility due to radiotherapy.
The exact type of cancer and its staging will determine specifically the types of treatment that may be used. Generally a combination of the follow treatments is used:
Dormant but migratory tumour cells in desmoplastic stroma of invasive ductal carcinomas.
Raviraj V, Zhang H, Chien HY, Cole L, Thompson EW, Soon L. Source Australian Centre for Microscopy and Microanalysis (ACMM), AMMRF, The University of Sydney, Madsen Building F09, Room 243, Sydney, NSW, 2006, Australia.
Keywords: Breast cancer – Single cell dormancy – Cell migration – Dense stroma – Tumour microenvironment – Laser capture microdissection
Mortality in breast cancer is linked to metastasis and recurrence yet there is no acceptable biological model for cancer relapse. We hypothesise that there might exist primary tumour cells capable of escaping surgery by migration and resisting radiotherapy and chemotherapy to cause cancer recurrence. We investigated this possibility in invasive ductal carcinoma(IDC) tissue and observed the presence of solitary primary tumour cells (SPCs) in the dense collagen stroma that encapsulates intratumoural cells (ICs). In IDC tissue sections, collagen was detected with either Masson's Trichrome or by second harmonics imaging. Cytokeratin-19 (CK-19) and vimentin (VIM) antibodies were, respectively, used to identify epithelial-derived tumour cells and to indicate epithelial to mesenchymal transition (EMT). Confocal/multiphoton microscopy showed that ICs from acini were mainly CK-19(+ve) and were encapsulated by dense stromal collagen. Within the stroma, SPCs were detected by their staining for both CK-19 and VIM (confirming EMT). ICs and SPCs were subsequently isolated by laser capture microdissection followed by multiplex tandem-PCR studies. SPCs were found to be enriched for pro-migratory and anti-proliferative genes relative to ICs. In vitro experiments using collagen matrices at 20 mg/cm(3), similar in density to tumour matrices, demonstrated that SPC-like cells were highly migratory but dormant, phenotypes that recapitulated the genotypes of SPCs in clinical tissue. These data suggest that SPCs located at the breast cancer perimeter are invasive and dormant such that they may exceed surgical margins and resist local and adjuvant therapies. This study has important connotations for a role of SPCs in local recurrence.
Influence of the in situ component in 389 infiltrating ductal breast carcinomas. Jan 2012
Carabias-Meseguer P, Zapardiel I, Cusidó-Gimferrer M, Godoy-Tundidor S, Tresserra-Casas F, Rodriguez-García I,Fábregas-Xauradó R, Xercavins-Montosa J. Source Department of Obstetrics, Gynecology and Reproduction, Dexeus University Institute, Barcelona, Spain.
Keywords: Infiltrating ductal carcinoma – Intraductal carcinoma – Lymph node involvement
BACKGROUND: Our aim was to evaluate and compare lymph node involvement, as well as disease-free survival (DFS) and overall survival (OS), between infiltrating ductal carcinoma with (group 1) and without (group 2) intraductal carcinomacomponent in order to determine the prognostic value of the intraductal component.
METHODS: Data from 389 cases of infiltrating ductal carcinoma of the breast were included in the study by means of reviewing medical charts and pathology slides.
RESULTS: There was no statistically significant difference between both groups regarding node status. The 5-year DFS rate was 90.7% in group 1 and 81.8% in group 2 (p = 0.014), with a median follow-up of 73.2 months (95% CI 68.3-77.4). There was no statistically significant difference in 5-year OS between groups (98% group 1 vs. 93% group 2) with a median global survival of 134 months (95% CI 131-137).
CONCLUSIONS: The presence of intraductal component in the infiltrating carcinoma seems to increase DFS and may be an independent and favorable prognostic factor for breast cancer.
Expression of estrogen and progesterone receptors in human ductal invasive breast carcinoma not otherwise specified: is there any difference between premenopausal and postmenopausal women?
Petricević J, Petković M, Jonjić N. Source School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina.
Determination of hormone receptors is of utmost importance in planning therapy in patients with breast cancer. The aim of the study was to assess the expression of estrogen (ER) and progesterone (PR) receptors in ductal invasive breastcarcinoma not otherwise specified (NOS) according to patient menopausal state and tumor histopathology. The study included 549 patients treated at University Department of Surgery, Rijeka University Hospital Center, between January 1, 2000 andJanuary 1, 2005. The patients were diagnosed with breast cancer and underwent mastectomy. ER and PR status was determined by immunohistochemistry. Study results showed no statistically significant differences in the expression of ER and PR, tumor size and grade of histologic differentiation between premenopausal and postmenopausal women. However, tumor size and grade of histologic differentiation differed significantly according to the expression of hormone receptors. Tumors greater than 5 cm in size were mostly ER- in premenopausal (P = 0.012) and PR- in postmenopausal (P = 0.044) patients. Poorly differentiated cancers were associated with ER-PR-status in both premenopausal and postmenopausal patients (P < 0.001). Hormone dependent tumors (ER+PR+) were of smaller diameter and lower histologic grade, while hormone independent tumors (ER-PR-) had greater diameter and higher histologic grade, the difference being statistically significant (P = 0.004 and P < 0.001, respectively). Study results on the characteristics of ductal invasivecarcinoma according to hormone status were consistent with those described in the literature. Considering controversies about the role of steroid receptors in endocrine therapy response, our future objective is assessment of the 5-year prognosis in our patients.
Arm Exercises (for lymphedema)