Medullary carcinoma of the breast

Medullary breast cancer is a form of invasive ductal carcinoma (IDC). When detected, it typically appears as a rounded, soft lump during mammograms or self-examinations. This rare type of cancer makes up roughly 3-5% of breast cancer diagnoses.

If you’re diagnosed with medullary breast cancer, our breast cancer specialists at Advocate Cancer Institute are here for you. From genetic testing to access to clinical trials, we offer the most comprehensive cancer care in Illinois.

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Is medullary carcinoma benign or malignant?

As a malignant cancer, medullary breast carcinoma has the potential for aggressive growth. Despite the risk of spreading to other parts of your body, medullary carcinoma of the breast typically carries a better prognosis compared to other high-grade breast cancers. This is primarily due to the immune system response that prevents its spread.

What age does medullary breast cancer occur?

It’s common for medullary breast cancer to be found in women in their 40s and 50s. It can emerge at any age, and it’s common in younger women compared to other breast cancer types.

Risk factors for medullary carcinoma

The cause of medullary breast cancer is unknown. Several risk factors may heighten your chance of developing a form of breast cancer, including:

• Age: Women in their 40s and 50s face an elevated risk.
• Reproductive factors: Early onset of menstruation (before age 12), late onset of menopause (after age 55), delayed childbirth, or never having children can influence risk levels.
• Genetic factors: A family history of breast cancer, particularly involving mutations in the BRCA1 or BRCA2 genes.
• Personal history of breast cancer: Previous breast cancer diagnosis increases the likelihood of recurrence in the same breast or developing it in the other breast.
• Lifestyle factors: Habits such as smoking, excessive alcohol consumption, obesity, and a sedentary lifestyle may contribute.

Early detection through self-exams, mammograms and knowing the signs and symptoms of breast cancer can help improve your prognosis.

Medullary carcinoma symptoms

You might not notice any symptoms of medullary breast carcinoma. It’s common to feel a noticeable lump in your breast. If you do experience symptoms, they may include:

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

Diagnosing medullary carcinoma

A combination of exams and tests will be used to diagnose medullary breast carcinoma. Your doctor will first perform a physical exam of your breasts and nearby lymph nodes to detect any lumps, thickening or visual changes.

Imaging tests, primarily mammograms, serve as the gold standard in breast cancer screening. Additional digital imaging tests such as a ultrasound or MRI may be used to get more detailed images of the breast tissues and identify any suspicious areas.

If abnormalities are detected in these imaging tests, a biopsy will be needed to confirm the diagnosis. Biopsy methods may include:

• Core needle biopsy: A hollow needle retrieves a small tissue sample from the breast.
• Fine needle aspiration (FNA): A thin needle withdraws cells from the breast for analysis.
• Surgical biopsy: In certain cases, surgery is performed to obtain a larger tissue sample for analysis.

The collected tissue is examined under a microscope by a pathologist to confirm the presence of cancer cells and to characterize the type, stage and grade of cancer.

What is a medullary carcinoma grade?

Tumor grading determines your cancer cells characteristics, which helps your doctor predict the cancer’s growth rate and potential to spread.

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

• Grade 1 (low grade): Cancer cells closely resemble normal breast tissue cells, exhibiting slow growth and limited spread, making this grade less aggressive.
• Grade 2 (intermediate grade): Cancer cells display some abnormal characteristics but remain like normal cells. They may grow and spread at a moderate pace.
• Grade 3 (high grade): Cancer cells differ significantly from normal cells, displaying aggressive behavior with rapid growth and spread, often resulting in a poorer prognosis.

Stages of medullary carcinoma

Following a diagnosis, your doctor will determine the stage of your medullary carcinoma to gauge any potential spread. This helps your care team create the best treatment strategy tailored to your needs.

Breast cancer staging spans from 0 (carcinoma in situ, a non-invasive stage) to IV (metastatic cancer, indicating spread beyond the breast).

Lower stages signify that the cancer is more contained. Higher stages mean the cancer has spread beyond its original site.

Medullary carcinoma treatment

Surgery is the go-to treatment for medullary carcinoma. There are two primary surgical options:

• Mastectomy: This involves complete removal of the breast. Depending on individual circumstances, a double mastectomy, involving removal of both breasts, might be recommended.
• Lumpectomy: This procedure removes the tumor along with a small margin of surrounding healthy tissue.

Following a lumpectomy, radiation therapy is provided to kill any remaining cancer cells and reduce the risk of recurrence. Sometimes, a mastectomy may be followed by breast reconstruction surgery.

Additional treatments may include:

• Hormone therapy: As medullary carcinoma typically lacks estrogen and progesterone receptors (known as triple-negative), hormone therapy isn't typically effective. However, it may be utilized to mitigate the risk of other breast cancer types.
• Chemotherapy: Chemotherapy may be used to shrink the tumor, reduce your recurrence risk or slow the spread.
• Targeted therapy: Targeted therapy drugs zero in on specific pathways that are known to help your cancer’s growth and progression.

Your care team at Advocate Health Care will use a collaborative approach to provide the best treatment possible. This includes supportive care services such as counseling, nutrition therapy, palliative care and physical therapy that may be beneficial to help you manage the physical and emotional challenges of cancer treatment.