Cribriform Carcinoma of the Breast

In invasive cribriform carcinoma, the cancer cells invade the stroma (connective tissues of the breast) in nestlike formations between the ducts and lobules. Within the tumor, there are distinctive holes in between the cancer cells, making it look something like Swiss cheese. Invasive cribriform carcinoma is usually low grade, meaning that its cells look and behave somewhat like normal, healthy breast cells. In about 5-6% of invasive breast cancers, some portion of the tumor can be considered cribriform. Usually, some ductal carcinoma in situ (DCIS) of the cribriform type is present as well.

For information about how cribriform invasive carcinoma is treated, see the section on treatment for invasive ductal carcinoma.

Papillary Carcinoma of the Breast

Invasive papillary carcinomas of the breast are rare, accounting for less than 1-2% of invasive breast cancers. In most cases, these types of tumors are diagnosed in older women who have already been through menopause. An invasive papillary carcinoma usually has a well-defined border and is made up of small, finger-like projections. Often it is Grade 2, or moderate grade, on a scale of 1 to 3 — with Grade 1 describing cancer cells that look and behave somewhat like normal, healthy breast cells, and Grade 3 describing very abnormal, fast-growing cancer cells. In most cases of invasive papillary carcinoma, ductal carcinoma in situ (DCIS) is also present. (DCIS is a type of cancer in which the carcinoma cells are confined to the breast duct.)

For information about how papillary invasive carcinoma is treated, see the section on treatment for invasive ductal carcinoma.

Follow-up Care for Mucinous Carcinoma of the Breast

After treatment, you and your doctor will work together to come up with a schedule of follow-up visits and exams that is right for your situation. Your schedule may include the following tests and exams:

  • You’ll likely have a physical exam and medical history every 4-6 months for 5 years, and then every year after that. If you are taking tamoxifen or other forms of hormonal therapy, you can consult with your doctor about treatment for any side effects you may experience.
  • If you had lumpectomy or breast-conserving surgery, you’ll arrange for a mammogram of the affected breast 6 months after radiation is completed, and then mammography on both breasts every year.
  • If you had mastectomy, you’ll schedule a mammogram of the remaining breast every year. If you are considered high-risk for developing another breast cancer, whether due to strong family history or a positive genetic test for BRCA1 or BRCA2 mutations, your doctor may recommend breast MRI in addition to yearly mammograms.
  • If you are taking tamoxifen, you’ll have a physical exam and medical history taken by a gynecologist every year, because this medication can increase the risk of cancer of the uterus. Any unusual symptoms, such as abnormal bleeding, should be reported immediately to your doctor. (If you have had a hysterectomy and no longer have a uterus, this recommendation does not apply to you.)
  • If your treatments have put you into menopause early or you have already gone through menopause naturally and are taking an aromatase inhibitor, you’ll need regular monitoring of your bone health with a bone density test. Having lower levels of estrogen in the body, which is a result of early menopause or taking an aromatase inhibitor, can impact bone health.

You may need to have additional tests or more frequent office visits, depending on your individual needs. Ask your doctor what he or she recommend

Treatment of Mucinous Carcinoma of the Breast

You and your doctor will work together to develop a treatment plan for mucinous carcinoma of the breast. Pure mucinous carcinoma is easier to treat than invasive ductal carcinoma, so it may not require as much treatment — especially if the tumor is small and the cancer has not spread to the lymph nodes.

Your plan can include:

  • Surgery to remove the cancer and any affected lymph nodes. Possible procedures are:
    • Lumpectomy: The surgeon removes only the part of your breast containing the tumor (the “lump”) and some of the normal tissue that surrounds it. Your doctor may also remove some lymph nodes.
    • Total or simple mastectomy: Removal of the breast without removal of the axillary (underarm) lymph nodes. A sentinel node biopsy may be performed to check the node or nodes closest to the tumor for any signs of cancer spread.
    • Modified radical mastectomy: Surgery to remove the breast, the lining of the chest wall muscle, and some of the lymph nodes under the arm. Since pure mucinous carcinoma does not usually spread outside the original tumor, this type of mastectomy is not commonly done.
  • Adjuvant (additional) therapy, such as hormonal therapy and/or chemotherapy.
    • Hormonal therapy involves taking medications such as tamoxifen or an aromatase inhibitor, which either block the effects of estrogen or lower the amount of estrogen in the body. Almost all mucinous carcinomas are estrogen-receptor-positive, which means that hormonal therapy is likely to be an effective treatment. Adjuvant hormonal therapy is given to lower the chances of the breast cancer coming back.
    • Chemotherapy involves taking anti-cancer medicines in the form of a pill or directly into a vein. The medicines travel through the bloodstream to all parts of the body. The main goal is to destroy any cancer cells that may have broken away from the original tumor. There is some ongoing debate over how necessary chemotherapy is in cases of pure mucinous carcinoma.

    Many doctors base their recommendations about adjuvant therapy for mucinous carcinoma on the size of the tumor and whether or not there is evidence of cancer in the lymph nodes. Some general guidelines follow — but remember that individual doctors may have different opinions about whether additional treatment is needed for mucinous carcinoma.

    • If the tumor is smaller than 1 cm, with no cancer or just a very small amount of cancer in one lymph node: Hormonal therapy may be used, but no other treatment is needed after surgery.
    • If the tumor is between 1 and 2.9 cm in size, with no cancer or just a very small amount of cancer found in one lymph node: Chemotherapy may be considered along with hormonal therapy.
    • If the tumor is 3 cm or larger and there is spread to the lymph nodes: Chemotherapy is more strongly recommended, with the addition of hormonal therapy.

