Medullary carcinoma of the breast

Medullary breast carcinoma is an invasive cancer that starts in the milk ducts of the breast. It’s characterized by its well-defined boundary between the tumor and the surrounding breast tissue.

Medullary carcinoma of the breast is detectable in a mammogram or through self-examination because of the presence of a lump that is rounded, soft and sometimes large.

Despite its aggressive nature, medullary carcinoma often has a better prognosis compared to other types of invasive ductal carcinomas. This is usually because of the presence of white blood cells that control the tumor from spreading.

Is medullary carcinoma benign or malignant?

Medullary carcinoma is malignant. This means it’s a type of cancer that can grow aggressively and has the potential to spread to other parts of the body. Despite its aggressive nature, medullary carcinoma of the breast often has a better prognosis compared to other high-grade breast cancers.

Risk factors for medullary carcinoma

While the exact cause of medullary carcinoma is unknown, certain factors may increase your risk of developing it and other types of breast cancer. These include:

• Genetic factors: A family history of breast cancer, especially involving mutations in the BRCA1 or BRCA2 genes.
• Age: Women in their 40s and 50s have an increased risk.
• Lifestyle factors: Smoking, excessive alcohol consumption, obesity and lack of physical activity.
• Personal history of breast cancer: Having had breast cancer in one breast increases the likelihood of developing it in the other breast or experiencing a new cancer in the same breast.
• Reproductive factors: Factors such as early menstruation (before age 12), late menopause (after age 55), delayed childbirth or never having children.

Medullary carcinoma symptoms

If you have medullary carcinoma, you may not experience any noticeable symptoms other than a lump in your breast.

If you do experience any medullary carcinoma symptoms, they may include:

• Breast pain or discomfort
• Changes in breast shape or size
• Changes in the skin of the breast
• Nipple discharge
• Swelling of the breast or arm
• Thickening or hardening of breast tissue

If you notice any abnormal changes in your breast health, schedule an appointment with your doctor.

Diagnosing medullary carcinoma

A combination of exams and tests are used to diagnose medullary breast cancer. Typically, your doctor will start with a physical exam of your breasts and surrounding lymph nodes to look for lumps, thickening or changes in appearance.

Imaging tests and biopsies play a crucial role in detecting and evaluating breast abnormalities. Mammograms are usually the initial screening tool for breast cancer. Additional digital imaging tests, such as breast ultrasound or MRI, may be used to further evaluate any suspicious areas found during a physical exam or mammogram.

If imaging studies reveal any abnormalities in the breast, a biopsy is performed to confirm the diagnosis. There are different types of biopsies that may be used by your doctor:

• Core needle biopsy: A hollow needle is used to extract a small sample of tissue from the breast
• Fine needle aspiration (FNA): A thin needle is used to withdraw cells from the breast for analysis.
• Surgical biopsy: In some cases, a surgical procedure may be performed to obtain a larger tissue sample for analysis.

The tissue sample is examined under a microscope by a pathologist to determine whether cancer cells are present and to characterize the type of cancer, its stage and grade.

What is a medullary carcinoma grade?

Your tumor’s grade describes the characteristics of your cancer cells when examined under a microscope. This system helps doctors predict the speed at which your cancer cells may grow and spread to nearby tissue or other parts of your body.

Medullary carcinoma is graded on a scale ranging from one to three:

• Grade 1 (low grade): Cancer cells closely resemble normal breast tissue cells. They grow and spread slowly, making this grade less aggressive.
• Grade 2 (intermediate grade): Cancer cells show some abnormal characteristics but are not visibly different from normal cells. These cells have a moderate growth rate and could invade other areas of the body.
• Grade 3 (high grade): Cancer cells appear significantly different from normal cells. These cells are aggressive and grow quickly, often leading to a poorer prognosis.

Stages of medullary carcinoma

Once diagnosed, your doctor will use a process called staging to determine how far the cancer has spread. This information is vital for creating the most effective treatment plan for you.

Breast cancer staging typically ranges from 0 (carcinoma in situ, a non-invasive stage) to IV (metastatic cancer, where the cancer has spread beyond the breast). Lower stages indicate the cancer is more contained, while higher stages suggest it's spread further. Generally, lower stages have better survival rates.

Medullary carcinoma treatment

Surgery is usually the first step in treatment for medullary carcinoma. Because the tumor is well-defined and is usually confined due to being surrounded by white blood cells, prognosis is often good with surgical treatment.

There are two main types of surgery:

• Lumpectomy: This involves removing the tumor and a small margin of surrounding healthy tissue. It is often followed by radiation therapy.
• Mastectomy: This involves removing the entire breast. Depending on your cancer and health history, a double mastectomy, where both breasts are removed, might be recommended.

If you have a lumpectomy, your doctor will give you radiation therapy to destroy any remaining cancer cells in your breast and reduce the risk of it returning. In some cases, a mastectomy might be followed by breast reconstruction surgery.

Other possible treatments for medullary carcinoma may include:

• Hormone therapy: Medullary carcinoma is often triple-negative, meaning it lacks estrogen and progesterone receptors. As a result, hormone therapy is not typically effective for this type of cancer. However, hormone therapy could be used to help prevent other types of breast cancer.
• Chemotherapy: Chemotherapy may be used to shrink the tumor, reduce the risk of recurrence or treat cancer that has spread to other parts of the body.
• Targeted therapy: Therapy drugs target certain pathways involved in cancer growth and progression.

Your care team at Aurora Health Care will use a collaborative approach to provide the best treatment possible. Supportive care services such as counseling, nutrition therapy, palliative care and physical therapy may also be offered to help you manage the physical and emotional challenges of cancer treatment.