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Types of Breast Cancer

Breast cancer is often thought of as one disease, but is actually a group of different cancers that affect the breast.  There are several types of breast cancer, though some are quite rare. The types of breast cancer include noninvasiveNoninvasive (breast cancer):
Breast cancer that does not spread beyond the tissue where it originally developed (i.e., confined to the milk
or in situIn situ:
“in its original place.” In situ cancers are confined to the original location where they developed and do not invade surrounding tissue or spread to other parts of the body. May also be referred to as noninvasive cancers.
, invasiveInvasive (breast cancer):
Cancer that spreads from where it started in the breast (i.e., the breast ducts or lobules) into surrounding, healthy breast tissue.
, inflammatoryInflammatory breast cancer:
An uncommon type of breast cancer with symptoms that resemble inflammation (e.g. swelling, redness, pain, and an orange peel-like skin texture). Usually there is no lump or tumour.
and Paget’s diseasePaget’s disease:
A rare form of breast cancer that begins in the milk passages (ducts) and spreads to the skin of the nipple and areola. The affected skin may appear crusted, scaly, red, or oozing.
of the nipple.

If you are diagnosed with breast cancer, it is helpful to find out more about which type it is. Knowing about the type of breast cancer you have been diagnosed with can help you to better understand what is happening in your body and learn more about the treatment options available to you.

Noninvasive or In Situ Breast Cancer

Noninvasive breast cancer refers to cancer that remains within the milk ductsDuct (mammary duct):
A hollow passage for gland secretions. There are ducts in the female and male breast.
or lobulesLobules:
Small glands in the breast that produce milk.
of the breast.

There are two types of noninvasive breast cancer: Ductal carcinoma in situDuctal carcinoma in situ (DCIS):
The most common type of noninvasive breast cancer. In DCIS, the cancer is confined to the lining of the milk ducts.
(DCIS) and lobular carcinoma in situLobular carcinoma in situ (LCIS):
A condition where abnormal cells develop in the lobules of the breast. LCIS is not considered to be a true cancer, but is an indicator that a woman is at increased risk for developing invasive breast cancer in the future.
(LCIS).

Ductal carcinoma in situ (DCIS). This is the most common type of noninvasive breast cancer. DCIS means that the cancer is located only in the lining of the milk ducts. It has not spread through the walls of the ducts into the tissue of the breast and so cannot spread to lymph nodesLymph nodes:
Small structures that filter lymph fluid for harmful substances. They contain immune cells that can help fight infection by attacking and destroying germs. Cancer can travel through the lymphatic system spread to the lymph nodes.
or other parts of the body. For this reason, DCIS is always considered stageStage:
A way of classifying breast cancer that describes how far a cancer has spread. It identifies whether breast cancer is at an early, locally advanced or metastatic stage. The stage of breast cancer can sometimes be represented as a number (e.g. between 0 and 4).
0 breast cancer, though the gradeGrade:
A way of classifying cancer that describes how aggressive the cancer is likely to be (i.e., how fast it will grow and spread).
can vary. For most women with this type and stage of cancer, treatment will be successful.

DCIS has no signs and symptoms and usually can’t be felt with a clinical breast examinationClinical breast exam (CBE):
A physical examination of the breasts by a health-care provider.
. Occasionally, a lumpLump:
A mass that can be found in the breast or elsewhere in the body. This can also be called a nodule.
may be found or there may be dischargeDischarge (nipple):
Fluid from the nipple, that is not breast milk or related to breastfeeding. Nipple discharge should be evaluated by a health care provider.
from the nipple. One of the best ways to find DCIS early is by mammographyMammogram (also called mammography):
A low-dose X-ray of the breast. It is used to take images of the breasts and is an important screening tool for the earlier detection of breast cancer.
. The treatment for DCIS is usually a lumpectomyLumpectomy:
Surgery to remove a breast tumor and a small margin of surrounding normal tissue.
, sometimes followed by radiation therapyRadiation therapy:
(Sometimes called radiotherapy) A treatment method that uses a high energy beam to destroy cancer cells by damaging the DNA of cancer cells so that they can’t continue to grow.
. If the DCIS is hormone receptorReceptor:
Cells have many different proteins on their surface called receptors. Her-2 is one kind of receptor. In normal cells, HER-2 receptors are thought to be involved in cell growth and reproduction. In some breast cancers, there are too many HER-2 receptors and they speed up cancer cell growth.
positive, hormone therapy may be offered after surgery.

Although not life-threatening, DCIS can recur and increases your risk for developing invasive breast cancer in the future. Higher grades of DCIS are associated with a higher risk of developing invasive breast cancer.

Lobular carcinoma in situ (LCIS). LCIS occurs when abnormal cells develop in the milk-making glands (lobules), but do not go through the wall of the lobules and spread to other parts of the body. LCIS is not considered to be a true cancer and is not life-threatening, but it is an indicator that a woman is at increased risk for developing invasive breast cancer in either breast in the future.

