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Invasive lobular carcinoma is the second most common type of breast cancer, about one in seven cases. Its cells have lost the glue protein E-cadherin, so they spread in single files rather than forming a lump, which makes it hard to see on mammograms and to measure. Almost all cases are hormone-receptor positive and are treated like other hormone-driven breast cancer.
Invasive lobular carcinoma is defined in the WHO classification by its discohesive growth, single cells and single-file cords infiltrating the stroma, and by loss of E-cadherin from inactivation of CDH1 (Tan 2020). The Cancer Genome Atlas profiled 817 breast tumours including 127 lobular, 490 ductal and 88 mixed: beyond E-cadherin loss, mutations of PTEN, TBX3 and FOXA1 were enriched in lobular disease, PTEN loss went with the highest AKT phosphorylation of any breast cancer subtype, proliferation and immune signatures defined three lobular transcriptional subtypes with different survival, and mixed ductal-lobular tumours were molecularly either lobular-like or ductal-like rather than true hybrids (Ciriello 2015).
How it differs from its parent: detection and surgery. Its diffuse growth makes it multicentric, multifocal and bilateral more often, with a high likelihood of incomplete excision after breast-conserving surgery; MRI and contrast-enhanced mammography surpass conventional imaging for its extent and improve surgical outcomes when added to the work-up (Healthcare 2023). Even mastectomy left positive margins in 10.6 percent of 357 patients, and in 18.7 percent of T3 tumours (American Journal of Surgery 2022). Metastases favour the peritoneum, ovaries, gut and meninges, and are often small foci needing immunohistochemistry to find in nodes; in 1,269 SEER patients meeting the Z0011 criteria, sentinel node dissection alone and full axillary dissection gave the same survival (PLoS One 2014). It is extremely uncommon in men (Breast Cancer 2017).
How common: about 15 percent of breast cancers (Cancer Research UK).
Treatment follows the HR-positive breast cancer page, because almost all lobular cancers are hormone-receptor positive and HER2-negative: endocrine therapy with CDK4/6 inhibitors in advanced disease, and surgery with the imaging above. Whether lobular disease responds differently to chemotherapy or specific endocrine agents is under study; the fluoroestradiol PET trial linked here images its oestrogen receptors.
Around 15 in every 100 breast cancers, the second most common type (Cancer Research UK). GLOBOCAN counts it within the 2,296,840 breast cancers of 2022.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive breast carcinoma with medullary pattern (medullary carcinoma), Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Treated as HR-positive breast cancer: surgery planned with MRI, endocrine therapy, CDK4/6 inhibitors in advanced disease; sentinel node biopsy as in ductal disease.
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Query for this cancer: (TITLE:"Invasive lobular carcinoma of the breast" OR ABSTRACT:"Invasive lobular carcinoma of the breast" OR TITLE:"Invasive lobular carcinoma" OR ABSTRACT:"Invasive lobular carcinoma" OR TITLE:"ILC" OR ABSTRACT:"ILC" OR TITLE:"Lobular breast cancer" OR ABSTRACT:"Lobular breast cancer" OR TITLE:"Invasive lobular breast cancer" OR ABSTRACT:"Invasive lobular breast cancer" OR TITLE:"Infiltrating lobular carcinoma" OR ABSTRACT:"Infiltrating lobular carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Invasive lobular carcinoma of the breast, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
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A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
Possible QT prolongation. Check ECG and electrolytes; review other QT-prolonging drugs.
Blood clots in the leg veins or lungs. Cancer makes blood clot more easily and some treatments (IMiDs, anti-VEGF drugs, hormone therapy, central lines, surgery) add risk; clots are the second commonest cause of death in cancer patients after the cancer itself.
See all on the product pages:Letrozole (and other aromatase inhibitors)Tamoxifen·Printable cards in the navigator
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