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Almost or Actually?

Types of high risk lesions, breast cancers and information about diagnoses and what they might mean.

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High Risk Lesions

Yes, the images are of rubber duckies.

Yes, that's kind of weird.

But, why not?

Image by Marcus Lenk

Atypical Lobular Hyperplasia

Lobular Neoplasia

ALH

ALH occurs when there is an overgrowth of cells in the lobules of the breast where milk is produced. 

The line between ALH and LCIS can sometimes become blurred so ask for clarification when receiving your pathology results.  While both are benign processes they care increase your risk for breast cancer. 

 

Discuss surgical excision or follow up with your care team. If left unmonitored this might progress to breast cancer.

Image by Nick Fewings

Intraductal, multiple, juvenile or papillomatosis

Papilloma

If you have nipple discharge for no good reason - it might be due to a papilloma. There may be a corresponding lump or bump behind your nipple.. 

They can be visualized with mammography or sonography, sometimes  biopsy or nipple exploration surgery is recommended for definitive tissue diagnosis.

No matter how you get your diagnosis of this type of papillary lesion there is an increased risk of cancer with this diagnosis due to the presence of abnormal cells. 

Image by Jason Richard

Complex Sclerosing Lesions / Radial Scars

Radial Scar

Not actually related to scaring as the name might suggest. These findings tend to look a lot like scary cancer on breast imaging. 

You will need a biopsy to determine the actual pathological diagnosis and rule out cancer.

While most complex sclerosing lesions are technically benign they are classified as very high risk findings. In fact, about a third of radial scars show variety of breast cancer when surgically removed so if you have received this diagnosis you will probably be recommended for surgery. 

Rubber Duckies

Atypical Ductal Hyperplasia

ADH

An overgrowth of the cells in that line the ducts within the breasts. 

While this is technically a benign condition it is high risk for developing into breast cancer. 

It is not essential for you to treat your atypical hyperplasia but many doctors recommend that you remove it to reduce your breast cancer risk. If you decide against surgery it might be recommended that you monitor these findings with more frequent breast imaging to ensure that the area does not continue to change. 

Image by JOSHUA COLEMAN

Columnar Cell Lesions

Flat Epithelial Atypia (hyperplasia)

 CCL/FEA

Changes or hyperplasia that occurs within the terminal ductal lobular unit. 

Sometimes it can present as a thickening of the cells lining the TDLU and sometimes as an increased number of cells. Either way it is an abnormal finding and is considered to be a risk for cancer. 

Your doctors may recommend surgery to prevent breast cancer from growing in this area.

Image by Brett Jordan

so rare their like batman, hard to find, but very obvious once found.

Phyllodes Tumor

Phyllodes tumors are very rare connective tissue disorders in the breast in which a tumor grows in a branching leaf-life pattern. Less than 1% of breast tumors can be classified as phyllodes tumors; they tend to develop later in life and are more likely if you have a genetic condition called Li-Fraumeni Syndrome.

While the majority of these findings are completely benign they are almost always considered risky due to their tendency to grow rapidly. Sometimes they can break through the surface of your skin, presenting as an open sore.  You should consider excision for this finding as it can grow out of control quickly. If there is a cancerous component to your tumor you will need additional treatment.

In Situ Carcinoma

Skyblue Balloon

Lobular Carcinoma In Situ

LCIS

LCIS is a high risk lesion and is not officially considered to be cancer though its name suggests it.

 

Atypical cells are found within the lobules of the breast but are confined there.

 

Your doctors will probably recommend that you have an excision to remove the area as a precaution.  

Some patients opt to wait and see if the disease progresses - this is your choice.

Image by Charles Deluvio

Ductal Carcinoma In Situ

DCIS

DCIS is a hot debate - is it cancer, is it not? The answer will depend on your doctor's perspective.

Cancer cells are present in this diagnosis but they are confined within the duct of the breast. 

