Tubular Carcinoma of the Breast

Tubular carcinoma of the breast is a subtype of invasive ductal carcinoma (IDC), a cancer that starts inside a milk duct and expands into other parts of the breast. These tumors are small and grow very slowly. Tubular carcinomas account for 1% to 5% of all breast cancer diagnoses and the prognosis is often excellent.

This article covers the symptoms, causes, and diagnosis of tubular carcinoma of the breast. It also covers prognosis and treatment options.

Symptoms of Tubular Carcinoma of the Breast

Tubular carcinomas usually do not produce symptoms. Because of their size—typically less than 1 centimeter (cm) in diameter, or about the size of a pencil eraser—they may not be felt during a breast self-exam. Most are found with routine medical exams, including mammograms. 

That said, a lump may grow large enough (and firm enough) over time that it can be felt during a self-check or physical examination by a healthcare provider.

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
• 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

The exact cause of tubular carcinoma of the breast is unclear. Like other forms of breast cancer, several influences are likely at play.

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

• Being overweight or obese
• A family history of breast cancer
• Having a first baby after the age of 30
• Never having a baby
• Not breastfeeding
• Overuse of alcohol
• Hormone replacement therapy
• Undergoing radiation therapy to the chest or face before the age of 30
  

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.

Diagnosis of Tubular Carcinoma of the Breast

Although tubular carcinoma tumors are often very small, they may show up on a mammogram as irregularly shaped masses with spiky or star-like outlines. On a breast ultrasound, a tubular carcinoma can show up as a mass with a fuzzy outline, and it may have calcifications nearby.

The center of a tubular carcinoma will be denser than the outer areas of the mass. A biopsy is needed to obtain a tissue sample, which a pathologist will examine to confirm a diagnosis.

Your healthcare provider will also conduct various other diagnostic tests to determine the specifics of the tumor, including its size, stage, hormone receptor status, and more.

Tubular carcinomas tend to be estrogen receptor-positive, HER2/-negative cancers. Sometimes, tubular cancer cells are mixed with ductal or lobular cancer cells, giving a mixed-tumor diagnosis.

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Tubular Carcinoma of the Breast Treatment

There are several possible treatment options for tubular carcinoma. For most people, surgery is the only one necessary. However, this depends on the specifics of a tumor and where it has spread.

Surgery

Initially, either a lumpectomy (more common) or mastectomy may be done to remove tubular carcinomas.

A lumpectomy involves removal of the part of the breast containing the tumor and its surrounding tissue. A mastectomy removes the whole breast.

Tubular carcinoma rarely spreads to the lymph nodes, but their removal may be done at the same time as a lumpectomy or mastectomy.

Radiation Therapy

Radiation therapy is used after lumpectomy to treat the remaining breast tissue.

Drug Therapies

Tubular carcinomas are often estrogen-receptor positive, so hormonal therapy can be very effective in reducing the risk of recurrence. For premenopausal women, tamoxifen is often used. For postmenopausal women and premenopausal women who have had their ovaries removed or who have had ovarian suppression therapy, aromatase inhibitors are recommended.

Treatment with these medications is recommended if the tumor is larger than 3 centimeters and/or if lymph nodes are positive. In some cases, hormonal therapy is considered for smaller tumors.

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. However, hormonal therapy (and sometimes also chemotherapy) is usually recommended if one or more lymph nodes are positive.

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

What Is the Survival Rate of Tubular Carcinoma of the Breast?

Tubular carcinoma of the breast is associated with an excellent prognosis.

The five-year disease survival rate for tubular carcinoma is more than 90%, and the 10-year overall survival rate is similar to that of same-age people who have never had this type of cancer, 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.

Furthermore, a report in the Journal of Clinical Oncology notes that the recurrence rate is less than 7%. If tubular carcinoma of the breast recurs, it may involve other types of IDCs, usually in the previously unaffected breast. Research is ongoing to understand these types of recurrences. 

Summary

Tubular carcinoma is a rare form of breast cancer characterized by small, slow-growing tumors. The prognosis for this condition is generally considered excellent. Detection is usually done by mammogram or ultrasound, with a follow-up biopsy to determine the diagnosis. Treatment can involve surgery, radiation, or drug therapies.