Invasive lobular carcinoma (ILC) is a form of breast cancer that originates in the milk-producing glands, known as lobules. The term “invasive” signifies that the cancer cells have moved beyond the lobules into the surrounding breast tissue, where they can potentially spread to other areas of the body. ILC accounts for about 10% of all invasive breast cancers, making it the second most common type. A feature of ILC is its growth pattern; instead of forming a distinct lump, the cells often spread in single-file lines, which can make it more difficult to detect on a mammogram. A Nottingham grade 2 designation provides information about the cancer’s characteristics to help guide evaluation.
Decoding the Nottingham Grade
The Nottingham grade, also called the Elston-Ellis grade, is a system used to classify the appearance of cancer cells compared to healthy breast tissue. This grade helps communicate how aggressive the cancer appears under a microscope. The final grade is determined by scoring three separate features, and a total score of 6 or 7 results in a Grade 2 classification, an intermediate grade. The three components are:
- Tubule formation: This assesses the extent to which cancer cells have organized into tube-like structures similar to normal breast ducts. A low score is given when many of these structures are present, while a high score is assigned when very few tubules are seen, suggesting more disorganized growth.
- Nuclear pleomorphism: This evaluates the uniformity of the cancer cell nuclei. In low-grade tumors, the nuclei are small and consistent, while a higher score is given when the nuclei vary significantly in size and shape, indicating a greater degree of abnormality.
- Mitotic count: This measures the rate of cell division by counting the number of cells actively dividing within a specific area of the tumor sample. A lower mitotic count signifies a slower-growing tumor, while a higher count indicates more rapid multiplication.
Prognosis and Other Key Factors
A Nottingham Grade 2 classification suggests the cancer is growing at an intermediate rate, between a slow-growing Grade 1 tumor and a fast-growing Grade 3. However, this grade is just one aspect of the overall prognosis, which depends on several other factors from a pathology report. A primary factor is the cancer’s stage, which is distinct from its grade.
While the grade describes what the cells look like, the stage describes the tumor’s size and whether it has spread. For example, Stage 1 ILC involves a small tumor that may or may not be in nearby lymph nodes, whereas Stage 3 indicates a larger tumor with more extensive lymph node involvement.
The tumor’s hormone receptor status is another factor. Tests determine if the cancer cells have receptors for estrogen (ER-positive) or progesterone (PR-positive). More than 80% of ILC cases are hormone receptor-positive, meaning hormones can fuel their growth. The HER2 status is also evaluated to see if the cancer cells produce excess amounts of the HER2 protein, which can promote cell growth.
Standard Treatment Approaches
Treatment plans for ILC are tailored to the individual, based on the tumor’s grade, stage, and receptor status. Surgery is a common first step, with options including a lumpectomy to remove the tumor and a margin of healthy tissue, or a mastectomy to remove the entire breast. The choice depends on factors like tumor size and location.
Following a lumpectomy, radiation therapy is often administered to the remaining breast tissue. This treatment uses high-energy rays to destroy any cancer cells left after surgery, reducing the chance of the cancer returning. Systemic therapies, which treat the whole body, are selected based on the tumor’s biological markers.
- For cancers that are ER-positive or PR-positive, hormone therapy is a mainstay treatment that works by blocking estrogen’s effects or lowering its levels.
- If a cancer is HER2-positive, targeted therapy drugs that specifically attack HER2-positive cells are used.
- Chemotherapy may also be recommended, particularly for higher-grade or larger tumors, to kill cancer cells throughout the body.
Follow-Up Care and Monitoring
After primary treatment is complete, a structured plan for follow-up care and monitoring begins. This long-term surveillance is to manage health and watch for any signs of recurrence. Patients will have regular appointments with their oncology team, which become less frequent over time but continue for many years.
Ongoing imaging is a standard part of the follow-up plan. This includes annual mammograms for any remaining breast tissue, and other imaging tests like a breast MRI might also be recommended based on individual risk factors. Many patients continue with long-term treatments, such as hormone therapy, for five to ten years. Follow-up care involves managing the side effects of these medications and performing self-exams to promptly report any changes to a healthcare provider.