You and your doctor can discuss all of the risks and benefits of additional treatment beyond surgery. This decision may come down to what you and your doctor feel is best for you.

Most mucinous carcinomas test negative for receptors for the protein HER2/neu, so they usually would not be treated with Herceptin (chemical name: trastumuzab). Still, be sure to confirm with your doctor whether or not you are a candidate for this medication, which targets receptors for HER2.

Symptoms and Diagnosis of Mucinous Carcinoma of the Breast

In this section you can learn about symptoms of mucinous carcinoma and different diagnosing methods.

Signs and symptoms

Like other types of breast cancer, mucinous carcinoma of the breast may not cause any symptoms at first. Over time, a lump may grow large enough to be felt during breast self-exam or examination by a doctor. The tumors tend to range in size from 1 cm to 5 cm.

Diagnosis

Diagnosing mucinous carcinoma usually involves a combination of steps:

  • A physical examination of the breasts. Your doctor may be able to feel the lump in the breast, or you may feel it yourself during a breast self-exam.
  • A mammogram to locate the tumor and check for evidence of cancer in other areas of the breast. A screening mammogram may be able to detect a mucinous carcinoma, but it often looks like a benign (non-cancerous) breast lump. A mucinous carcinoma has well-defined edges and pushes against nearby healthy breast tissue, but does not invade it (grow into it).
  • Ultrasound uses sound waves to obtain images of breast tissue.
  • MRI to obtain additional images of the breast and check for other areas of cancer.
  • Biopsy involves making a small incision and taking out all of the tumor, or using a special needle to remove tissue samples from the suspicious area, for examination under a microscope. Biopsy is the key to accurate diagnosis, because imaging tests alone can’t tell the difference between mucinous carcinoma, other types of breast cancer, and benign breast lumps.

When a pathologist examines the tissue under a microscope, he or she looks for small clusters of tumor cells that appear to “float” in pools of mucin. The tumor may be made up mostly of mucin, or it may be made up mostly of cancer cells separated by small amounts of mucin.

Mucinous carcinoma also can be found near, or mixed in with, other more common types of breast cancer. Sometimes a ductal carcinoma in situ (or DCIS, cancer that has not spread outside the milk duct) is found near the mucinous carcinoma. A mucinous carcinoma also may have some areas within it that contain invasive ductal carcinoma cells. If the invasive ductal carcinoma cells make up more than 10% of the tumor, the cancer would be called a “mixed” mucinous carcinoma. A “pure” mucinous carcinoma means that at least 90% of the cells are mucinous.

As with the other rare subtypes of breast cancer, diagnosing mucinous carcinoma takes special skill. You may want to seek a second opinion from another hospital pathology lab if this is your diagnosis.

There are some other key features of pure mucinous carcinoma:

  • Hormone-receptor-positive: Studies show that pure mucinous carcinoma tests positive for estrogen receptors 90-100% of the time and for progesterone receptors in 50-68% of cases.
  • HER2-negative: Mucinous carcinoma usually tests negative for receptors for the protein HER2/neu.
  • Negative lymph nodes: Pure mucinous carcinoma rarely spreads to the lymph nodes, especially if the tumor is 1-2 cm or smaller. Larger tumors may involve spread to the lymph nodes. Sometimes, cancer in the lymph nodes indicates that the tumor is actually a mixed mucinous carcinoma, with invasive ductal carcinoma cells present.

Mucinous Carcinoma of the Breast

Mucinous carcinoma of the breast — sometimes called colloid carcinoma — is a rare form of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it). Mucinous carcinoma of the breast accounts for about 2-3% of all breast cancer cases. In this type of cancer, the tumor is formed from abnormal cells that “float” in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus.

Normally, mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver, and other vital organs. Many types of cancer cells — including most breast cancer cells — produce some mucus. In mucinous carcinoma, however, the mucus becomes a main part of the tumor and surrounds the breast cancer cells.

Mucinous carcinoma tends to affect women after they’ve gone through menopause. Some studies have found that the usual age at diagnosis is 60 or older.

Mucinous carcinoma is less likely to spread to the lymph nodes than other types of breast cancer. It’s also easier to treat.

On the following pages, you can learn more about:

Follow-up Care for Medullary Carcinoma of the Breast

After treatment, you and your doctor will work together to come up with a schedule of follow-up visits and exams that is right for your situation. Your schedule may include the following tests and exams:

  • You’ll likely have a physical exam and medical history every 4-6 months for 5 years, and then every year after that. If you are taking tamoxifen or other forms of hormonal therapy, you can consult with your doctor about treatment for any side effects you may experience.
  • If you had lumpectomy or breast-conserving surgery, you’ll arrange for a mammogram of the affected breast 6 months after radiation is completed, and then mammography on both breasts every year.
  • If you had mastectomy, you’ll schedule a mammogram of the remaining breast every year. If you are considered high-risk for developing another breast cancer, whether due to strong family history or a positive genetic test for BRCA1 or BRCA2 mutations, your doctor may recommend breast MRI in addition to yearly mammograms.
  • If you are taking tamoxifen, you’ll have a physical exam and medical history taken by a gynecologist every year, because this medication can increase the risk of cancer of the uterus. Any unusual symptoms, such as abnormal bleeding, should be reported immediately to your doctor. (If you have had a hysterectomy and no longer have a uterus, this recommendation does not apply to you.)
  • If your treatments have put you into menopause early or you have already gone through menopause naturally and are taking an aromatase inhibitor, you’ll need regular monitoring of your bone health with a bone density test. Having lower levels of estrogen in the body, which is a result of early menopause or taking an aromatase inhibitor, can impact bone health.

You may need to have additional tests or more frequent office visits, depending on your individual needs. Ask your doctor what he or she recommends.

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