There is a possibility for these cells to invade surrounding healthy tissue so you will probably be recommended for lumpectomy and preventative radiation to reduce the risk of anything from coming back.

Image by Danilo Batista

Comedo Carcinoma

DCIS with Comedo Necrosis

Basically this is DCIS with areas of dead cells. It is typically seen in high grade DCIS.

When comedonecrosis is present that means that the cells are rapidly reproducing and some of them don't get the energy they need to survive so they die.

Due to the high proliferation rate of this DCIS there is a higher likelihood that these cells might infiltrate healthy breast tissue outside the ducts and become invasive. 

Invasive Carcinoma

Image by National Cancer Institute

Adenocarcinoma

ADENOCA

Most forms of breast cancer are adenocarcinomas. Adenocarcinomas can be found throughout the body in secretory glandular tissue. 

In the breast adenocarcinomas arise in the lobules or ductal system where milk is made or transported. 

You may hear this generic term in discussion with your doctors. 

Image by Angiola Harry

Invasive Lobular Carcinoma

ILC

Cancer has grown in the lobules of the breast and managed to break through the cellular wall of these lobular units. 

It's a bit sneaky - frequently there is no associated mass because the pattern of the lobule units are branching at the end of the ductal system. 

ILC is the second most common invasive breast cancer. 

There are subtypes of lobular carcinoma: 

Alveolar

Pleomorphic 

Signet

Solid

Tubular

 

CLICK HERE to learn more about them. 

If you have received this diagnosis you will need to have a conversation with your doctors about the role of surgery, chemotherapy, radiation and endocrine therapies to reduce the risk of cancer recurring. 

Image by Angiola Harry

Invasive Ductal Carcinoma

IDC

Cancer cells have grown in the breast's ductal system and busted out through the duct's lining into healthy surrounding breast tissue.

IDC is the most common type of breast cancer diagnosed and there several are types of ICD. Click on the word to learn about each IDC type:

CRIBIFORM

MEDULLARY
MUCINOUS

PAPILLARY
TUBULAR

Depending on the extent of the disease your doctors will discuss surgery (lumpectomy or mastectomy) as well as chemotherapy, radiation, hormonal and targeted therapies to reduce likelihood of recurrence. 

Image by Kumiko SHIMIZU

Paget's disease of the breast/nipple

Paget's

Sir James Paget found a variety of problems in the human body and has a lot of diseases named for him - so be clear when googling as you're likely to find a few other unpleasant conditions that you don't want. 

Paget's disease of the breast involves skin changes to the nipple/areola and normally means there is an underlying mass within the breast. 

 

This variety of breast cancer is quite rare, your doctors are probably quiet excited (in a weird doctor way) to have found it.

Paget's disease of the breast is so uncommon it is listed in the National Organization for Rare Disorders (NORD) database. There are standard therapies for this diagnosis but you may want to also explore clinical trials that are specific to Paget's of the breast. 

 

 LEARN MORE about Paget's Disease and treatment.

Pink Lemons

Additional Varieties of Breast Cancer

Sub Types

List and links coming soon

Inflammatory Cancer

Image by Rene Lehmkuhl

Inflammatory Breast Cancer

IBC

A very rare type of invasive breast cancer that normally presents with changes to the surface of the breast with no palpable lumps in the breast itself..

One breast may look inflamed - hot to the touch, feel heavier than the other, often there is an area of redness, nipple inversion is common as is an orange peel appearance to the skin's surface. Symptoms tend to progress rapidly and can mimic mastitis or abscess so you may be put on an antibiotic first to rule out those possibilities. 

IBC is very aggressive and prognosis historically was not great. Advances in medical technology coupled with awareness about this variety of breast cancer have helped to drastically improve outcomes. Do not wait on your care if you have this diagnosis; in all likelihood you will need chemotherapy first to prevent additional spread of cancer cells, then a mastectomy followed by a course of radiation and endocrine therapy to prevent recurrence.

