Generality
Infiltrative ductal carcinoma is a special type of breast cancer.
Also known as invasive ductal carcinoma, this tumor is thus defined for its ability to cross the boundary of the mammary structure to invade other body areas. Unfortunately, it is one of the most widespread forms of breast cancer which, in some cases, can also be associated with other types of cancer, such as lobular carcinoma.
Prognosis and therapeutic strategy depend on the degree of aggression and the stage of carcinoma. However, in general, the use of surgery is almost always necessary.
What is that
What is Infiltrating Ductal Carcinoma?
Infiltrative ductal carcinoma is one of the most common types of breast cancer. It is called "ductal" in that it originates from the mammary ducts (galactophores or lactose cells) and "infiltrating" because it goes beyond the structure of the breast, spreading even outside it, affecting lymph nodes and other organs ( metastases ).
There are two different subtypes of infiltrating ductal carcinoma:
- Infiltrative ductal carcinoma not otherwise specified (abbreviated as "NAS");
- Special type infiltrating ductal carcinoma.
During the article, however, we will not go into the details of the aforementioned subtypes, but only the general characteristics of infiltrating ductal carcinoma will be analyzed.
Incidence
Infiltrative ductal carcinoma is the most common and widespread form of breast cancer, in fact, it accounts for 75-80% of all cases of breast cancer.
Causes
What are the Causes and Risk Factors of Infiltrative Ductal Carcinoma?
As with any other type of tumor, infiltrating ductal carcinoma arises following an uncontrolled proliferation of cells (in this case, located at the level of the ducts of the breast) which - escaping the cellular control mechanisms - reproduce at high speed and lose their function.
The exact causes that lead to the aforementioned hyperproliferation, unfortunately, are not yet fully known, but - in the development of the disease - it is believed that there is competition from more risk factors, among which we recall:
- Genetic predisposition and familiarity ( family history of infiltrating ductal carcinoma or other types of breast cancer);
- Advanced age, the risk of appearance of mammary tumors such as infiltrating ductal carcinoma increases progressively with advancing age;
- Early menarche, the early appearance of the first menstruation can represent a risk factor for the development of infiltrating ductal carcinoma;
- Late menopause, similarly to what was said above, even late menopause can predispose to the onset of the tumor;
- Childbirth, women who have given birth have a greater temporary risk of developing breast cancer such as infiltrating ductal carcinoma;
- Obesity and overweight, in particular, during menopause;
- Diabetes ;
- Lifestyle, an unruly lifestyle characterized by bad habits (unbalanced diet, alcohol consumption, smoking habit, little or no physical activity, etc.) is a major risk factor for the development of breast cancer and not only ;
- Environmental factors (for example, exposure to radiation).
Symptoms
Clinical Manifestations and Symptoms of Infiltrative Ductal Carcinoma
Infiltrative ductal carcinoma usually manifests as a tactile nodule that - on ultrasound or mammographic examination - presents itself with poorly defined or spiculated margins ("star" shape) and may or may not be associated with micro-calcifications (small calcium deposits). In the early stages, this palpable mass - generally with a hard consistency - hardly causes pain, but can be accompanied by:
- Breast skin ripple;
- Swelling and redness;
- Nipple secretions;
- Increased volume of axillary lymph nodes.
As the development of infiltrating ductal carcinoma continues, the above nodule increases its size and begins to spread to surrounding tissues, lymph nodes and potentially other organs. At this stage symptoms may occur, such as:
- Pain in both the breast and the axillary lymph nodes;
- Retraction and redness of the nipple;
- Ulceration of the overlying skin.
Unfortunately, the absence of pain in the early stages of infiltrating ductal carcinoma can cause a delay in diagnosis.
Diagnosis
How do you diagnose Infiltrative Ductal Carcinoma?
The diagnosis of infiltrating ductal carcinoma is, of course, the prerogative of the specialist doctor who - in addition to collecting data directly from the patient (anamnesis) about the presence of symptoms or any family history - will use suitable diagnostic tests, such as:
- Bilateral mammography : radiographic examination that allows the identification, even early, of mammary pathologies such as infiltrating ductal carcinoma.
- Cytological examination by means of needle aspiration : this is an examination that is carried out after the mammogram in the case in which this has shown the presence of anomalous formations or masses in one or both breasts. The technique consists in the aspiration of a part of the lesion through a very thin needle. The aspirated material is then subjected to cytological examination in order to detect the presence of malignant tumor cells.
- Cytological examination of secretions escaping from the nipple.
- Biopsy : this is a more invasive method than needle aspiration, it consists in performing a small surgical operation during which part of the suspected malignant lesion is removed and then subjected to histological examination.
