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Oncologic Treatment of Breast Cancer

Oncologic treatment Case 2 Lobular carcinoma in situ

Authors: Sarah Gierahn Nielsen, med. student & Hanne Melgaard Nielsen, MD

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Step 1: Patophysiology

Lobular carcinoma in situ (LCIS) is a non-invasive lesion , where abnormal cells develop in the milk glands, known as lobules. .

  • In Denmark, LCIS is considered a precursor for developing invasive lobular carcinoma later on.[4]
  • There are no clinical features – only 40% of the cases are associated with microcalcifications. In most cases it is an incidental finding in a biopsy for some other mass producing lesion such as a fibroadenoma.
  • In Denmark, more than 90% are diagnosed in premenopausal women, and the mean age are 45 years.
  • Studies shown that it is often multicentric (70%) and frequently bilateral (22%-60%) [5]
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Step 2: Predictive factors

To distinguish whether possible predictive factors exists for developing invasive lobular carcinoma, the registration of the following is of uttermost importance

  • Genetic predisposition
  • Nulliparity
  • Age at first-time birth
  • Age at menarche
  • Previously biopsies with/without ALH/LCIS
  • Menopause
  • Hormone replacement therapy
  • HRT.
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Step 3: Excisional biopsy

Recommended treatment in Denmark according to Danish Breast Cancer Group (DBCG) if the excisional biopsy shows lobular carcinoma

  • Clinical control scans every second year
  • Mammography
  • Participation in clinical trials with anti-estrogen treatment
  • Bilateral mastectomy under certain circumstances – (eg. patients wish or patients with other predictive factors)
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Step 4: Core needle biopsy

Recommended treatment in Denmark according to Danish Breast Cancer Group (DBCG) if the core needle biopsy shows lobular carcinoma

  • If the mammography and ultrasound is normal (eg. without any suspicious abnormality), treatment is as according to treatment mentioned above.
  • If the mammography and ultrasound is positive (eg. with any suspicious abnormality) an excisional biopsy will determine any further treatment.

Acknowledgements

Illustrators: Caroline Lilja, med. student


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Ductal carcinoma in situ


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