Metastatic Cancer

Metastatic breast cancer is always stage IV. Breast cancer tends to metastasize to certain body parts more than others. Chin up if you got this diagnosis - it sounds defeating and completely overwhelming.  There are many women living (well) with metastatic breast cancer due to advancing medical treatments. 

Speak with your oncologist about what would be right for you depending on your diagnosis and personal preferences. Remember you are in control of your medical decisions and your doctors are working for and with you. Ask millions of questions and make an informed decision that you are comfortable living with.

Image by Mathew Schwartz

Metastatic Breast Cancer in Bone

Bone Mets

Unfortunately, this is the most common area where breast cancer cells like to go. 

If you had a breast cancer diagnosis and have bone or joint pain, don't just chalk it up to getting old or arthritis.

You may need bone scans, x-rays, CT or MRI scans to determine what the cause. 

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Metastatic Breast Cancer to the Liver

Liver Mets

Normally there is no symptom that you would experience so type of metastatic disease this gets picked up from bloodwork. Abnormal liver function tests are typically the only clue.

Biopsy will likely be recommended after imaging to locate any lesions for determination of what is going on. 

Brain Sketch

Metastatic Breast Cancer in the Brain

Brain Mets

Brain Mets are often a secondary metastatic site, meaning you might be finding out about this after already having learned that the breast cancer spread to another organ.

 

Brain Mets  are more common if you had a more aggressive type of breast cancer at initial diagnosis.

Normally lesions in the brain are discovered through MRI imaging. 

Image by National Cancer Institute

Metastatic Breast Cancer to the Lung

Lung Mets

You may be asymptomatic, though sometimes  though symptoms present like a common cold or respiratory illness.

You will probably get a chest x-ray first then other diagnostic tests depending on how things look. 

Receptors

Your hormone receptor status is important to know as there are treatments available depending on how your specific cancer will respond to chemotherapy or medicines - specifically if your cancer has receptors for certain molecules than it can be treated with medications that bind to those receptor sites. 

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Estrogen Receptor

ER

Breast cancers that have estrogen receptors are classified as ER+ (ER-positive); those without estrogen receptors are ER-negative (ER-).

If you are ER+ then your cancer is stimulated by estrogen, so medications that bind to estrogen receptors would work well for treatment. 

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Human Epidermal Growth Factor Receptor 2

HER2

This protein promotes the growth of cells. Therefore, treatments specifically targeted to bind to HER2 receptors have a favorable treatment options. 

Unfortunately HER2-positive  breast cancers - those with HER2 receptors tend to be more aggressive. 

A pathologist will determine your receptor status with IHC (immunohistorychemistry) testing or a FISH (flourescence in situ hybridization) test.

An ICH test provides your care team with a score of o to 3+. A score of 0 or 1+ is classified as negative. A score of 2+ is equivocal and 3+ is considered positive.

FISH testing provides a straight positive or negative for a result and tends to be a bit more sensitive, so if you have received a 2+ or an equivocal on IHC, your sample will probably go on for additional testing to further clarify your status.

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Progesterone Receptor

PR

Breast cancers that have progesterone receptors are classified as PR+ (PR-positive); those without progesterone receptors are PR-negative (PR-).

If you have been classified as PR+ then your cancer would respond well to treatments that bind to progesterone receptors.

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Triple Negative Breast Cancers

HR or 3x negative

Breast cancers test negative for all estrogen, progesterone and HER2 receptors. Therefore treating these cancers with hormonal therapy or medicines that target HER2 protein receptors would not be effective. 

Triple negative breast cancers are considered to be more aggressive and be of a higher grade cancer. Unfortunately they also have a poorer prognosis. 

BRCA 1 genetic mutations are more prone to triple negative breast cancers. There is also a higher incidence reported in younger patients and Black and Hispanic women. 

It can be deflating to hear that you are receptor negative for all of these. There are still treatments and clinical trials for patients with a diagnosis of triple negative breast cancer. 

If you have been diagnosis as triple negative check out the Triple Negative Breast Cancer Foundation for resources.