Lobular carcinoma in situ, or LCIS for short, is a growth on the mammary gland that can spread to the milk ducts. Lobular carcinoma in situ is one of the noninvasive carcinomas. In situ means in place, meaning that it does not grow into surrounding tissue. However, lobular carcinoma in situ is a risk factor for developing breast cancer. The disease should be distinguished from ductal carcinoma in situ.
What is lobular carcinoma in situ?
Lobular carcinoma in situ is an early form or a so-called risk marker of breast cancer. LCIS – lobular carcinoma in situ (Latin name) – is a noninvasive carcinoma that occurs mainly in the mammary gland and milk ducts. Although it occurs rarely, lobular carcinoma in situ can develop into invasive carcinoma. Lobular carcinoma in situ often occurs multicentrally, meaning it is located in different areas of the breast. However, LCIS can also occur in both breasts at the same time. Lobular carcinoma in situ is usually discovered rather incidentally. Because LCIS does not form microcalcifications, it cannot be detected on mammography.
Causes
The causes of lobular carcinoma in situ are not known. However, LCIS often occurs in families where there are cases of breast cancer. It has also been observed that more women were affected who were very late in menopause. However, this has not been scientifically proven to date.
Symptoms, complaints and signs
Lobular carcinoma in situ usually does not cause definite symptoms. Typical breast cancer symptoms such as lumps or pain in the breast occur only when the carcinoma metastasizes. In a severe course, other symptoms occur, such as inflammation and bleeding in the area of the nipples, hardening and an increasing feeling of illness. Externally, lobular carcinoma in situ can be recognized by the palpable growth in the breast area. Depending on the size and location of the carcinoma, occasionally a swelling or even a lump may also be detected under the skin. The nodes reach a size of one to two centimeters. They are usually firm, cannot be moved and do not cause pain when touched. Occasionally, swelling also occurs next to the breastbone, in the armpit or in the area of the collarbone, accompanying the lump formation in the breast. In severe cases, the nipple may also be retracted. This is usually accompanied by skin changes, for example inflammation, redness or enlarged pores. If lobular carcinoma in situ is treated early, metastasis can be reliably avoided and any accompanying symptoms quickly disappear.
Diagnosis and course
Lobular carcinoma in situ is usually discovered by chance. Lobular carcinoma in situ does not form microcalcifications; therefore, it cannot be imaged with the aid of a mammogram. Furthermore, lobular carcinoma in situ is neither visible nor can it be palpated from the outside. It is usually discovered during preventive examinations such as breast screening and subsequent biopsy. Diagnosis of lobular carcinoma in situ is made by a pathologist. In a biopsy, tissue from the mammary gland is removed for subsequent histological examination. As with all carcinomas, the course of the disease should be evaluated with caution. As long as there is a lobular carcinoma in situ, i.e. a non-invasive carcinoma, there are no reasons to expect a shorter lifespan or deterioration of health. Because LCIS does not cause symptoms, affected individuals usually lead completely normal lives.
Complications
In most cases, there are no particular symptoms or pain associated with this condition. For this reason, this complaint is also diagnosed relatively late and usually only by chance. Since this is a cancerous disease, the further course of the disease depends very much on the extent of the tumor. If the tumor has already metastasized, the course of the disease is usually no longer positive and the patient’s life expectancy is significantly reduced. Only in rare cases does the disease cause pain in the breasts or nipples. These may also be bloody or discharge a secretion.As a rule, however, the complaints are relatively rare. As a rule, this tumor can be treated relatively well if treatment begins at an early stage. However, the success also depends strongly on the patient’s state of health. Further complaints or complications usually do not occur. Without treatment, breast cancer may develop. As a rule, patients are also dependent on psychological treatment.
When should you go to the doctor?
Changes and abnormalities of the nipples should be presented to a doctor. If there is bleeding, the formation of pus or a feeling of inflammation on the nipples, a doctor is needed. If there is fever, a general feeling of malaise or pain in the breast, a doctor should be consulted. If there is swelling of the breast, a feeling of pressure or tightness in the breast, a doctor’s visit is needed. If lumps or other irregularities can be felt in the breast, these should be shown to a doctor. A doctor should also be consulted if the symptoms increase or spread. A distinctive feature of lobular carcinoma in situ is the nondisplaceability of the palpable lumps in the breast. If pain presents when the breast is touched, this is considered worrisome. If everyday movements or locomotion can no longer be performed without pain, a visit to the doctor should be made. Since metastases can form, early treatment is essential for survival in the case of lobular carcinoma in situ. In case of psychological problems, behavioral abnormalities or changes in personality, a visit to the doctor is also advisable. The affected person needs therapeutic support in coping with the disease.
