The Difference Between DCIS, LCIS, ILC, IBC, Paget’s Disease & Phyllodes Tumors

Some of my subscribers have voiced a little confusion in past weeks over the various types of breast cancer and exactly how they differ, prompting me to write this article and hopefully untangle that confusion.

The 8 Faces of Breast Cancer

Ductal Carcinoma In Situ (DCIS) is the most common type of non-invasive breast cancer.  Ductal means that the cancer starts inside the milk ducts, carcinoma means any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and “in situ” means “in its original place.” DCIS is considered “non-invasive” because it hasn’t spread beyond the milk duct into any of the surrounding breast tissue.  DCIS is not considered to be life-threatening, however, having DCIS can increase the risk of developing an invasive breast cancer later on.  Experts feel that when you have had DCIS, you can be at an increased risk for the cancer returning or for developing a new breast cancer than a person who has never had breast cancer.  Studies indicate that most recurrences happen within 5-10 years after initial diagnosis (but this is certainly not always the case).

Invasive Ductal Carcinoma (IDC), sometimes referred to as infiltrating ductal carcinoma, is the most common type of breast cancer, comprising about 80% of all breast cancers.  Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Ductal is defined in the paragraph above, and carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue.  All together, “invasive ductal carcinoma” refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast.  Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.  According to the American Cancer Society, about 2/3 of women are 55 or older when they are diagnosed with an invasive breast cancer, however, it can strike at any age.  IDC also affects men.

There are 5 sub-types of IDC – tubular carcinoma, medullary carcinoma, mucinous carcinoma, papillary carcinoma and cribriform carcinoma.  These all refer to a specific type of tumor and these further classifications help your oncologist decide on treatment.  You can find out a lot more about these subtypes on www.breastcancer.org.

Invasive Lobular Carcinoma (ILC) is the second most common type of breast cancer after IDC.  Invasive is defined above, lobular refers to cancer that has grown in the milk-producing lobules which empty out into the ducts that carry milk to the nipple. Carcinoma is defined above.  All together, “invasive lobular carcinoma” refers to cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast.  Again – over time, ILC can spread to the lymph nodes and possibly to other areas of the body.  According to the American Cancer Society, this type of breast cancer is more common as women age.

Lobular Carcinoma In Situ (LCIS) is when abnormal cells grow inside the lobules of the breast, but have not spread to any nearby tissue or beyond.  With LCIS, the abnormal cells are still in place inside the lobules and have not invaded any other tissues.  Experts feel that it is rare for LCIS to become invasive breast cancer, however, having LCIS increases the risk of invasive breast cancer, statistically speaking.  Compared to women without LCIS, those with LCIS are 7-12 times more likely to develop invasive cancer in either breast.  Studies show that women with LCIS “may” go on to develop ILC or IDC.

Inflammatory Breast Cancer (IBC) is a rare and more aggressive form of breast cancer.  According to the National Cancer Institute, about 1-5% of all breast cancer cases in the USA are IBC.  Inflammatory breast cancer generally starts with the reddening and swelling of the breast rather than a distinct lump.  The alarming thing about IBC is that it tends to spread and grow quickly, with symptoms worsening within days or even hours.  It is very important to recognize symptoms and seek treatment PROMPTLY.  Although IBC is considered a serious diagnosis, keep in mind that treatments today are better at controlling the disease than they used to be.  The average age at diagnosis for IBC in the USA is 57 for white women and 52 for African American women, and that’s about 5 years younger than the average ages at diagnosis for other forms of breast cancer.  I’ve found an excellent resource for women with IBC.  Go to http://eraceibc.com – they are wonderful over there and will provide you with extra support for your specific diagnosis.

Paget’s Disease is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola (the dark circle of skin around the nipple). The nipple and areola often become scaly, red, itchy, and irritated.  According to the National Cancer Institute, Paget’s disease accounts for less than 5% of all breast cancer cases in the USA. It’s important to be aware of the symptoms because more than 97% of people with Paget’s disease also have cancer, either DCIS or invasive cancer, somewhere else in the breast. The unusual changes in the nipple and areola are often the first indication that breast cancer is present. Doctors aren’t quite sure how Paget’s develops.  It is more common in women, but is sometimes found in men as well and usually develops after the age of 50.

Phyllodes Tumors – Prior to my doing research for this article, I have to admit I’d never even heard of this type of tumor.  It’s a rare one and accounts for less than 1% of all breast cancers.  A phyllodes tumor can be benign (harmless) or malignant (cancerous).  This type of tumor is called a “sarcoma,” because it occurs in the connective tissue (stroma) of your breast, rather than in the tissue lining of ducts and lobes.  Phyllodes tumors take their name from the Greek word phullon (leaf) because of their leaf-shaped growth pattern.  This type of tumor will feel like a firm, smooth-sided, bumpy (not spiky) lump in your breast tissue and the skin over the tumor may become reddish and warm to the touch.  This type of tumor seems to grow very fast – so much so that the lump can become bigger in a couple of weeks.

Male Breast Cancer – Breast cancer in men is rather rare, less than 1% of all breast cancers occur in men but no discussion of the types of breast cancer would be complete without mentioning this.  In 1998 I lost a family friend to male breast cancer that was diagnosed too late (RIP, Bud).  In 2011, about 2,140 men were diagnosed with male breast cancer.  For men, the lifetime risk of being diagnosed with breast cancer is only about 1 in 1,000.  For risk factors, symptoms, diagnosis of male breast cancer and treatment for male breast cancer go to www.breastcancer.org, an excellent resource.

A Good Visual For You

Someone clever has photographed a bunch of lemons and used them to illustrate things like lumps, a growing vein, nipple retraction – all things to be aware of in reference to breast changes.  The photo is on Stumble Upon (click this link).  I hope this information helps someone!

Sources:

http://www.breastcancer.org/symptoms/types/

http://breastcancer.about.com/od/types/p/phyllodes_sa.htm

http://www.eraseibc.com/ibc.html

http://ww5.komen.org/understandingbreastcancerguide.html

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