Treatment of Tubular Carcinoma of the Breast

You and your doctor will work together to develop your treatment plan. If you have a true tubular carcinoma — made up mostly of the characteristic tube-shaped cells, without other types of breast cancer cells mixed in — it probably won’t require as much treatment as invasive ductal carcinoma does. If invasive ductal carcinoma (IDC) is found in the same or the other breast, the treatment plan will reflect this fact and will likely be different than the treatment plan for tubular carcinoma alone. Tubular carcinoma alone tends to be small and usually does 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. Some lymph nodes may be removed as well.
    • Total or simple mastectomy: The surgeon removes the breast without removal of any 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: The surgeon removes the breast, the lining of the chest wall muscle, and some of the lymph nodes under the arm. Since tubular carcinoma is usually small and doesn’t tend to spread, this type of mastectomy is not commonly done.
  • Adjuvant (additional) therapy, such as chemotherapy, radiation therapy, and/or hormonal therapy.
    • 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.
    • Lumpectomy may be followed by radiation therapy, which directs high-energy rays at the area where the cancer was to destroy any remaining cancer cells. Although radiation therapy is considered standard after lumpectomy, some doctors may feel it is not needed for tubular carcinoma, especially in cases where the tumor is very small.
    • 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 tubular carcinomas are estrogen-receptor-positive, which means that hormonal therapy is likely to be effective.

    Many doctors base their recommendations about hormonal therapy and chemotherapy for tubular 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 keep in mind that individual doctors may have different opinions about whether additional treatment is needed for tubular 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 recommended, but no other treatment is needed.
    • 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 having more treatment beyond surgery. There is some ongoing debate over how necessary additional treatment is in cases of tubular carcinoma. Because this type of tumor is small and slow-growing, some experts feel that more treatment may not have much benefit. This decision likely will come down to what you and your doctor feel is best for you.

Most tubular 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.

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