What Is Lobular Carcinoma in Situ?
Lobular carcinoma in situ (LCIS) is a condition in which the lobules (glands) inside the breast change abnormally. Although the word carcinoma is in the name, it is not cancer. It is a precursor of cancer. The presence of lobular carcinoma in situ increases the chance of getting breast cancer. The word ‘in situ’ means ‘in the original place,’ which this condition stays wherever it originated, unlike cancer. Cancer always shows the tendency to spread to other body parts. A person with lobular carcinoma in situ has a 30 percent chance of getting breast cancer in the future. 4 to 11 females out of 100000 are affected by lobular carcinoma in situ.
What Are the Causes of Lobular Carcinoma in Situ?
The cause of lobular carcinoma in situ is not clear to date. However, taking hormone replacement therapy for more than five years after menopause can increase the risk of getting lobular carcinoma in situ. A family history of breast cancer and being above 40 years of age also make risk factors for lobular carcinoma in situ.
Lobular carcinoma in situ develops when the cells in the lobules of milk-producing glands start to mutate and become an abnormal mass of cells. But what initiates this mutation is an unknown fact.
What Are the Clinical Features of Lobular Carcinoma in Situ?
Signs and symptoms are absent in most lobular carcinoma in situ cases. Some patients may notice a breast lump. Women in their premenstrual age will most likely get lobular carcinoma in situ. As there are no symptoms present in lobular carcinoma in situ, it is usually diagnosed incidentally during an examination or by a mammogram.
What Is the Diagnosis of Lobular Carcinoma in Situ?
A biopsy is the main method of diagnosis of lobular carcinoma in situ. A small piece of tissue from the breast is removed and examined under a microscope during a biopsy. Different types of biopsies used in the diagnosis of lobular carcinoma in situ are as follows;
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Needle Biopsy - Under local anesthesia, a small amount of tissue from the breast is removed using a needle and examined. Usually, a needle biopsy is enough to diagnose lobular carcinoma in situ.
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Excisional Biopsy - In case a needle biopsy is not enough for the diagnosis, an excisional biopsy is done. A slightly larger piece of tissue is removed from the affected site and examined. It is usually done under general anesthesia.
What Are the Different Types of Lobular Carcinoma in Situ?
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Classic Lobular Carcinoma in Situ - The cells inside the lobules of milk-producing glands are smaller and the same in size.
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Pleomorphic Lobular Carcinoma in Situ - The cells inside the lobules of milk-producing glands are larger and abnormal in size.
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Florid Lobular Carcinoma in Situ - The cells inside the lobules of milk-producing glands are grown into a large abnormal mass of cells with necrotic cells in the middle.
How is Lobular Carcinoma in Situ Treated?
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Observation - It is the preferred management option currently. Every 6 to 12 months, follow-up for physical examination and follow-up for mammogram annually is recommended. If there is a history of breast cancer running in the family, imaging techniques like MRI (magnetic resonance imaging) and molecular breast imaging are recommended.
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Surgery - Surgery is recommended in cases of a special type of lobular carcinoma in situ called pleomorphic lobular carcinoma in situ (PLCIS), which has a higher risk of developing breast cancer. Sometimes only the affected part is removed (lumpectomy). If the whole breast tissue is removed, it is called mastectomy. For individuals having strong risk factors, a preventive mastectomy is recommended, which includes removing both breasts to eliminate the risk of getting breast cancer. Radiation therapy may be recommended after lumpectomy and mastectomy.
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Preventive Therapy - A chemotherapy to prevent lobular carcinoma in situ from becoming breast cancer. Tamoxifen is a selective estrogen receptor modulator (SERM) drug given to reduce the risk of breast cancer. Another type of drug is Aromatase inhibitors like Anastrozole and Exemestane, which can decrease the estrogen levels in the body and thereby prevent the growth of cancer cells.
What Are the Steps to Reduce the Risk of Getting Breast Cancer?
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Limiting hormonal therapy for menopause - only the lowest dose for the shortest period is advised to reduce the risk of breast cancer.
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Maintaining a healthy weight.
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Regular exercise.
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Limiting alcohol consumption.
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Smoking cessation.
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Doing frequent self-examination to see if there is any lump in the breasts.
Conclusion
Lobular carcinoma in situ is a precursor of breast cancer. It is a benign condition involving a mutation of the cells of lobules inside the breast. There is a 30 percent chance of getting breast cancer in women with lobular carcinoma in situ. As the name suggests, it remains contained where it began unless cancer. Once the diagnosis is confirmed, it can be treated with medications or surgeries like mastectomy and lumpectomy. But continuous observation and follow-up are recommended as the primary mode of treatment. By making some lifestyle modifications and regular visits to a doctor for general examination, one can reduce the risk of getting breast cancer.
