What are the types of breast cancer?

As the title suggests, breast cancer is not a single disease. It is a group with subtypes requiring different treatments. Appropriate treatment requires knowing which type is present.

This section examines types by microscopic and biological characteristics. First, we discuss the 2 earliest forms, ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).

Ductal carcinoma in situ - DCIS

Cells lining breast milk ducts begin becoming abnormal; this is a very early breast cancer stage. If a biopsy reports DCIS, some cells in your breast ducts have begun turning cancerous.

DCIS can be high, intermediate or low grade. High-grade tumors tend to proliferate faster, recur more often after treatment and more readily become conventional breast cancer (invasive ductal carcinoma).

The main treatment for high- and intermediate-grade DCIS is surgery removing the tumor with some surrounding normal tissue. This is called “wide local excision” or “lumpectomy.” Recently reported research found no additional survival benefit from surgery for low-grade tumors; active monitoring with breast examination every 6-12 months and annual mammography should be considered an option.

Lobular carcinoma in situ - LCIS

Cells in the lobules where milk production begins become abnormal. This is not cancer. LCIS diagnosis means increased future breast cancer risk, but most women with LCIS will not develop breast cancer.

LCIS does not appear on mammography and usually causes no complaints. It is often found in biopsies performed for various reasons or microscopic examination of tissue removed during breast surgery. Because most affected women will not develop breast cancer, immediate treatment is unnecessary. Instead, active monitoring with examination every 6-12 months and annual mammography is recommended.

Invasive breast cancer

This is the most common type, such that "breast cancer" and "invasive breast cancer" are used synonymously. Invasive ductal and invasive lobular carcinoma are the most common subtypes.

Invasive (or infiltrating) ductal carcinoma)

Of every 10 breast cancers, 8 are this type. Invasive ductal carcinoma (IDC) begins in cells lining the milk ducts and spreads into fatty breast tissue. At that point, it can spread (metastasize) elsewhere through blood or lymph.

Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma begins in milk-producing glands. Like IDC, it can spread elsewhere (metastasize). Detecting it on mammography is harder than detecting IDC. İ

nvasive breast cancer may be treated with one or more of the following options suitable for you

• Surgery
• Chemotherapy
• Radiotherapy
• Hormonal therapy
• Smart drug therapy

Click the links above for detailed treatment information. Another important treatment determinant is the stage of the disease, which provides information about size and spread.

Inflammatory breast cancer

It accounts for %1-4 of breast cancers. It is called inflammatory because the breast develops a widespread inflamed appearance, caused by cancer cells blocking small lymphatic vessels.

The widespread inflammation produces swollen, red, firm and warm breast tissue.

Symptoms and complaints may appear rapidly. Because they are very similar, it can be confused with breast infection (mastitis). Mastitis is uncommon in women who are not breastfeeding or pregnant, and very rare after menopause; it also responds well to antibiotics.

Treatment differs somewhat from other breast cancers. It normally begins with chemotherapy. Responders are assessed for surgical suitability. After surgery, radiotherapy radiotherapy is given to prevent local recurrence. Hormonal and targeted treatments may also be used according to biological and genetic characteristics.

Paget's disease

Paget's Disease is another breast cancer-related condition, occurring in every 100 breast cancers in 1 - 4.

It begins in the nipple or surrounding dark area (areola), initially as a red, scaly rash that may itch. Untreated or scratched, it may bleed, ulcerate and crust. It closely resembles psoriasis or eczema and may therefore be diagnosed late.

Diagnosis requires surgical removal of a small affected tissue sample (biopsy). If Paget's Disease is diagnosed, your physician will request mammography, because in many patients it may indicate cancer in breast tissue behind the nipple.

What is the treatment for Paget's Disease?

The whole breast or affected area may be removed surgically. Further treatment depends on whether invasive breast cancer is found in the removed tissue.

Rare types of breast cancer

Physicians have developed ways to classify breast cancers into groups. Rare cancers are called special type (special type), while common cancers are called no special type (no special type). As noted above, more than %90 of breast cancers are invasive cancers of no special type.

The names of rare cancers called special-type breast cancers are listed below.

• Medullary breast cancer: treated like conventional breast cancer. It is known to be associated with a BRCA 1 mutation.
• Mucinous breast cancer: tends to grow and spread slowly. It is treated like other breast cancers. If smaller than 1 cm, underarm lymph nodes need not be removed.
• Tubular breast cancer: Treated like other breast cancers, with a low risk of recurrence after treatment.
• Adenoid cystic breast cancer: usually grows slowly. Removing the entire breast is usually unnecessary; wide local excision, removing the tumor with some normal surrounding tissue, is preferred.
• Metaplastic breast cancer: a mixture of 2 cell types. It is treated like other breast cancers with surgery, chemotherapy and radiotherapy, but metaplastic tumors tend not to respond to hormonal therapy.
• Angiosarcoma of the breast: very rare, and a type of breast sarcoma. Sarcomasare cancers of structural and supporting tissues such as connective tissue, bone, blood vessels and nerves. Angiosarcoma, sometimes called hemangiosarcoma, originates in blood or lymph vessel cells. It often presents as a tumor larger than 4 cm, causing bluish overlying skin. Risk is higher after mastectomy for breast cancer or radiotherapy. Treatment is chemotherapy and surgery.
• Basal-type breast cancer: results from genetic changes. The gene P53 is mutated or lost. Basal-type cancers are frequently triple-negative, meaning their cells carry no estrogen, progesterone or Her2 receptors. Treatment is surgery, chemotherapy and radiotherapy.
• Phyllodes or cystosarcoma phyllodes: a breast tumor that can be malignant or benign. If malignant, it can spread to lymph nodes, but this is rare. The main treatment is surgery.
• Papillary breast cancer: these tumors usually affect older women. Rarely, they can also be benign. They tend to grow slowly and not spread elsewhere; surgery is the main treatment.

Breast cancer in men

Male breast cancer is very rare. Approximately every 150 female cases correspond to 1 male case.

Symptoms, diagnosis and treatment closely resemble female breast cancer, while risk factors and causes differ somewhat. Surgery also differs in men. Although much explanatory information exists for women, information about male breast cancer is insufficient.

The most important symptom in men is swelling in the breast area, almost always painless.

Breast cancer types according to tumor biology

Dear readers, breast cancer treatment is among the fields with the most innovation and knowledge accumulation recently. Until ten years ago, we roughly classified it by sensitivity to estrogen as two groups, sensitive and insensitive. This knowledge has changed: besides the cellular subtypes listed above, breast cancer has been discovered to have 4 main biological types. These require different strategies personalized to the individual and their tumor.

1. Estrogen-sensitive tumors (Luminal A)
2. Estrogen-sensitive tumors also carrying the Her2 receptor (Luminal B)
3. Estrogen-insensitive tumors carrying Her2 receptors (Her2-positive)
4. Tumors carrying neither estrogen hormone nor Her2 receptors (Triple-negative breast cancer, also called basal type)

Our choice of the most appropriate treatment depends on:

• Cancer stage
• How abnormal cells look under the microscope (grade)
• Whether cancer cells carry receptors for particular hormones
• Whether cancer cells carry receptors for targeted treatments

If you wish, visit our breast cancer page for more information.

You can also call 05065354826 for information. We would be happy to answer any question.