How to treat ILC in the elderly?

Question

Hello doctor,

We are seeking advice for my 82-year-old grandmother, who was recently diagnosed with invasive lobular carcinoma, grade 2, in her right breast. The tumor is 0.59 inches, ER-positive (90 %), PR-positive (60 %), and HER2-negative. Her Oncotype DX score is 15, suggesting a low benefit from chemotherapy. She has severe osteoporosis and compromised kidney function, and her albumin levels are low. A recent CT scan showed no signs of metastasis.

She is deeply fearful of hospitals and is reluctant to undergo aggressive treatment, expressing that she has lived a full life. Given her age, frailty, and existing conditions, we are concerned about how to proceed without overwhelming her physically or emotionally.

We are looking for less invasive treatment options that respect her preferences while offering reasonable disease control. Additionally, we are struggling with how to communicate effectively and compassionately with her about realistic next steps.

What would be the best approach to treatment in her case? Would hormonal therapy alone be reasonable? Are there resources to help guide sensitive discussions with elderly patients who are hesitant about medical care? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Diagnosing invasive lobular carcinoma or ILC (a type of breast cancer that begins in the lobules, the glands in the breast that produce milk, and spreads to nearby breast tissues) and other types of breast cancer typically begins with a physical examination and a detailed discussion of your symptoms. Imaging tests help examine breast tissue for abnormalities.

To confirm the presence of cancer, a biopsy (a medical procedure that removes a small sample of tissue to check for the presence of cancer cells under a microscope) is performed, where a sample of tissue is removed and tested.

A mammogram, which is an X-ray of the breast tissue, is commonly used for breast cancer screening. If an abnormality is found, a diagnostic mammogram may be performed to take a closer look. Though invasive lobular carcinoma is less easily detected on a mammogram compared to other types of breast cancer, it remains a valuable tool.

Ultrasound imaging, which uses sound waves to create images of internal structures, can provide additional information. For instance, it can help distinguish between a solid mass and a fluid-filled cyst. However, invasive lobular carcinoma may be more difficult to detect with ultrasound.

A magnetic resonance imaging (MRI) scan uses a magnetic field and radio waves to produce detailed images of the breast. It is particularly useful in identifying cancer in other areas of the affected breast or in the opposite breast. This procedure often involves injecting a contrast dye to enhance image clarity.

Treatment for invasive lobular carcinoma usually begins with surgery to remove the tumor. Post-surgery, most patients receive radiation therapy, chemotherapy, or hormone (endocrine) therapy. In some cases, chemotherapy or hormone therapy may be administered before surgery to shrink the tumor and facilitate its removal.

Treatment for invasive lobular carcinoma generally follows similar protocols as for other types of breast cancer. However, some differences exist:

Many invasive lobular carcinomas are hormone receptor-positive, meaning they respond well to hormone-blocking treatments, also known as endocrine therapy.
Most of these tumors are human epidermal growth factor receptor 2 (HER2)-negative, which means they do not produce excessive HER2 protein and are unlikely to benefit from HER2-targeted therapies.

Your treatment plan should be personalized, taking into account factors such as the stage and growth rate of the cancer, your general health, and your personal preferences.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.