Relapse of Invasive Lobular Carcinoma

Abstract

The diagnosis of Invasive Lobular Carcinoma (ILC) in the relapse setting is as problematic and challenging as in the primary setting due to the enigmatic nature of this malignant process. As discussed in previous chapters for early ILC, this special neoplastic process is often difficult to identify by clinical and imaging studies, which applies to the metastatic situation, too. These difficulties relate to a variety of factors, including the diffusely infiltrative nature of the malignant process, the spatial and site specific pattern of metastatic disease which is associated with ILC. It is of the utmost importance that the past history of Invasive Lobular Carcinoma of breast is available to the entire clinical team involved in the management of the individual patient, even if this history is many (often 20 or 30) years prior to the current clinical episode. Invasive Breast Carcinoma of any histological type may be associated with relapse which may be loco regional, involving the breast, chest wall or regional lymph nodes, or distant relapse at any anatomical site. Due to the possibility of relapse and the increased risk of a second primary breast carcinoma, it is recommended that all individuals should be followed up. Follow up should include clinical and radiological options for assessment of the patient as a whole as well as both the treated and contra lateral breast. The aim of the follow up is that the early detection of recurrence either local or distant will be more effective and be associated with a survival benefit however no robust evidence exists to support this belief. Through regular surveillance the clinician aims to identify recurrence or be informed of new symptoms affecting the patient at the earliest opportunity. It is known that Invasive Lobular Carcinoma has an early advantage in disease free survival when compared to Invasive Ductal Carcinoma, but when compared at 6 & 10 years the invasive ductal carcinoma group has a late advantage. Invasive Lobular Carcinoma is associated with an increased incidence of bone metastases but a decrease in regional and lung relapses [1]. Thus, due to the nature of this process, the diagnosis of cancer relapse can be difficult.