LCIS is the Origin of ILC. No? Let's learn something

msippiqueen

Here's how the National Comprehensive Cancer Network addresses the origin of LCIS and explains that ILC starts as LCIS.



Proliferative abnormalities of the breast are limited to the lobular and ductal epithelium.



In both the lobular and ductal epithelium, a spectrum of proliferative abnormalities may be seen, including hyperplasia, atypical hyperplasia, in situ carcinoma, and invasive carcinoma.



In terms of treatment, breast cancer may be divided into 1) the pure noninvasive carcinomas, which include lobular carcinoma in situ (LCIS) and DCIS (stage 0)



Pure Noninvasive Carcinomas (Stage 0)



Both LCIS and DCIS may be difficult to distinguish from atypical hyperplasia or from carcinomas with early invasion.



The goal of treatment for pure in situ carcinoma is either preventing the occurrence of invasive disease or diagnosing the development of an invasive component when still localized to the breast.



These statements can be found here: http://www.jnccn.org/content/8/10/1182.full



Additionally, to keep it simple, health care providers have brochures that show that ILC occurs when a break in the LCIS membrane happens. If you never got one, ask for it. Please seek this information, it is readily available for you.

gardengumby

Thank-you msippiqueen.  I was re-reading my diagnosis the other night (why, I don't know - maybe I just wanted to get depressed all over again....)  Anyway, I saw the lobular and also tubular and necrotic conditions of the cancer, and got a little confused.  My doctors all seem to be completely convinced that they got the cancer, so I'll probably continue on my merry way, hoping that they are right (and of course continuing to take my medication. 

Anyway, thanks again.  (BTW, you have a misspelled word in your signature line....   at least I assume that you left out an "o"  )

msippiqueen

OMGosh, the O was missing all this time! Thanks for the catch, I'll correct that pronto.



I just noticed you live in Seattle, we're going there in exactly two weeks for two nights, then sail on to Alaska. Can't wait!



Really, I'm so glad you feel better after re-reading your diagnosis. I had a sense right away you were in good hands and that's all the more reinforced.

It drives home the point we need a Dr we can trust and who "gets us". It makes hard decisions easier and asking questions less intimidating.



When we're in Seattle, I'll stand and wave in every direction, to send you a greeting!

gardengumby

Enjoy your cruise - and enjoy our city.  I REALLY hope you find good weather when you get here, not just because I want good weather, but because it's such a truly gorgeous area and the sun makes it sparkle!!

I've been very happy with my doctors at the cancer care alliance. 

auntiems3

Garden gummy - from what I understand from your questions is how does breast cancer progress? A very tall order since there are so many different types.



Anatomically speaking the lobes, which are made up of several lobules and function in making breast milk, are located at the far ends of the ducts. The ducts then carry the milk to the nipples.



Research states that LCIS is NOT cancer, but a marker for higher risk of developing cancer in the future ( approx 20 o/o). LCIS is usually multi focal and has a high incidence of occurring in the opposite breast as well.



While most women who have LCIS will not develop cancer over their lifetime, if a cancer does progress it can be in the form of DCIS ( an early form of ductal) , ILC, or IDC both which happen to be invasive to their respective tissue areas.



I see from your profile that IDC was your dx, and that LCIS or ILC were never an

issue. (?). IDC typically does not have the same risk factor for occurring in the opposite breast.



Two questions you might want to ask your onc based on your dx, what is your risk factor of developing the same in the opposite breast? And what does ＂lobular involvement" mean? It could just be that yours was located at the end of the duct closest to the lobule.



Hope this helps.

auntiems3

Msippiqueen, the www.nature.....link was quite interesting. One I have not come across before, thanks!

GreenMonkey

Hello everyone, 

I just finished reading this thread and I realize its been awhile since anyone posted but I had a question or two.  I read somewhere along the line that LCIS is uncommon. I'm curious how "uncommon" it is to have it in both breasts. I also read that LCIS typically does not show up in a mammo. Mine did not. So, if you were diagnosed with LCIS how was it detected? 

After numerous mammo's, 2 biopsy's and an MRI, I had a BMX (against the advise of Memorial Sloan Ketterings Head Breast Surgeon) knowing I had high grade DCIS on my right and ADH on my left. Both were removed during the biopsy. My final pathology report also showed: 

Left - focal lobular carcinoma in situ (LCIS), columnar cell changes with and without atypia, fibroadenomatoid changes, microcysts and a few microcalcifications. 

Right - Lobular carcinoma in situ (LCIS) AND ATYPICAL LOBULAR HYPERPLASIA (ALH) 

What is the difference between focal lobular and lobular?

How "common" is it to have LCIS and DCIS - or perhaps a better way to word that is what percentage of LCIS progresses to DCIS? 

Is LCIS more likely to progress to DCIS or ILC?

Needless to say, I am very pleased with my decision to have a BMX. 

I was premenopausal, ER+, no family history

PR test, HER2 test was not done. (this annoys me)

(missqueen - "chose" and "choose" - I mess those up allll the time! along with then and than)

longislandmom

green monkey-- sounds like you and i had very similar pathology.  i had high grade DCIS with some foci of lcis in left breast.  mammo nothing showed in right breast until after my bmx.  final path found there was atypia with columnar cell changes, there.  not sure if LCIS progresses to DCIS-- but every consult i had told me it most definitely increased my chance of bc in my contralateral breast, which contributed(though not the only reason) to my decision to have a bmx.  i didn't need "validation"-- but the fact they found atypia in my right breast leads me to believe that at some point in the future, had i had just a lumpectomy & rads in left (recommended)..i would be facing BC in right with fewer options.    i too was premenopausal, er+

MelissaDallas

GreenMonkey, LCIS tends to be diffusely through both breasts. I have sclerosing adenosis that presented as a mass with calcifications on my mammogram. When that was biopsied they also found ALH suspicious for LCIS. Had excisional biopsy, LCIS confirmed.



I so hope I get nothing more serious. Oncology will not let me take anti-hormonals because of risk of blood clots because I had a pulmonary embolism when I had ovarian cancer.

auntiems3

Hi Greenmonkey,

From experience and research, LCIS is fairly rare and difficult to diagnose.  It does not show up on a mammogram since the cells are diffuse, and it is usually found on a biopsy for something else.  Mine was discovered upon excision of a recurring complex cyst.  In my opinion, focal lobular and lobular mean exactly the same thing. 

LCIS can become DCIS and or ILC or IDC.  What matters most is that this type of condition increases the risk of developing cancer as each year passes.  Once LCIS is diagnosed, the risk for developing cancer increases one percent each year and will continue for decades.  If LCIS develops into an invasive cancer, the contralateral breast has an 80% chance of developing cancer as well.  This is very much unlike DCIS or IDC.

This is the reason why patients who have been diagnosed with LCIS sometimes choose to have a PBMX done to eliminate the possibility to develop CA in either breast.

Personally,   I was diagnosed in 2008 and did the "increased surveillence" for 5 years. I am tired of being constantly anxious every six months between mammograms and MRI s and 4 biopsies.  If I were older ( I am 55 with a  sixteen year old daughter) I might consider tamoxifen or evista as a preventative measure. But, I have so much to consider, including the fact that my husband's first wife battled and lost her fight against breast cancer for 7 years. 

I am DONE.  I plan to have my PBMX in May 2013.  I give you GREAT KUDOS for making the decision you did and in the words of many I have spoken to regarding this type of decision.....don't look back.  You are in a better place and will NEVER regret your choice!

Sincerely, Marie