Treatment

Your treatment options for invasive lobular carcinoma depend on the aggressiveness of your cancer, its stage, your overall health and your preferences. Treatment often consists of surgery and additional (adjuvant) therapy, which may include chemotherapy, radiation and hormone therapy.

Surgery

Surgery for invasive lobular carcinoma may include:

• Removing the cancer and a small portion of healthy tissue. Called a lumpectomy (wide local excision), this procedure allows you to keep most of your breast tissue.

  The surgeon removes the tumor itself, as well as a margin of normal tissue surrounding the tumor to make sure all the cancer that can be removed is taken out.

  If the tissue around the tumor shows signs of cancer cells (positive margins), you may need additional surgery until negative margins are achieved. In some cases, this may mean removing all of the breast tissue.

• Removing all of the breast tissue. Mastectomy is an operation to remove all of your breast tissue. During a total (simple) mastectomy the surgeon removes all of the breast tissue — the lobules, ducts, fatty tissue and skin, including the nipple and areola. Some other types of mastectomy may leave the skin or the nipple in place and may be options based on your specific situation.

• Sentinel lymph node biopsy. To determine whether cancer has spread to the lymph nodes near your breast, your surgeon identifies the first few lymph nodes that receive the lymph drainage from your cancer. These lymph nodes are removed and tested for breast cancer cells (sentinel node biopsy).

  If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed.

• Axillary lymph node dissection. If cancer is found in the sentinel node, then your surgeon may remove additional lymph nodes in your armpit (axillary lymph node dissection).

  Knowing if cancer has spread to the lymph nodes helps determine the best course of treatment, including whether you'll need chemotherapy or radiation therapy.

Hormone therapy

Hormone therapy — perhaps more properly termed hormone-blocking therapy — is often used to treat breast cancers that are sensitive to hormones. Most invasive lobular carcinomas are hormone receptor positive, meaning they use hormones to grow.

To decrease the chance of your cancer returning, hormone therapy can be used before or after surgery or other treatments. If the cancer has already spread, hormone therapy may shrink and control it.

Treatments that can be used in hormone therapy include:

• Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)
• Medications that stop the body from making estrogen after menopause (aromatase inhibitors)
• Surgery or medications to stop hormone production in the ovaries

Radiation therapy

Radiation therapy uses high-powered energy, such as X-rays and protons, to kill cancer cells.

During radiation therapy, you lie on a table while a large machine moves around you, directing energy beams at precise points in your breast.

Radiation therapy may be recommended after a lumpectomy. It may also be recommended after a mastectomy if your cancer was large or involved the lymph nodes.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Treatment often involves receiving two or more drugs in different combinations.

Chemotherapy can be given through a vein, in pill form or both ways.

Chemotherapy may be recommended after surgery to kill any cells that may remain.

Chemotherapy can also be used before surgery to shrink a tumor that is large. For women with larger tumors, chemotherapy before surgery may make it possible to choose lumpectomy over mastectomy.