Invasive ductal breast cancer

Most breast cancers fall into this category. You may also hear this type of breast cancer called ‘no special type’.

A diagnosis of invasive ductal breast cancer means that cancer cells have developed within the milk ducts but have spread outside the ducts to the surrounding breast tissue. Invasive ductal breast cancer also has the potential to spread to other parts of the body.

Symptoms

There are a number of different symptoms for invasive ductal breast cancer. A change in the size of a breast, a lump or thickening of the skin, changes to the nipple, puckering or dimpling of the skin and swelling under the arm can all be signs of invasive ductal breast cancer.

Diagnosis

A range of tests will be done to help make the diagnosis. They include a clinical examination, mammogram, ultrasound scan, fine needle aspiration and/or needle core biopsy. These investigations are known as triple assessment.

Treatment

The aim of treatment is to remove the cancer in the breast and destroy any cancer cells that may have already spread from the breast through the bloodstream or the lymphatic system into the rest of the body.

Surgery

As for most types of breast cancer, surgery will usually be the first treatment. You may be offered breast-conserving surgery or a mastectomy, with or without breast reconstruction.

Breast conserving surgery, usually referred to as wide local excision or lumpectomy, is the removal of the cancer with a margin (border) of normal breast tissue around it. A mastectomy is the removal of all the breast tissue including the nipple.

You may be given a choice between these two types of surgery. If a wide local excision is possible, then it is important that a clear margin of tissue is taken from around the cancer. If a clear margin of tissue is not seen when the area removed is examined under the microscope, then sometimes a second operation is needed.

Your doctors will also want to check whether breast cancer cells have spread from the breast to the lymph nodes (glands) under the arm (the axilla). This helps them decide whether you will benefit from additional treatment after surgery, such as chemotherapy.

To see whether or not any of the lymph nodes under the arm contain cancer cells, your surgeon may wish to do an operation to remove some (a lymph node sample) or all of them (a lymph node clearance). Another way of checking the lymph nodes under the arm is called ‘sentinel node biopsy’. This identifies whether or not the first lymph node (or nodes) is clear of cancer cells. If it is, this usually means the other nodes are clear too, so no more will need to be removed. However, sentinel node biopsy is not appropriate for everyone and your surgeon will discuss whether or not this procedure is an option for you.

Adjuvant (additional) treatment

These are treatments given in addition to surgery and include chemotherapy, radiotherapy, hormone therapy and targeted therapies. The aim of adjuvant treatment is to reduce the risk of the cancer coming back in the same breast (local recurrence), the opposite breast or elsewhere in the body.

If you have a wide local excision you will usually be offered radiotherapy to reduce the risk of the cancer coming back in the same breast. If you have a mastectomy you may not need radiotherapy.

For many people chemotherapy is recommended, for example if the cancer has spread to the lymph glands in the armpit.

You may be offered hormone therapy if your cancer is oestrogen receptor positive, which means that it depends on the hormone oestrogen for growth.

Targeted therapies, such as trastuzumab (Herceptin), may be offered to people who are HER2 positive usually after surgery and chemotherapy.