What is Tubular Breast Carcinoma?

Tubular carcinoma is a rare and less aggressive type of breast cancer, making up about 1 to 2% of all invasive breast cancers. This cancer forms in well-developed tube-like structures, usually only one cell layer thick, and surrounded by lots of connective tissue. The cancer’s mild behaviour and low likelihood to return in the same place, spread to the underarm lymph nodes, or spread to distant parts of the body, generally leads to a good outlook for recovery. Doctors confirm the diagnosis of tubular carcinoma through a detailed examination of tissue removed during surgery.

What Causes Tubular Breast Carcinoma?

Changes in the genes of tubular carcinoma, a type of breast cancer, are rare. These mainly involve changes in the 16q and 1q chromosomes. Chromosome 16q often undergoes loss, while 1q often gains extra material – this happens in 78 to 86% and 50 to 62% of cases respectively. These changes often occur at the same time.

There are also other alterations that can occur in the genes, including losses on the 8p and 3p chromosomes – where the FHIT gene is located. Gains can also happen on chromosome 16p, and alterations can occur at the 11q chromosome, where the ATM gene is found.

Through examination of gene expressions, or how genes are turned on and off, studies have found that tubular carcinoma falls under the category of “luminal A” breast cancer. This type of cancer is generally slow-growing and less likely to spread.

Further studies have looked at the characteristics of tumors that develop in those who carry the BRCA1 or BRCA2 gene mutations, which are known to increase one’s risk of breast and ovarian cancers. These studies have also looked at non-BRCA1/2 families. However, these studies haven’t found any frequent links between these gene mutations and tubular carcinoma.

Risk Factors and Frequency for Tubular Breast Carcinoma

Pure tubular carcinoma, a type of invasive breast cancer, makes up about 1 to 2% of all breast cancer cases. This cancer is more common in places where screening mammography, a special type of breast imaging, is performed. It’s most frequently found in women in their 50s or 60s who have undergone breast cancer screening. On average, women are diagnosed with this form of breast cancer between the ages of 54 and 60. While it can occur in males, it is very rare. This type of cancer tends to affect the upper outer part of the breast. In 20% of cases, the cancer can be found in more than one area of the breast. Studies indicate that white individuals are diagnosed with this cancer more often than black individuals.

Pure tubular carcinoma is a type of breast cancer that accounts for 1-2% of all invasive breast cancers.
It’s more common in areas where screening mammography is carried out.
The cancer is most common in women in their 50s or 60s who have done breast cancer screening.
The average age of diagnosis is between 54 and 60.
While rare, this type of cancer can also affect men.
Usually, it occurs in the upper outer part of the breast.
In 20% of cases, it can be found in multiple parts of the breast.
White individuals are more likely to be diagnosed with this type of cancer than black individuals.

Signs and Symptoms of Tubular Breast Carcinoma

Tubular carcinoma is a type of breast cancer that doesn’t show any specific signs in the beginning, making it difficult to distinguish from other forms of invasive breast cancers. Over time, as the cancer cell grows, it may form a lump that can be felt during self-examination or a doctor’s examination of the breast. Usually, tubular breast carcinomas are quite small, typically around 1 cm or less in diameter, and they feel firm or hard to the touch.

Testing for Tubular Breast Carcinoma

When it comes to screening for tubular carcinomas – a type of breast cancer – a mammogram is usually the first method of detection. In most cases, this will reveal a lump in the breast that has a central density and sometimes tiny, chalk-like deposits called microcalcifications. The lump might appear round, oval, or lobulated (lobe-shaped), and the edges might be irregular or spiky. However, on a mammogram, it’s difficult to reliably distinguish a tubular carcinoma from other types of invasive ductal carcinoma or radial scars because these conditions show similar patterns.

Since there’s a high chance of having different types of coexisting cancer in the same breast or new cancer in the other breast, it’s important to get a mammogram on both breasts when first diagnosed with tubular carcinoma.

Ultrasound, another type of imaging technique, can be particularly useful in identifying some tumors that may not be visible on a mammogram. On an ultrasound, a tubular carcinoma appears as a mass with an uneven surface and has what’s called posterior acoustic shadowing, which looks like a shadow behind the mass on the ultrasound image.

