Symptoms and Diagnosis of Tubular Carcinoma of the Breast

Tubular carcinoma doesn’t always have obvious symptoms in the breast. Below are symptoms you may have and ways doctors make a diagnosis.

Signs and symptoms

Like other types of breast cancer, tubular carcinoma of the breast may not cause any symptoms at first. Over time, a lump may grow large enough to be felt during breast self-exam or examination by a doctor. Tubular carcinomas are usually small — 1 cm or less in diameter — and feel firm or hard to the touch.

Diagnosis

Most tubular carcinomas are first detected either during breast examination or by a screening mammogram. On a mammogram, a tubular carcinoma looks like a small mass with an irregular shape. Further testing is needed to tell for sure whether it is a tubular carcinoma.

Diagnosing tubular carcinoma usually involves a combination of steps:

• A physical examination of the breasts. Your doctor may be able to feel the lump in the breast, or you may feel it yourself during a breast self-exam.
• A mammogram can locate the tumor and check for evidence of cancer in both breasts.
• MRI, ultrasound, or both may be used to obtain additional images of the breasts and check for other areas of cancer.
• Biopsy. A biopsy involves taking out some or all of the tumor to look at it under the microscope. The sample can be taken by inserting a special needle or making a small incision. Biopsy is the key to accurate diagnosis, because imaging tests alone can’t distinguish tubular carcinoma from other types of breast cancer and benign (noncancerous) breast conditions.

When a pathologist examines the tumor samples under a microscope, he or she looks for the tube-shaped structures that give tubular carcinoma its name. Experts generally agree that the vast majority of the tumor must have this characteristic appearance in order to be called tubular carcinoma. The more “tubular” it is, the less likely it is to spread and the easier it should be to treat.

Tubular carcinoma is sometimes found near other more common types of breast cancer. Ductal carcinoma in situ (or DCIS, a type of cancer that begins and remains within the milk duct) is often found next to or mixed in with the tubular carcinoma. Less often, doctors may find a lobular carcinoma in situ (LCIS, a precancerous condition confined to the lobule) or even an invasive lobular carcinoma.

Studies have shown that about 10-15% of women found to have tubular carcinoma in one breast also have cancer in the other breast. The cancer in the other breast is usually invasive ductal carcinoma (IDC), the most common type of breast cancer. This is why it is so important to have both breasts checked thoroughly.

As with the other rare subtypes of breast cancer, diagnosing tubular carcinoma takes special skill. You may want to ask for a second opinion if this is your diagnosis.

There are some other important features of a true tubular carcinoma of the breast:

• Hormone-receptor-positive: Studies show that tubular carcinoma tests positive for estrogen receptors 80-90% of the time. Tubular carcinoma also tests positive for progesterone receptors in most cases — about 68-75% of the time, according to one study.
• HER2-negative: Tubular carcinoma usually tests negative for receptors for the protein HER2/neu.