1. What is invasive ductal breast cancer?
2. How does invasive ductal breast cancer start?
3. What are the symptoms of invasive ductal breast cancer?
4. How is invasive ductal breast cancer diagnosed?
5. How is invasive ductal breast cancer treated?
6. Further support
Invasive ductal breast cancer is the most common type of breast cancer in both women and men and accounts for about 75% of all breast cancers.
We use the term invasive ductal breast cancer although this type of breast cancer is also known as:
- Invasive ductal breast cancer (IDC)
- Invasive ductal carcinoma of the breast (IDC)
- Invasive breast cancer of no special type (NST)
- Breast cancer not otherwise specified (NOS).
It's sometimes referred to as ‘no special type’ or ‘not otherwise specified’ because the cells have no particular features that class them as a specific type of breast cancer when examined under the microscope.
The breasts are made up of lobules (milk-producing glands) and milk ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue.
Invasive ductal breast cancer starts when cells within the milk ducts begin to divide and grow in an abnormal way. Invasive ductal breast cancer means the cancer cells are no longer only in the breast ducts. They have spread outside the ducts to the surrounding breast tissue and have the potential to spread to lymph nodes and other parts of the body.
Cancer cells are given a grade according to how different they are to normal breast cells and how quickly they are growing. Invasive ductal breast cancer is graded 1, 2 or 3. In general, a lower grade (1) indicates a slower-growing cancer within the breast while a higher grade (3) indicates a faster-growing cancer.
Sometimes invasive ductal breast cancer is found mixed with other types of breast cancer.
Find out more about the different types of primary breast cancer.
There are a number of possible symptoms of invasive ductal breast cancer. These include:
- a lump or thickening of the breast tissue
- a change of skin texture such as puckering or dimpling of the skin
- a lump or swelling under the arm
- changes to the nipple
- a discharge from the nipple
- a change in the size or shape of the breast
- constant pain in the breast or armpit
- less commonly, a type of rash involving the nipple known as Paget’s disease of the breast.
Routine breast screening with mammograms can often pick up cancer before a woman notices any symptoms. Therefore some women will be diagnosed with invasive ductal breast cancer after attending breast screening without having any of the symptoms described above.
When you visit the breast clinic, you will have an assessment which usually includes a breast examination and one or more investigations to help to make the diagnosis. These can include
- a mammogram (breast x-ray)
- an ultrasound scan (uses high frequency sound waves to produce an image) of the breast and under the arm (axilla)
- a core biopsy of the breast and/or lymph nodes or possibly a fine needle aspiration (FNA) of the breast and/or lymph nodes.
When there is change to the skin or nipple a punch biopsy may be performed.
Find out more about being referred to a breast clinic and the tests you may have.
Surgery to the breast
Surgery tends to be the first treatment for invasive ductal breast cancer. The treatment aims to remove the cancer from the breast. This may be breast-conserving surgery or a mastectomy. The type of surgery recommended will depend on factors such as the area of the breast affected, the size of the cancer in your breast and whether there is more than one area in the breast affected.
Some people are offered a choice between breast-conserving surgery and a mastectomy. Studies have shown that long term survival is the same for breast conserving surgery followed by radiotherapy as for mastectomy. You may find it helpful to talk through your options with your specialist team. There’s also an online, interactive decision-making aid Option Grid that may help you make your choice.
If you are going to have a mastectomy, you’ll usually be offered a breast reconstruction.
Some women who have a mastectomy choose to wear a prosthesis – an artificial breast form that fits inside the bra – while others do not.
Surgery to lymph nodes under the arm
Because breast cancer can spread through the lymph system, your specialist team will want to check if the lymph nodes (glands) under the arm (the axilla) contain cancer cells. This helps them decide whether or not you will benefit from any additional treatment after surgery. To do this, your surgeon is likely to recommend an operation to remove either some (a lymph node sample or biopsy) or all of the lymph nodes (a lymph node clearance).
What are the adjuvant (additional) treatments?
After surgery you may need further medical treatment. The results from any tests and your surgery will help your specialist team decide which treatment(s) to recommend. This is called adjuvant (additional) therapy.
The aim of treatment is to reduce the risk of breast cancer cells returning in the same breast or spreading elsewhere in the body, or a new primary breast cancer developing in either breast. The type of breast surgery you have will not affect which type(s) of systemic therapy (which treats the whole body) your specialist team will recommend following your operation.
These treatments can also be given before surgery when they are called neo-adjuvant therapies. Your specialist will discuss with you if they think neo-adjuvant treatments are needed.
Chemotherapy is a treatment using anti-cancer (also called cytotoxic) drugs which aims to destroy cancer cells. Whether it is recommended will depend on various features of the cancer, such as its size, its grade (how quickly the cells are dividing and how different they are to normal breast cells) and whether the lymph nodes are affected.
Radiotherapy is the use of high energy x-rays to destroy cancer cells. If you have breast-conserving surgery you will usually be given radiotherapy to reduce the risk of the breast cancer returning in the same breast. If you have a mastectomy you may be given radiotherapy to your chest in the area where you had your surgery. This is more likely if there is a high risk that cancer cells may return around the mastectomy scar or if cancer cells are found in the lymph nodes under the arm (axilla).
Hormone (endocrine) therapy
Hormone therapy will only be prescribed if your breast cancer has receptors within the cell that bind to the female hormone oestrogen and stimulate the cancer to grow (known as oestrogen receptor positive or ER+ breast cancer). All breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery.
If your cancer is oestrogen receptor positive, your specialist will discuss with you which hormone therapy they think is most appropriate.
This is a group of drugs that block the growth and spread of cancer by interfering with the biology of the cancer cells. The most widely used targeted therapy is trastuzumab (Herceptin).
Only people whose cancer has high levels of HER2 (HER2 positive), a protein that makes cancer cells grow, will benefit from having trastuzumab.
Being diagnosed with breast cancer can be a difficult and frightening time.
There may be times when you feel alone or isolated. There are people who can support you so don’t be afraid to ask for help if you need it.
Some people find it helpful to discuss their feelings and concerns with their breast care nurse or specialist. If you’d like to talk through your feelings and concerns in more depth over a period of time, you may want to see a counsellor or psychologist. Your breast care nurse, specialist or GP can arrange this.
You may find our information on coping emotionally helpful.
You can also call Breast Cancer Care’s Helpline on 0808 800 6000 and talk through your diagnosis, treatment and how you are feeling with one of our team.