Magnetic Resonance Imaging (MRI), a different type of imaging, can also be performed to identify tubular carcinoma. Some experts have observed unique enhancement patterns on MRIs that can help distinguish tubular carcinoma from other types of breast cancer.

Treatment Options for Tubular Breast Carcinoma

Some research suggests that tubular carcinoma, a type of breast cancer with a good prognosis, might not require intensive treatment. Some experts have questioned the necessity of radiation therapy, especially in patients who have undergone surgery to conserve the breast. Others have raised doubts about the need to evaluate the lymph nodes (which can show if cancer has spread), and about the use of additional treatment after surgery.

However, until we know more about the importance of the lymph nodes’ status, they should continue to be evaluated in patients with smaller tumors. This is because even a small primary tumor can still spread to the lymph nodes. Given that tubular carcinoma is typically not very invasive, preserving the breast through therapy, with or without radiation, is likely the best approach, especially if no cancer cells are found in the lymph nodes.

According to some experts, using radiation therapy after surgery can lessen the chances of tubular carcinoma coming back in the same area. But older patients who have undergone surgery to conserve the breast seem to have a low risk of the cancer coming back, even without radiation therapy.

Most tubular carcinomas react to hormones, so some form of hormone treatment after surgery could apply to most patients. The decision on whether to give chemotherapy after surgery should be made on a case-by-case basis. This consideration takes into account factors such as the size of the tumor, its grade (a measure of how quickly the cancer might grow and spread), and the lymph node status. Patients with tubular carcinoma generally aren’t recommended to have chemotherapy because the cancer’s prognosis is excellent, the risk of recurrence is low, and the side effects of chemotherapy can significantly outweigh any potential small benefits it may have.

Based on the guidelines provided by the National Comprehensive Cancer Network in 2015, endocrine therapy (treatment that removes or blocks hormones that fuel cancer growth) isn’t recommended for patients with tumors smaller than 10 mm, including tubular carcinoma. If the tumor is responsive to the hormone estrogen, endocrine therapy may be considered to reduce the risk and address the small chance of the disease recurring. If the tumor is between 10 and 29 mm, endocrine therapy should be considered. For tumors 30 mm or more, endocrine therapy should be given after surgery. Patients with cancer cells in one or more lymph nodes may also be considered for chemotherapy in addition to endocrine therapy.

When a doctor is considering a diagnosis of tubular breast carcinoma, they may also explore the following conditions that could mimic or coincide with the disease:

Sclerosing adenosis
Complex sclerosing lesions or radial scars
Microglandular adenosis
Low-grade invasive carcinoma of no special type
Tubulo-lobular carcinomas

These alternatives should be considered and ruled out to make the correct diagnosis.

What to expect with Tubular Breast Carcinoma

People diagnosed with pure tubular carcinoma, a type of breast cancer, usually have a much better prognosis or outlook than those with invasive ductal carcinoma, another type of breast cancer. Studies have shown that 93.1 to 99.1% of these patients have no recurrence of the disease for at least 10 years, and their overall survival rate is close to 100% after treatments like mastectomy (surgery to remove all breast tissue) or partial resection (surgery to remove part of the breast).

It’s also uncommon for this type of cancer to spread to the axillary lymph nodes, which are the nodes in the underarm area. On the rare occasion that it does spread to these nodes, it usually only involves one or two, not multiple nodes. Even in cases where it does spread to this area, the patient’s chances for a successful recovery are still excellent.

Possible Complications When Diagnosed with Tubular Breast Carcinoma

Lymph node metastases refer to the spread of cancer to the lymph nodes. In the case of tubular carcinoma, a type of breast cancer, the spread of cancer to the lymph nodes can vary between 0% and 20%.

As for cancer recurrence, which means the return of cancer after treatment and after a period of time during which the cancer could not be detected. With tubular carcinoma, the rate of recurrence, either local (near the original tumor location) or systemic (in other parts of the body), is reported to be 8% or less after mastectomy, a surgery that removes the entire breast.

Key Information:

Spread of tubular carcinoma to lymph nodes varies from 0% to 20%
Recurrence rates of tubular carcinoma after mastectomy are reported to be 8% or less

Preventing Tubular Breast Carcinoma

It’s essential for patients to regularly check their own breasts for any changes or unusual findings. If anything out of the ordinary is detected, they should reach out to their doctors for advice. This self-examination helps in early detection of any potential problems.