If you are diagnosed with Lobular Breast Cancer, there is a range of treatments available for you. Not everyone has the same treatments in the same order, it depends on the size of your tumour; whether and how much it has spread and to where; how quickly the cells are growing; and genetic factors .
You may be given a choice of treatments. Your doctor or specialist nurse will explain all of your treatment options and help you to choose the right treatment for you.
Always remember that it is your choice and take your time to ensure that it is the right treatment for you.
In the UK, your surgeon and or oncologist might have discussed your treatment options, by using software called PREDICT, Oncotype or Mammaprint. Different NHS Trusts and different countries use different software.
It can help you to write down any questions you want to ask before your appointment. Taking someone to your appointments, such as your partner, friend or family member, to write down or record what is said can help you to remember and make better decisions.
You have the right to record your appointment if that works best for you. Sometimes, medical professionals can feel uncomfortable about your recording meetings, so let your doctor or nurse know why you want to do it.
Different treatments will be offered if your tumour is localised (in your breast and/or lymph nodes) or has metastasised (spread to other parts of your body.)
The main treatments for localised
(Stages 1, 2 & 3) lobular breast cancer are:
· Hormone therapy
· Targeted therapy
Image: Keep Dancing, Anna Sreenan
Surgery may be your first treatment. Usually a few nodes in your lymph system are removed for analysis to see if the cancer has spread outside of the tumour. This is called sentinel lymph node biopsy. This is done to prevent the removal of all of your lymph nodes which can cause future health complications.
Surgery can be a lumpectomy, which removes the lump and keeps as much of the breast as possible, or a mastectomy. A mastectomy removes all the breast tissue. Sometimes all of the skin is removed too and a straight scar is left where the skin is sewn back up. Alternatively, you can have a skin sparing mastectomy where the skin is saved for reconstruction such as with an implant or by using muscle or fat from different parts of your body.
You can find out information about how to prepare for a mastectomy here, from NHS UK. You might want to see some photos of after a mastectomy
You may be offered reconstruction after mastectomy, this is when either your own body fat will be used to make a new breast, or a synthetic implant is used. The choice will be made between you and your plastic surgeon. You may decide to ‘go flat’ and not use any form of prosthetic. A prosthetic is an artificial breast that you can pop into a pocket inside your bra. There is a lot to consider before deciding on reconstruction, but your surgeon will guide you through it.
The surgeon who does your breast reconstruction will be either a Plastic Surgeon on an Oncoplastic Breast Surgeon. An Oncoplastic Breast Surgeon has been trained to complete a lumpectomy or mastectomy, and then do some breast reconstructions.
After surgery you will be offered more treatments
(they are often called adjuvant, meaning after surgery)
You may be given chemotherapy if there is cancer in your nodes, or elsewhere. Not everyone who has breast cancer is given chemotherapy. Many lobular breast cancer patients do not have chemotherapy as research has shown it to not respond as well to the treatment. This is because lobular is frequently a slower growing disease, and chemotherapy works on cells that are fast growing.
The removed tumour may be analysed through an Oncotype Test that measures how likely your tumour will reduce due to chemotherapy.
You will see an oncologist to discuss what will happen if you do decide to have chemotherapy.
Radiotherapy might be offered to you after surgery to kill any remaining cancer cells in your breast..
If you have radiotherapy, you will be given very short bursts of radiation to kill any cancer cells in the area of the affected breast.
In the UK radiotherapy has traditionally been given for 15-19 days, but trials have indicated the potential benefit from shorter periods of treatment. Some people are now being given 5 days of radiotherapy.
You can talk with your oncologist about the different options and decide which one is best for your type of lobular breast cancer.
You may be given hormone therapy, but not everyone’s cancer will respond to hormones .
Your tumour will be tested at the first biopsy and after removal to examine whether it grows using oestrogen and progesterone. Most lobular cancers are oestrogen positive, which means that oestrogen blockers will really help.
You may be put on hormone tablets as initial treatment, which can reduce the size of the tumour before surgery. This is called neo-adjuvant therapy. This will be decided between you and your oncologist.
Surgery will remove as much of the cancer as possible and then you will be put on hormone therapy for at least 5 years.
If you have side effects from your treatment, always remember to tell your oncologist so that they can consider alternative versions of similar drugs.
Terms you may hear include: Aromatase Inhibitors or AIs , Letrozole, Anastrozole, Zoladex.
You may be given targeted therapy to block the growth or spread of cancer by targeting specific molecules, at a cellular level. This will be decided between you and your oncologist. Herceptin is a targeted therapy and may be given to treat HER2+ tumours.
A relatively new treatment is bisphosphonates. Different types of bisphosphantes are given to protect your bones from hormone treatment and/or reduce the risk of breast cancer spreading to your bones.
You may hear this treatment being called Zometa, which is simply the name of a drug that is given. Zometa can be provided either as a daily tablet, or as a monthly or three-monthly infusion that is injected into your body.
Advanced or Secondary Treatment
There are different treatments available for secondary disease but timely diagnosis and meaningful vigilance is paramount in managing the disease. Try not to panic, many people live with metastatic cancer for years due to the advances of medical and clinical practice and the increasing array of drugs.
Treatments will depend on the sub-type of lobular cancer you have, whether that cancer has evolved during metastasis and where it has metastasised too.
Treatment plans need to reflect the specific needs of each individual’s disease. Sometimes you may need to be proactive in monitoring and ensuring you are getting meaningful follow up.