Updated: 6/3/2020

Invasive Ductal Carcinoma

0%
Topic
Review Topic
0
0
100%
0%
Evidence
1
0
0
Topic
https://upload.medbullets.com/topic/120427/images/idc_tumor..jpg
https://upload.medbullets.com/topic/120427/images/idc_mammo..jpg
https://upload.medbullets.com/topic/120427/images/idc_h_e.jpg
Snapshot
  • A 51-year-old woman presents to her primary care physician with a lump in her right breast. She says it has been there for around a year. Mammography shows a dominant mass with an irregular fibrotically stranded boundary, with some of the strands seeming to extend toward the nipple. A core biopsy was done and showed the following histology. 
Introduction
  • Overview
    • most common type of breast cancer
      • infiltrating ductal carcinoma accounts for ~76% of breast cancer cases 
    • forms a solid tumor
    • most common cancer diagnosis in women
  • Epidemiology
    • demographics
      • commonly women in mid-30s to late-50s
    • incidence
      • 260,000 cases per year in U.S.
      • 40,000 deaths per year
    • risk factors
      • increasing age
      • female sex
        • breast cancer can occur in men
        • < 3,000 cases per year in U.S.
      • Caucasian race
      • obesity in post-menopausal women
      • hormone replacement therapy
  • Genetics
    • inheritance
      • increased risk with BRCA1 and BRCA2 gene mutation
    • mutations
      • cancer cells can be estrogen (ER)-positive, progesterone (PR)-positive, or HER2/neu-positive
      • guides targeted treatment
  • Prognosis
    • tumor size is most important prognostic factor
    • mestastasis associated with poorer prognosis
    • second most common cause of cancer-related death in women
Presentation
  • Symptoms
    • asymptomatic
    • breast lump
      • most often in upper/outer quadrant
    • nipple discharge
  • Physical exam
    • firm immobile, painless lump
    • +/- inverted nipple 
    • +/- skin changes
      • redness
      • ulcerations
      • edema
      • nodularity
        • skin retraction indicates involvement of Cooper ligament
    • axillary lymohadenopathy
      • more advanced cases
    • breast skin edema with dimpling ("peau d' orange") is a finding with a poor prognosis
      • represents obstruction of the lymphatics cancer
  • See Breast Cancer General 
Imaging
  • Mammography 
    • indications
      • regular screening mammography
      • evaluation following detection of a breast lump
    • findings
      • mass with an irregular, fibrotically stranded border 
  • Core or excisional biopsy
    • indications
      • diagnosis
    • findings
      • gross pathology
        • hard grey-white gritty mass invading surrounding tissue in an irregular stellate shape 
      • histology 
        • solid nest of neoplastic cells invading the surrounding structures 
        • more poorly differentiated = higher grade
        • stains positive for E-cadherin
  • Stage with TNM Staging System
Studies
  • Serum calcium level
    • may be elevated
  • Alkaline phosphatase
    • elevation may indicate metastasis
  • Hormone receptor tests
    • ER
    • PR
    • Her2/neu
Differential
  • Invasive lobular carcinoma
    • key distinguishing factors
      • gross pathology
        • often no mass lesion is evident
      • histology
        • individual invasive cells or cells in a single file
        • negative E-cadherin staining
  • Ductal carcinoma in situ (DCIS) 
    • key distinguishing factor
      • no evidence of invasion on biopsy
Treatment
  • Medical
    • chemotherapy
      • indications
        • tumors with high risk features
        • locally advanced tumors
        • neoadjuvant chemotherapy prior to lumpectomy
      • modalities
        • trastuzamab
          • HER2/neu-positive tumors
    • hormone therapy
      • indications
        • hormone receptor-positive tumors
      • modalities
        • tamoxifen or raloxifene
          • ER-positive tumors
          • reduces risk of metastasis
    • radiation
      • indications
        • following breast lumpectomy
  • Surgical
    • modified radical mastectomy
      • indications
        • multicentric disease
        • large tumor size in relation to breast
        • presence of diffuse malignant-appearing calcifications on imaging
        • prior chest radiation
        • pregnancy
        • positive margins after lumpectomy/re-excision
    • lumpectomy
      • indications
        • smaller tumors relative to breast size
        • patients who desire breast-conservinig therapy
      • always followed by postoperative radiation therapy
    • sentinel lymph node biopsy
      • indications
        • used for staging to detect spread of cancer
        • must be performed prior to mastectomy
        • if positive nodes detected and patient underwent lumpectomy, then sentinel lymph node biopsy may be performed again to search for additional nodes 
Complications
  • Metastasis
  • Recurrence
    • majority of recurrences occur within first 5 years
  • Death

Please rate topic.

Average 5.0 of 2 Ratings

Evidence (1)
EXPERT COMMENTS (5)
Private Note