Lobular Carcinoma in Situ - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Lobular carcinoma in situ (LCIS) or lobular neoplasia is a rare breast condition. The abnormal cells do not cross beyond the breast lining, hence the name 'in situ,' which means 'in place.' It is not breast cancer, but the abnormal cells within the lobules increase the risk of developing cancer in either of the breasts.

What Are the Types of Lobular Carcinoma in Situ?

Lobular carcinoma in situ (LCIS) is a benign (non-cancerous) condition. The three different types of this condition include:

1. Classic LCIS - The cells in the lobules are small and uniform in size.

2. Pleomorphic LCIS - The cells are larger and abnormal in size.

3. Florid LCIS - This type refers to a large group of cells with dead cells in the center.

What Are the Causes of Lobular Carcinoma in Situ?

The exact cause of this condition is unknown. It is believed that genetic mutation in the breast cells makes them turn into abnormal cells that remain within the confines of the breast tissue. The individuals who are at risk of developing LCIS include:

• A familial history of breast cancer.

• Those above forty years of age.

• Women who are under any hormone replacement therapy for more than three years after menopause.

Women with the factors mentioned above are more prone to develop LCIS. Hence, regular check-ups and imaging studies must be done to prevent such conditions early.

What Are the Symptoms of Lobular Carcinoma in Situ?

LCIS usually does not cause any symptoms. It is an incidental finding on performing a biopsy to detect any other abnormality in the breast. It is found only on microscopic evaluation of breast tissue. Any signs or changes in the breast must be noticed and checked with the physician as soon as possible. Some signs included under self-examination of the breast are:

• Visible changes in the shape and size of the breast.

• Feeling a lump in the breast on touching.

• Feeling of lump in the armpit.

• Inverted nipples.

• Presence of rash on the nipples.

• Any discharge from the nipples.

• A thicker skin of the breast.

• Any discomfort in the breast region that persists for a long time.

The presence of any of these changes does not mean cancer. There might be any abnormality that is benign and can be treated by medications or minor surgery.

How to Diagnose Lobular Carcinoma in Situ?

Diagnosis of LCIS is made only by a biopsy. The mammogram does not show any findings related to this condition. The biopsies that show LCIS include:

• Needle Biopsy - A small portion of the breast tissue is removed using a needle. This tissue sample is sent to the laboratory to detect any presence of abnormal cells in the breast.

• Excisional Biopsy - A larger portion of the breast tissue is removed to rule out breast cancer. It is a minor surgery that is done under general anesthesia or sedation.

How to Treat Lobular Carcinoma in Situ?

The treatment option for the individual depends on the type of LCIS and any other underlying medical illness.

1. Observation - Any signs of changes observed in the breast must be notified to the doctor. Medical examination by a doctor, self-examination, and yearly mammogram (X-ray of the breast) or MRI (magnetic resonance imaging) scan is performed regularly to observe any abnormalities in the breast.

2. Prevention - Chemoprevention or chemotherapy (a treatment using drugs to kill cancer cells) reduces the risk of developing cancer.

3. Surgery - Surgical breast removal is the only option when an excisional biopsy does not entirely remove the affected tissues. Surgery is usually a treatment option in a pleomorphic variant of LCIS. After confirming with a biopsy that it is a pleomorphic (varying size and shape of cells) type, surgical removal of the breast tissue is done depending on the extent of abnormalities detected. If only a small portion is affected, then only that part is removed. In rare cases, the whole breast is removed by a procedure called mastectomy as a preventive operation.

The surgeon only decides on the surgical option as a preventive measure when there is any serious underlying illness, strong family history of breast cancer, gene mutation, or any other factor that increases the risk of breast cancer.

How to Prevent the Development of Lobular Carcinoma in Situ?

There is no exact preventive strategy available for this condition. Certain lifestyle modifications are adopted to reduce the risk of developing cancer. Some ways to lower the risk of breast cancer include:

• Regular exercising.

• Having a healthy diet.

• Weight must be maintained according to the age of the patient.

• Avoid taking hormone replacement medications as it increases the risk of developing breast cancer. The doctor is consulted if the patient is under hormone replacement therapy, and regular breast screening must be done.

• The habit of alcohol consumption must be avoided or at least reduced.

• If the patient has children, they must be breastfed.

• Find out if there is a family history of breast cancer, as it increases the risk of developing cancer in their children.

• A regular follow-up with the physician to find any cancer-like abnormalities with screening and imaging studies.

How to Lower the Risk of Breast Cancer in Those With Lobular Carcinoma in Situ?

Women diagnosed with Lobular Carcinoma in situ have a seven to twelve times increased risk of breast cancer than those without LCIS.

• Medications are available that can be used to reduce the risk. In premenopausal women, a drug called Tamoxifen is taken for five years to lower the risk. In postmenopausal women, Tamoxifen or Raloxifene is prescribed.

• Lifestyle changes.

• Prophylactic (as an indent to prevent a disease) mastectomy (breast removal) prevents cancer spread.

Both these drugs block the action of estrogen, which is responsible for the tumor cells to multiply. But, these medications are effective only against estrogen-receptor-positive breast cancer. It is not effective against estrogen-receptor-negative breast cancer. Hence, the doctor must be consulted for the proper treatment to lower the risk of breast cancer.

Conclusion:

Lobular carcinoma in situ is rare but has a high risk of breast cancer. It does not always carry the risk of breast cancer being developed. There are some women with LCIS who have never developed cancer at all. It all depends on how the individual maintains a healthy life, self-examining the breast to look out for changes, and regular follow-ups with the doctor. The doctor must discuss all the risk-reducing options for a perfect life without cancer.