Invasive Lobular Carcinoma: A Comprehensive Review

Abstract

Introduction

Invasive Lobular Carcinoma (ILC) is a type of breast cancer originating in the milk-producing glands (lobules) and is the second most common breast cancer, accounting for about 10% of cases. Unlike invasive ductal carcinoma (IDC), ILC has distinct molecular features, including a lack of E-cadherin protein, leading to a unique single-file growth pattern and often bilateral breast involvement. It tends to be hormone receptor-positive and HER2-negative, which affects treatment responses.

Causes and Genetics: ILC arises from mutations in the CDH1 gene, affecting E-cadherin function. Germline mutations in CDH1 and BRCA2 increase ILC risk, while BRCA1 mutations do not. ILC tumors are often heterogeneous and more difficult to detect through conventional exams due to their diffuse growth.

Risk Factors: Increased exposure to female hormones, either endogenous (early menarche, late menopause, low parity) or exogenous (hormone therapy, oral contraceptives), elevates risk. Lifestyle factors like alcohol consumption and postmenopausal obesity also increase risk.

Signs and Symptoms: Early ILC may be asymptomatic. Advanced signs include breast texture changes, nipple inversion, breast asymmetry, pain, and non-milk nipple discharge. ILC stages range from small localized tumors to metastatic spread, with unusual metastasis sites like the colon and ovaries.

Diagnosis: ILC is challenging to detect due to its growth pattern. Mammograms have limited sensitivity (57-81%). Ultrasound and MRI improve detection, with MRI having the highest sensitivity (93-100%). Breast-specific gamma imaging (BSGI) is an emerging diagnostic tool. Biopsy confirms diagnosis.

Treatment: Multidisciplinary approaches include:

• Surgery: Lumpectomy (breast-conserving) for early stages or mastectomy for larger/multifocal tumors.

• Radiation Therapy: Post-surgery to reduce recurrence.

• Chemotherapy: Pre- or post-surgery based on tumor features.

• Hormone Therapy: For hormone receptor-positive tumors to block estrogen effects.

• Targeted Therapy: Usually less effective in ILC due to low HER2 expression but used when applicable.

Conclusion

Invasive lobular carcinoma is a slow-growing cancer and often an under-recognized subtype of breast cancer that differs significantly from the more common invasive ductal carcinoma in terms of pathology, biological behavior, and clinical presentation. Due to its diffuse growth pattern, bilateral involvement, and subtle radiological findings, it is harder to diagnose. Imaging advances and better understanding of cause, risk factors, signs and symptoms, stages, and grades improve ILC diagnosis. Despite generally being hormone receptor positive and HER2-negative, ILC responds unpredictably to conventional therapies, underscoring the importance of personalized treatment strategies. More people knowing about this type of breast cancer and using a multidisciplinary approach to treat it can help find it early, make better treatment choices, and give people who have it a better outlook.

References

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Copyright

Copyright © 2025 Ms. Diksha Maheshwari, Mr. Mukulraj Singh Rao, Mr. Adtiya Pant, Dr. B. S. Sonigara. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.