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Treatments and drugs
By Mayo Clinic staff
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Lumpectomy |
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Simple mastectomy and modified radical mastectomy |
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Sentinel node biopsy |
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Radiation therapy |
Your treatment options for invasive lobular carcinoma depend on your cancer, its stage, your overall health and your preferences. Treatment often consists of surgery and additional (adjuvant) therapy, which may include chemotherapy, radiation and hormone therapy.
Surgery
Surgery for invasive lobular carcinoma may include:
- Removing the cancer and small portion of healthy tissue. Called a lumpectomy or a wide local excision, this procedure allows you to keep most of your breast tissue. The surgeon removes the tumor itself, as well as a margin of normal tissue surrounding the tumor to make sure all the cancer that can be removed is taken out. Negative, or clean, margins reduce the chance of leaving any cancer in the breast. If the margins are positive, you may need additional surgery until negative margins are achieved. In some cases, this may mean removing the entire breast.
- Removing all of the breast tissue. Mastectomy is an operation to remove all of your breast tissue. Mastectomy can be simple, meaning the surgeon removes all of the breast tissue — the lobules, ducts, fatty tissue and skin, including the nipple and areola. Another option is a modified radical mastectomy, which involves removing all of the breast tissue, as well as removing some of the skin and lymph nodes in the nearby armpit.
- Sentinel lymph node biopsy. To determine whether cancer has spread to the lymph nodes near your breast, your surgeon identifies the first lymph nodes that receive the lymph drainage from your cancer. These lymph nodes are removed and tested for breast cancer cells (sentinel node biopsy). If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed.
- Axillary lymph node dissection. If cancer is found in the sentinel node, then your surgeon may remove additional lymph nodes in your armpit (axillary lymph node dissection). Knowing if cancer has spread to the lymph nodes helps determine the best course of treatment, including whether you'll need chemotherapy or radiation therapy.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Treatment often involves receiving two or more drugs in different combinations. Chemotherapy can be given through a vein, in pill form or both ways. For invasive lobular carcinoma, chemotherapy is commonly used after surgery to kill any cells that may remain. Chemotherapy can also be used before surgery to shrink a tumor that is large. For women with large breast tumors, chemotherapy before surgery may make it possible to choose lumpectomy over mastectomy.
Radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a large machine moves around you directing energy beams at precise points in your breast. Radiation therapy may be recommended after a lumpectomy. It may also be recommended if your cancer was large or involved the lymph nodes.
Hormone therapy
Hormone therapy may be an option if your cancer cells are sensitive to hormones. Most invasive lobular carcinomas are hormone receptor positive, meaning they are sensitive to hormones. A sample of your tumor cells is tested to determine whether your cancer is hormone receptor positive. If it is, hormone therapies can block your body from producing hormones or block the cancer cells' ability to use the hormones. One class of hormone therapy drugs called selective estrogen receptor modulators (SERMs), which includes tamoxifen, can be used in women who are premenopausal and in those who have experienced menopause. Another class of hormone therapy drugs called aromatase inhibitors is useful only in women who have experienced menopause. This class includes the drugs anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).
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- Chen WY. Postmenopausal hormone therapy and breast cancer risk: Current status and unanswered questions. Endocrinology and Metabolism Clinics of North America. 2011;40:509.
- Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-4/0/1709/0.html. Accessed April 24, 2012.
- Breast cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed April 24, 2012.
- Biglia N, et al. Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: Implications for diagnosis, surgical and medical treatment. Endocrine-Related Cancer. 2007;14:549.
- Schrader KA, et al. Hereditary diffuse gastric cancer: Association with lobular breast cancer. Familial Cancer. 2008;7:73.
- Breast cancer treatment (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional. Accessed April 24, 2012.
- Breast cancer prevention (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/prevention/breast/healthprofessional. Accessed April 24, 2012.
- Avis NE. Breast cancer survivors and hot flashes: The search for nonhormonal treatments. Journal of Clinical Oncology. 2008;26:5008.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. May 7, 2012.
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