LCIS rarely causes a lump or changes that can be detected by mammography. It is usually diagnosed from a biopsyBiopsy:
A procedure in which tissue samples are removed from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
to investigate other breast changes. Many cases of LCIS likely go undiagnosed and never cause a problem. LCIS is most commonly found in pre-menopausalPre-menopause:
The years or stage in a woman’s life immediately before the onset of menopause (when menstrual periods permanently end).
women between the ages of 40 and 50.

LCIS on its own may not require treatment and does not always lead to invasive breast cancer, but patients are usually followed closely with regular clinical breast examinations by a health care provider, mammography of both breasts, and in some cases MRIMagnetic Resonance Imaging (MRI):
An imaging technique that uses powerful magnetic fields and radio waves to create detailed, 3-dimensional images of the organs and tissues in the body, such as the breast.
. If the LCIS is hormone receptor positive, you may be offered the option of taking hormone therapyHormone therapy:
A treatment method for breast cancer that uses medication to block the production of the hormone estrogen, or the way that it works in the body.
as a preventive measure to help lower your risk for developing invasive breast cancer.

Speak with your health care provider to learn about the benefits and limitations of the treatment options available to make a decision that is right for you.

Invasive Breast Cancer

Invasive ductal carcinoma (IDC) (sometimes called infiltrating ductal carcinoma or ductal adenocarcinoma) is the most common type of invasive breast cancer. Up to 80% of invasive breast cancers are IDCInvasive ductal carcinoma (IDC):
The most common type of invasive breast cancer. IDC starts in the milk ducts and can spread into (invade) surrounding breast tissue. It can also spread to the lymph nodes and other parts of the body (metastasize).
. It starts in a milk passage (a duct), breaks through the wall of the duct and invades the surrounding tissue of the breast. From there it may be able to spread (metastasizeMetastatic (metastases):
The spread of cancer from its original (primary) location to another part of the body. A tumour that is formed by cancer cells that have spread to another part of the body is called a “metastatic tumour” or a “metastasis.”
) to the lymph nodes and other parts of the body.

The signs and symptoms of IDC can include some or all of the following: a lump in the breast or armpit area, skin changes such as redness, thickening, irritation or dimplingDimpling:
A pucker or indentation of the skin on the breast.
, persistent breast pain and/or swelling, and nipple changes and discharge.

IDC is usually found by mammography, and a diagnosis is confirmed through a series of follow-up tests including diagnostic mammograms and/or ultrasoundUltrasound:
An imaging technique that uses sound waves to take a picture of structures in the body, such as the breast.
, and biopsy. During diagnosis, the stage and grade of the breast cancer will be confirmed, and tissue samples collected during biopsy will be used to determine hormone receptor and HER-2HER-2-neu:
Cells have many different proteins on their surface called receptors. HER-2 is a type of naturally occurring receptor. In normal cells, HER-2 receptors are thought to be involved in cell growth and reproduction. In some breast cancers, there are too many HER-2 receptors and they speed up cancer cell growth. HER-2 therapy is used to treat some breast cancers by targeting receptors that stimulate breast cancer growth.
status.

IDC can be broken down into different subtypes, based on the appearance and behaviour of the cancer cells. These include invasive not otherwise specified (NOS) or no specific type (NST), invasive mucinous carcinoma, tubular carcinoma, medullary carcinoma and invasive micropapillary carcinoma.

Treatment for IDC usually involves surgery (lumpectomy or mastectomyMastectomy:
Surgery to remove all or part of the breast and sometimes other tissue.
). Most women who have a lumpectomy also have radiation therapy. Other treatments that are often used include chemotherapyChemotherapy:
A treatment method that uses medication to destroy cancer cells.
, hormone therapy, and HER-2 targeted therapiesHER-2 targeted therapy:
A treatment method that uses medication to target HER-2 receptors that stimulate breast cancer growth.
, depending on the receptor status of the tumour. Your treatment plan will be decided by you and your health care team.

Invasive lobular carcinoma (ILC) makes up about 10% of invasive breast cancer cases. ILCInvasive lobular carcinoma (ILC):
A type of invasive breast cancer. ILC starts in the lobules of the breast and can spread into (invade) surrounding breast tissue. It can also spread to the lymph nodes and other parts of the body (metastasize).
starts in the milk-making glands (lobules) of the breast, breaks through the lobules, and invades the surrounding tissue of the breast. From there it may be able to spread (metastasize) to the lymph nodes and other parts of the body.

ILC does not form a distinct lump. The cellsCell:
The basic structural and functional unit of all organisms.
grow in a single line, leading to hardening or thickening of the affected breast tissue. ILC can occur in multiple locations within the breast or in both breasts. Its symptoms are similar to those of IDC. Since the cells grow in a single line rather than forming a lump, ILC can be hard to see by mammogram. Other imaging techniques like ultrasound or MRI may be used, but most often a biopsy is needed to diagnose ILC. 