In some cases, the doctor may also decide to resort to performing a breast ultrasound scan which, however, is not always useful from the diagnostic point of view.
Prognosis
What is the Prognosis in the presence of Infiltrating Ductal Carcinoma?
The prognosis of infiltrating ductal carcinoma varies according to the timeliness with which the diagnosis is made and is closely related to the degree of tumor spread (metastasis to surrounding tissues, lymph nodes or other organs) and to the concomitant presence of other malignant neoplastic forms ( for example, lobular carcinoma).
Clearly, if infiltrating ductal carcinoma is diagnosed when it has already affected other organs (generally, liver, lungs and bones) and / or manifests itself in association with other malignant tumors, the prognosis may be particularly negative.
The prognosis, therefore, can also vary greatly from patient to patient.
Care
Care and Treatment of Infiltrative Ductal Carcinoma
The treatment of infiltrating ductal carcinoma, as mentioned, depends on many factors, including the developmental stage in which the tumor is located at the time of diagnosis. However, in most cases we proceed with the surgical treatment which - depending on the expansion of the carcinoma - may include partial or total removal of the breast. In some cases, in addition to the removal of the tumor mass, the specialist may also consider it necessary to proceed with the removal of the lymph nodes (sentinel and axillary).
Following surgery, based on the characteristics of the tumor (analyzed by the anatomist) and on the degree of infiltration, the oncologist may decide to subject the patient to radiotherapy (also intra-operative) and / or chemotherapy cycles antitumor .
Conservative Surgical Treatment
Conservative surgical treatment can be performed:
- Removing only the tumor mass;
- Removing the breast quadrant in which the carcinoma in question is present, thus removing part of the surrounding tissue (in this case, we speak more precisely of quadrantectomy or extensive breast resection).
The purpose of conservative surgical treatment, therefore, is to remove the tumor while preserving the affected breast as much as possible.
Partial mastectomy
Partial or segmental mastectomy involves the removal of more than one quadrant of the breast, but also in this case, the breast is not completely removed.
Total mastectomy
Total mastectomy, on the other hand, involves the total removal of the breast affected by infiltrating ductal carcinoma . In some cases, the doctor may also decide to remove the sentinel node and possibly some or all of the axillary lymph nodes. In severe cases, it may also be necessary to remove part of the pectoral muscle and the overlying skin. Fortunately, in many cases it is possible to safeguard the areola and the nipple.
Please note
Generally, after the removal of the tumor and possibly of the lymph nodes, these are subjected to analysis by the anatomopathologist in order to investigate their biological characteristics and, in particular, the significant presence of particular types of receptors, such as the estrogen receptor and the receptor 2 for the human epidermal growth factor (encoded by the HER2 / neu gene). The identification of the presence of similar receptors - implicated in tumor growth - is very important to establish a correct therapeutic pharmacological approach.
Breast Surgical Reconstruction
Regardless of the type of surgical treatment (partial or total removal) to which the patient is subjected, the breast is then reconstructed . The reconstruction can take place during the same operation carried out to remove the carcinoma, or - if the patient has to undergo subsequent radiotherapy sessions - the reconstruction will take place once the radiotherapeutic cycles are completed.
Radiotherapy and Chemotherapy
Radiation therapy is often required in the treatment of infiltrating ductal carcinoma. It can be administered both intra-operatively and after surgical treatment.
Anti-cancer chemotherapy, on the other hand, may be useful but is not always necessary. The choice of resorting to the use of anticancer drugs is naturally up to the specialist. However, among the different active ingredients that could be used, we recall:
- Tamoxifen (useful in case of estrogen receptor positive tumors);
- Exemestane (used in post-menopausal women);
- Trastuzumab (indicated in the case of carcinomas expressing receptor 2 for the human epidermal growth factor).
Screening
Screening for the Early Detection of Infiltrative Ductal Carcinoma
To promptly diagnose infiltrating ductal carcinoma - and, more generally, for the early diagnosis of any other type of breast cancer - specific screening projects are active in our country. In fact, the faster the diagnosis, the faster the medical intervention will be and the better the prognosis may be.
The tools that can be used for breast cancer screening - therefore, even infiltrating ductal carcinoma - are mainly represented by:
- Breast self-examination (this is a simple technique to perform, so that it can be performed independently by the patient herself, is a very useful way to identify the presence of nodules or anomalous masses);
- The execution of mammography at regular time intervals, variable according to the age of the woman. In detail, the Ministry of Health has been planning a breast cancer screening program for many years now, inviting women aged 40 to 69 to undergo a mammographic examination every one or two years, free of charge.
According to the statistical studies conducted, the execution of the above screening for the early detection of breast tumors such as infiltrating ductal carcinoma is able to reduce mortality by 30-40%.
