You and your doctor will work together to develop your treatment plan for tubular carcinoma. If you have a pure tubular carcinoma — more than 90% showing the characteristic tube-shaped cells, without other types of breast cancer cells mixed in — it typically won't require as much treatment as invasive ductal carcinoma does. If another type of invasive ductal carcinoma (IDC) is found within the tumor, or in the same breast or the other breast, your treatment plan will take that into account. You can visit our Treatment for IDC section for more information.
Pure tubular carcinoma tends to be a small tumor (about 1 centimeter) and usually does not spread to the axillary (underarm) lymph nodes. However, research suggests that in up to 15% of cases, pure tubular carcinoma can involve these nodes — but usually no more than 1 to 3 of them. The larger the tumor, the more likely it is to spread into the axillary nodes.
Your treatment plan can include:
Surgery to remove the cancer and, in some cases, any affected lymph nodes. Possible procedures are:
- Lumpectomy: The surgeon removes only the part of your breast containing the tumor (the "lump") and some of the normal tissue that surrounds it. A sentinel node biopsy (removal of 1 or 2 nodes) may be performed to check the node or nodes closest to the tumor for any signs of cancer spread. If your tumor is small (less than 1 cm) and a pure tubular carcinoma, your surgeon may not think it's necessary to biopsy the underarm lymph nodes because the risk of spread to the lymph nodes is usually very small.
- Total or simple mastectomy: The surgeon removes the breast without removal of any axillary (underarm) lymph nodes. A sentinel node biopsy may be performed to check the node or nodes closest to the tumor for any signs of cancer spread.
Adjuvant (additional) therapy, such as radiation therapy, hormonal therapy, and/or chemotherapy.
- Lumpectomy is typically followed by radiation therapy, which directs high-energy rays at the area to destroy any remaining cancer cells. This is considered standard treatment for tubular carcinoma. However, some doctors may feel that radiation therapy is not needed for tubular carcinoma, especially if the tumor is very small.
- Hormonal therapy involves taking medications such as tamoxifen or an aromatase inhibitor, which either block the effects of estrogen or lower the amount of estrogen in the body. Almost all tubular carcinomas are estrogen- and/or progesterone-receptor positive, which means that hormonal therapy is likely to be helpful. However, if testing shows that a tubular carcinoma is estrogen- and progesterone-receptor negative, other treatments may be considered.
- Chemotherapy involves taking anti-cancer medicines in the form of a pill or directly into a vein to destroy any cancer cells that may have traveled to other parts of the body. Since tubular carcinoma isn't likely to spread to other areas of the body, chemotherapy is not usually needed.
- If the tumor is smaller than 1 cm, with no cancer or just a very small amount of cancer (a 2 millimeter area or less) in one lymph node: No hormonal therapy or chemotherapy is typically recommended after surgery.
- If the tumor is between 1 and 2.9 cm in size, with no cancer or just a very small amount of cancer found in one lymph node: Hormonal therapy is often considered as a next treatment, since most tubular carcinomas are estrogen- and/or progesterone-receptor positive.
- If the tumor is 3 cm or larger with no cancer or just a very small amount of cancer in one lymph node: Hormonal therapy is typically recommended after surgery.
If larger amounts of cancer — each more than a 2 mm area — have spread to one or more underarm lymph nodes, then your doctor may suggest treating you with chemotherapy in addition to hormonal therapy.
Your doctor also may recommend chemotherapy if a larger tubular carcinoma (greater than 1 cm) tests negative for estrogen and progesterone receptors, since hormonal therapy cannot be used in these cases. If your hormone receptor tests come back negative, be sure to ask for a repeat test. It's unusual for a tubular carcinoma to be hormone-receptor negative.
You and your doctor can discuss all of the risks and benefits of having more treatment beyond surgery and radiation therapy. There is some ongoing debate over how necessary additional treatment is in cases of tubular carcinoma. Because this type of tumor is small and slow-growing, some experts feel that more treatment may not have much benefit. This decision likely will come down to what you and your doctor feel is best for you.
Most tubular carcinomas also usually test negative for HER2 receptors, so cannot be treated with anti-HER2 medicines such as Herceptin (chemical name: trastuzumab), Kadcyla (chemical name: T-DM1 or ado-trastuzumab), Nerlynx (chemical name: neratinib), Perjeta (chemical name: pertuzumab), and Tykerb (chemical name: lapatinib).
Still, be sure to confirm with your doctor whether or not you're a candidate for anti-HER2 treatments.