Tubular Carcinoma of the Breast

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Tubular carcinoma of the breast is a type of breast cancer. It is a subtype of invasive ductal carcinoma (IDC), a cancer that starts inside a milk duct and expands into other parts of the breast. Tubular carcinomas take their name from their microscopic appearance, in which the cancer cells resemble small tubes.

Tubular carcinomas tend to be small, estrogen-receptor positive, HER2/neu negative cancers. In some cases, tubular cancer cells are mixed with ductal or lobular cancer cells, giving a mixed-tumor diagnosis. These tumors are small in size and grow very slowly.

Tubular carcinomas account for 1 to 5 percent of all breast cancer diagnoses. People who develop tubular carcinoma are usually 50 years of age or older. Much like other breast cancers, tubular carcinoma of the breast is rare in men.

Tubular carcinoma is also known as tubular breast cancer and tubulolobular carcinoma (TLC), when mixed with lobular carcinoma.

Signs and Symptoms

Tubular carcinomas usually do not produce symptoms. They are small and may not be felt during a self-breast exam. Most are found with routine medical exams, including mammograms

Over time, a lump may grow large enough to be felt during a breast self-exam or physical examination by a doctor.  Tumors associated with tubular carcinoma are smaller than 1 centimeter(cm) in diameter (about the size of a pencil eraser) and feel hard and firm to touch.

You may experience symptoms that are characteristic of all types of breast cancer, including:

  • Swelling in all or part of the breast
  • Skin irritation or dimpling (having the texture of an orange peel)
  • Breast or nipple pain
  • Nipple retraction where the nipple turns inward into the breast
  • Redness, scaling or thickening of breast and/or nipple skin
  • Nipple discharge, other than breast milk
  • A lump under the arm or around the collarbone

Causes

A number of risk factors are associated with tubular carcinoma of the breast. These include:

  • Genetics and family history
  • Radiation the chest or the face for treating another type of cancer previously
  • Being overweight and/or having an unhealthy diet
  • Not breastfeeding
  • Hormone replacement therapy
  • Overuse of alcohol

Having risk factors for tubular carcinoma does not mean you will get the condition. These risk factors increase the chance of your developing this type of cancer and having no risk factors does not mean a person won’t develop tubular carcinoma of the breast. You should discuss the effect of any risk factors with your doctor.

Diagnosis

Tubular carcinoma tumors are often very small but may show up on a mammogram as irregularly shaped masses with a spiky, or starry outlines. On a breast ultrasound, a tubular carcinoma can show up as a mass with a fuzzy outline and may have calcifications nearby.

The center of a tubular carcinoma will be denser than the outer areas of the mass. A biopsy will be needed to obtain a tissue sample so that a pathologist can do a microscopic examination, which will give a clear diagnosis.

Prognosis

The five-year disease survival rate for tubular carcinoma is more than 90 percent, while the 10-year overate survival rate is similar to that for people of the same age who have never had this type of cancer. this according to a 2013 report in the Journal of Breast Cancer. The survival rate is higher when tubular carcinoma cells appear alone and not mixed with other types of breast cancer cells.

Recurrence is less than 7 percent, this according to one report in the Journal of Clinical Oncology. Recurrence may also involve other types of IDC cancers, usually in the previously unaffected breast. Research is ongoing to make sense of these types of recurrences. 

Treatment

There are several possible treatment options for tubular carcinoma. Your doctor can discuss with you the best options after performing various diagnostic tests to determine the specifics of the tumor, including size and stage.

The following are treatment options that you and your doctor may consider:

Surgery: This is usually an initial treatment for tubular carcinoma. Either a mastectomy or lumpectomy may be done to remove these tumors. A lumpectomy involves removal the part of the breast containing the tumor and its surrounding tissue. A mastectomy removes the whole breast, but not the nearby lymph nodes, as tubular carcinoma rarely spreads to the lymph nodes. However, if testing reveals the lymph nodes are affected, a lymph node removal may be done at the same as the mastectomy.

Radiation therapy: Since a lumpectomy is usually done for these types of tumors, radiation therapy is used after surgery to treat the remaining breast tissue.

Hormone therapy: Tubular carcinomas are often estrogen-receptor positive, so hormonal therapy can be very effective in reducing the risk for recurrence. For premenopausal women, tamoxifen is often used. For postmenopausal women, or premenopausal women who have had their ovaries removed or ovarian suppression therapy, aromatase inhibitors are recommended. Treatment with these medications is recommended if the tumor is larger than 1 cm and/or if lymph nodes are positive.

Chemotherapy: Since these tumors are unlikely to spread to the lymph nodes, and hence to other regions of the body, it's less likely that adjuvant chemotherapy will be needed for these tumors. Chemotherapy, however, is usually recommended if more than one lymph node is positive.

Targeted therapy:  These medications block the growth and spread of cancer by targeting and interfering with certain proteins and processes within cancer cells.

For most people, surgery is the only treatment necessary. However, this depends on the specifics of a tumor and where it has spread. 

Follow-Up After Treatment

Careful follow-up after treatment is needed as with any type of breast cancer. It's not uncommon for women who have had a tubular carcinoma to develop cancer in their other breast, and therefore, monitoring with mammograms and/or breast MRIs is important for detecting and treating recurrences early on.

A Word From Verywell

Tubular carcinoma of the breast is a cancer that is usually small and often has an excellent prognosis. That said, any cancer of any stage is frightening. It's important to reach out to your friends and family. Consider joining an in-person or online support group. Learn as much as you can about your disease.

With tumors that are less common, it can also be helpful to get a second opinion at one of the larger cancer centers, which may have oncologists who have treated several people with this specific tumor. These tumors are usually small but also tend to spread to lymph nodes at a smaller stage than some other types of cancer. Fortunately, the majority of these tumors are estrogen-receptor positive, and hormone therapy can be effective in reducing the risk of recurrence.

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