Invasive ductal carcinoma is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas. According to the American Cancer Society, more than 180,000 women are diagnosed with invasive breast cancer every year in the United States. About two-thirds of women are 55 or older when they are diagnosed with invasive breast cancer and invasive ductal carcinoma can also affect men.
Invasive ductal carcinoma starts in a milk duct in the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. Ductal means that the cancer began in the milk ducts which carry milk from the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that involve internal organs, such as breast tissue. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body. Breast cancer cells can make their way to the lymph nodes under the arm, which offer them a pathway to other parts of the body.
In most cases, surgery is the first treatment for invasive ductal carcinoma. There are a number of surgical options, including lumpectomy, mastectomy and radical mastectomy. The surgical choice will depend on the size and extent of the tumor as well the patient--male or female--has the genetic predisposition for breast cancer as a result of the BRCA1 gene mutation.
How is Invasive Ductal Carcinoma Diagnosed?
During a sentinel node lymph node dissection, your surgeon looks for the first lymph node--the "sentinel node"--that filters fluid draining away from the area of the breast that contains the cancer. The sentinel lymph node is more likely than any other lymph node to contain cancer.
A biopsy is done when mammograms, other imaging tests, or a physical examination, shows a breast change that may be cancer. A biopsy is the only sure way to diagnose breast cancer. During a biopsy, a surgeon will remove cells from the suspicous area so they can be studied in the lab to determine if cancer cells are present. There are different kinds of breast biopsies--some use a needle and some use an incision.
A core biopsy uses a larger needle to sample breast changes felt by the doctor or pinpointed by ultrasound or mammogram. In a fine needle aspiration biopsy, a very thin, hollow needle attached to a syringe is used to withdraw (aspirate) a small amount of tissue from a suspicious area. The needle used for a fine needle biopsy is thinner than one used for blood tests. In rare cases, surgery is needed to remove all or part of the lump for testing. This is called a surgical biopsy or an open biopsy.
Breast MRI may also be done to diagnose invasive ductal carcinoma and requires special equipment. This MRI machine is called an MRI with dedicated breast coils. Not all hospitals and imaging centers have dedicated breast MRI equipment.
What Imaging Tests Can Detect a Recurrence of Breast Cancer?
PET (Positron Emission Tomography) scans can detect the spread of cancer. PET scan provides metabolic imaging that shows how the body's organs metabolize a radioactive compound in your body. A PET scan uses a small amount of radioactive drug, or tracer, to show differences between healthy tissue and diseased tissue. Before the PET scan, a small amount of FDG (fluorodeoxyglucose) is injected into the patient. Uptake is the amount of radioactive sugar that the cells are using for metabolism.
Tumor cells have a high rate of metabolism and because of this, they take up more of the radioactive glucose (FDG). The rate of uptake of FDG by the tumor cells is proportional to their metabolic activity. When a PET scan detects uptake on the FDG tracer, it means it might be cancer, but is not definite. When a PET scan does not show uptake (meaning it is not hot), there is unlikely to be cancer.
What is the Prognosis for Patients with Invasive Ductal Carcinoma?
Following surgery, cancer cells removed from the breast are checked under a microscope and the cancer cells are given a grade. The grade is based on how much the cancer cells look like normal cells and is used to predict the prognosis. Based upon the size of the tumor and the grade of the cancer cells, your doctor will make a prognosis based upon the stage of invasive breast cancer.
A lower grade ("well differentiated") means the cancer is slower growing and less likely to spread. A higher grade ("poorly differentiated") means a faster growing cancer. "Poorly differentiated" cancer cells (a/k/a high grade breast cancer) look very different from normal cells and will probably grow and spread faster. "Moderately differentiated" cancer cells are growing at a speed of and look like cells between high ("poorly differentiated") and low grade ("well differentiated"). Necrosis (areas of dead or dying cancer cells) means the tumor is growing quickly.
Have Questions About Invasive Ductal Carcinoma?
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