As with IDC, there are several subtypes of ILC based on the appearance and behaviour of the cancer cells. ILC tends to be hormone receptor positive and therefore may respond well to hormone therapy. ILC is also treated using surgery, radiation, chemotherapy, and HER-2 targeted therapy.

Inflammatory Breast Cancer (IBC)

This uncommon type of invasive breast cancer accounts for about 1-3% of all breast cancers. It tends to be more common in younger women, and women of African ancestry.  In its early stages, IBC is often mistaken for infection. If you have a breast infection that isn’t clearing up, speak to your health care provider.

IBC begins in the milk ducts of the breast and spreads to the lymph vesselsLymph vessels:
Ducts that carry lymph fluid through the lymphatic system.
. Its symptoms are caused by the cancer cells being in the lymph vessels.

Symptoms include redness and swelling of the breasts, skin that feels warm to the touch, a pitted, orange peel-like skin texture (referred to as peau d’orange), a change in the appearance of the nipple and breast pain. The breast may get bigger, hard, tender or itchy.

IBC can sometimes be difficult to diagnose, as its symptoms are not what many people typically associate with breast cancer. Usually there is no lump or tumourTumour:
An abnormal mass of tissue that occurs when cells divide more than they should or do not die when they should. Tumours may be benign (not cancer) or malignant (cancer). A tumour is also called a neoplasm.
, so IBC may appear differently on a mammogram. Other imaging methods, such as ultrasound or MRI, and biopsy are often needed to detect and diagnose IBC.

This type of cancer has a higher chance of spreading and it can be more aggressive and harder to treat than invasive ductal or lobular cancer. Treatment usually involves a combination of approaches including chemotherapy, surgery, radiation, and hormone and HER-2 targeted therapy, if appropriate.

Paget’s Disease of the Nipple

In Paget’s disease, cancer cells grow in and around the nipple. Paget’s disease is another less common type of breast cancer, accounting for less than 5% of all breast cancers. It is more common in women over the age of 50.

Symptoms include persistent itchiness and scaling of the nipple that gets worse over time, leading to weeping, crusting and nipple pain. The nipple may also appear flattened against the breast. Paget’s is often found on only one nipple.

Many people with Paget’s disease of the nipple may also have another form of breast cancer in the same breast, such as DCIS or IDC. In approximately half of the patients diagnosed with Paget’s disease, a lump or mass in the breast can be felt during physical examination. In some cases Paget’s disease may spread to the areolaAreola:
The dark pigmented area of the breast that surrounds the nipple.
or other regions of the breast.

If Paget’s disease is suspected, additional tests, such as a biopsy, will be done to confirm a diagnosis, and imaging such as mammogram and/or ultrasound may be used to look for cancer in other areas of the breast. Surgery is usually the first course of treatment for Paget’s disease. Additional treatments will depend on the type of surgery you have (e.g., how much breast tissue is removed) and on the type and extent of underlying breast cancer, if any.

Triple Negative Breast Cancer

Breast cancers can be further classified into different subtypes based on certain characteristics like their receptor status. Triple negativeTriple negative breast cancer:
Breast cancer that is estrogen receptor negative, progesterone receptor negative, and HER-2 negative. This means that hormone therapy and HER-2 targeted therapy cannot be used to treat these cancers.
breast cancers get their name from the fact that they are estrogen receptor negative, progesterone receptor negative, and HER-2 negative. This means that hormone therapy and HER-2 targeted therapy cannot be used to treat these cancers. Most triple negative cancers are invasive ductal carcinomas (IDC).Treatments like surgery, chemotherapy, and radiation can be used to treat triple negative breast cancers.

There are some features of triple negative breast cancers that make them different from other types of breast cancer:

As more research is done, more treatment options are becoming available for triple negative breast cancer. If you have been diagnosed with triple negative breast cancer, your medical oncologistOncologist:
A doctor or surgeon who specializes in treating cancer. A medical oncologist specializes in drug therapy (chemotherapy) for cancer. A radiation oncologist specializes in treating cancer with radiation.
will review your treatment options with you.

Your health care team will carefully consider the characteristics of your cancer. Using information about your condition, and drawing on scientific evidence and their experience of treating many patients with breast cancer, they will make recommendations for your treatment plan. They may also offer you the chance to participate in a clinical trialClinical trial:
One of the most common types of experimental studies in humans is the clinical trial. Clinical trials are designed to test new ways to prevent, detect, and treat specific diseases.
that explores new treatment options.

Given the range of symptoms that may be present for breast cancer and benignBenign:
Not cancerous. This is also referred to as non-malignant.
breast conditions, women and men of all ages are encouraged to be breast aware and discuss any persistent breast changes with a health care provider.

 

Sources:

American Cancer Society. What is Breast Cancer? Accessed January 3, 2014.

National Cancer Institute. Paget disease of the nipple. Accessed January 3, 2014.

Breastcancer.org. Types of Breast Cancer. Accessed January 3, 2014. 

Canadian Cancer Society. Malignant tumours. Accessed January 3, 2014.