Treatment and therapy
Not all lumps in the breast, indicate breast cancer. Nevertheless, they should be clarified in the mammogram. Treatment of lobular carcinoma in situ begins with a biopsy. Hormone therapy is usually initiated thereafter to reduce the risk of it developing into invasive carcinoma. A few years ago, a bilateral mastectomy (removal of the breast) was performed prophylactically. This was done to prevent any breast cancer that might develop. Today it is known that a lobular carcinoma in situ only very rarely turns into an invasive carcinoma, i.e. breast cancer. Mastectomy is recommended only to those who have a high risk of developing breast cancer. If a lobular carcinoma in situ has been diagnosed, close histological and mammographic control examinations should be carried out. Furthermore, psychological support should also be provided. The word carcinoma has the meaning “cancer” in colloquial usage and evokes horror and despair in most of those affected. Because of this, talk therapy with a trained therapist is highly recommended.
Outlook and prognosis
Lobular carcinoma in situ depends on several factors for its prognosis. There are three subtypes, each associated with a different risk with regard to the development of invasive breast cancer. If no breast cancer develops, the prognosis for lobular carcinoma in situ is exceptionally favorable, as it does not leave its region but remains in place in the tissue and does not show invasive tendencies. For this reason, close monitoring of the affected breast is sufficient in many cases. However, the prognosis may be unfavorably influenced by the lack of visualization in the tissue by conventional imaging techniques. This form of carcinoma in the glandular lobules cannot be palpated in the breast either. Therefore, it may develop unnoticed over a very long period of time until it is discovered at all. In addition, it often affects multiple areas of the breast, often both breasts, so it cannot be completely removed without a mastectomy if that is advised. Of the three types of lobular carcinoma in situ, the extended type is associated with a somewhat less favorable prognosis with regard to the development of invasive cancer. The prognosis then depends on the tissue removal in its completeness and the regularity of the controls.
Prevention
No measures can be taken to prevent lobular carcinoma in situ. Only general measures can be taken at this point, such as a balanced and healthy diet, avoidance of obesity.Currently, no imaging techniques exist to visualize lobular carcinoma in situ. Furthermore, there are no tumor markers in blood tests that could indicate this disease. Women with a high risk factor for breast cancer should be regularly screened for breast cancer. If lobular carcinoma in situ has been detected, preventive measures can be taken in this case to avoid developing breast cancer.
Follow-up care
Follow-up care represents a key element in the treatment of carcinoma. In this way, the recurrence of disease should be detected as early as possible, from which physicians hope to gain advantages in the course of therapy. After surgery, radiation or ablation, there is always the risk of tumor recurrence. In addition, aftercare is also about providing everyday support. Patients often complain of psychological problems after an operation and need help in their everyday lives. It is not always possible to remove a carcinoma completely. In such cases, permanent treatment is often necessary. Daily drug treatment remains unavoidable. Patients usually attend a follow-up examination once every quarter or every six months. The frequency depends on the type of carcinoma, the symptoms and the stage of the tumor at the time of initial diagnosis. In most cases, the intervals between appointments are extended if no new growth has been detected after two to three years. The primary care physician or a clinic is responsible for follow-up care. Essential elements of an appointment are an intensive conversation and a physical check-up. An ultrasound examination and other imaging procedures are arranged on a regular basis. Blood tests to determine specific markers also take place.
What you can do yourself
Lobular carcinoma in situ usually does not cause any typical symptoms, so patients learn about it at best by chance during a medical examination. Then, however, the shock sits deep with many sufferers in the face of the diagnosis of carcinoma. Nevertheless, it is important that patients remain calm and realize that the disease only relatively rarely leads to the development of breast cancer. The first priority is adequate monitoring of the state of development of the carcinoma. For this purpose, patients take advantage of all medical appointments and examination offers. It is usually necessary to visit different doctors and medical institutions. In their own interest, patients try to reduce psychological stress as much as possible. Mental balance has a beneficial effect on the physical state of health. Patients pursue a healthy lifestyle and turn to the attending physician for all questions and concerns. Sometimes, however, the disease leads to severe mental impairment, such as anxiety attacks or depressive phases. In such cases, the doctor refers the patients to a psychotherapist who helps the women deal with the carcinoma. This usually improves the quality of life of those affected and makes it easier to cope with the challenges posed by the disease.