Radiation Therapy For Secretory Carcinoma 

  • Stephanie Leadbitter MSc Cancer Biology & Radiotherapy Physics, BSc (Hons) Biomedical Science, University of Manchester, UK

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Introduction

Breast cancer is common in the UK, especially in women over 50, but younger women can get it too. About 1 in 7 women will have breast cancer at some point in their lives. If it's found early, there's a good chance to get better.

So, it's very important for women to check their breasts often for any changes and go see a doctor if they notice anything different.

Understanding secretory carcinoma of the breast

Definition

Secretory carcinoma of the breast is an exceptionally rare type of breast cancer, making up less than 1% of all invasive breast cancers. It is often referred to as "juvenile carcinoma" because it is more commonly found in children and adolescents, although it can occur in adults. This type of cancer has distinct characteristics when examined under a microscope.

Clinical presentation

People with secretory carcinoma of the breast typically notice a slowly growing, painless lump that feels well-defined and movable. The size of the tumour can vary widely, ranging from 0.5 to 16 cm, but it's usually between 1.5 to 3.0 cm in size. Most cases involve a single tumour, but there have been instances of multiple tumours in the breast.1

Diagnosis

Doctors use various tests to determine if someone has breast cancer:

  • Breast Ultrasound: A machine that uses sound waves to create images (sonograms) of the breast's internal structures.
  • Diagnostic Mammogram: A detailed X-ray of the breast is taken when there are concerns.
  • Breast Magnetic Resonance Imaging (MRI): A scan that provides detailed images of the breast using magnets and a computer.
  • Biopsy: A procedure to remove tissue or fluid from the breast for microscopic examination. Different biopsy methods are used, such as fine-needle aspiration, core biopsy, or open biopsy.

Staging

After diagnosing breast cancer, doctors try to figure out if it has spread and how far it has spread. This process is called "staging," and it helps determine the best treatment approach. Staging uses numbers from 0 (limited cancer) to IV (advanced cancer). Lower numbers mean less spread. The staging system commonly used is called the AJCC TNM system, which looks at factors like tumour size, whether it has spread to the lymph nodes or other distant sites, whether it has hormone receptors (like HER2), and cancer cell appearance.

This system helps doctors understand the extent of the cancer and decide on the most appropriate treatment.2

Radiation therapy for breast cancer

Overview of radiation therapy

Radiation therapy uses powerful X-rays, protons, or other particles to destroy cancer cells. It works well on fast-growing cells like cancer, and it's safe to be around others after treatment since you won't be radioactive.

Role of radiation therapy in breast cancer treatment

There are two main types:

  • External Radiation: A machine outside your body aims radiation at the breast. It's the most common type of breast cancer.
  • Internal Radiation (Brachytherapy): After surgery, a device with a radioactive source is temporarily placed inside your breast to deliver radiation.

Radiation can be used at nearly every stage of breast cancer treatment:

  • After surgery (like lumpectomy) to prevent cancer from coming back in the breast.
  • After mastectomy, it reduces the risk of cancer returning to the chest wall or lymph nodes.3

Benefits and potential side effects

  • Side effects depend on the type of radiation and the treated area. They usually peak towards the end of treatment and may take a few weeks to clear up.
  • Common side effects include:
  • Mild to moderate fatigue
  • Skin issues, like redness or itching (similar to a sunburn)
  • Swelling in the breast

Depending on the treatment, radiation might lead to:

  • Swelling in the arm (lymphedema) if lymph nodes are treated
  • Potential complications with breast implants
  • Rare issues like rib fractures, lung or heart problems, or even other cancers (though these are very uncommon).

Radiation for special cases

  • Locally Advanced Breast Cancer: When surgery can't remove the cancer.
  • Inflammatory Breast Cancer: An aggressive type that may need radiation after chemotherapy and mastectomy.4

Radiation for metastatic breast cancer

If breast cancer spreads to other body parts, radiation can help shrink tumours and relieve symptoms like pain.

Remember, the benefits of radiation usually outweigh the potential side effects, but your doctor will discuss these with you to make the best treatment plan for your situation.

Treatment options for secretory carcinoma of the breast

Primary treatment

There isn't a standard way to treat secretory carcinoma of the breast (SBC). The main approach is surgery, but other treatments like radiotherapy, chemotherapy, and targeted drugs might be used, too. The treatment plan depends on your age, tumour size, lymph node status, and the type of cancer.

Treatment for pediatric SBC

For kids with SBC, doctors pay attention to the future development of the breast. In prepubertal girls, they might remove the breast lump while preserving the breast buds. But in very young children, it can be tough to keep the breast shape during surgery, so some experts suggest removing the whole breast (simple mastectomy) instead.

Breast-conserving surgery

Doing breast-conserving surgery (keeping the breast) in children with local excision (just removing the lump) can have a higher chance of the cancer coming back.

Adjuvant radiotherapy after surgery

Doctors often recommend additional radiation after breast-conserving surgery. It helps control the cancer in the breast area. Improvements in radiation technology make this more common.

Radiation in kids and teens can lead to lung issues, uneven growth of the chest, and long-term effects on the skin and breast tissue.

Targeted therapy

There's a new treatment approach using TRK inhibitors (TKI) for patients with specific genetic changes in their tumours. This treatment has shown good results in various types of tumours.

Prognosis

  • Even if SBC spreads to nearby lymph nodes, it usually has a good outlook.
  • However, local recurrence (cancer coming back in the same area) is quite common in SBC cases, even after treatments like breast-conserving surgery.
  • SBC grows slowly, and recurrences often happen 10 to 20 years later. That's why patients, no matter their age, are recommended to have long-term follow-up care for at least 20 years or for life.5

Summary

  1. Breast cancer is common in the UK, affecting about 1 in 7 women, but early detection offers a good chance of recovery.
  2. Secretory carcinoma of the breast is an extremely rare type of cancer, mostly found in children and adolescents, with distinct features when examined under a microscope.
  3. Radiation therapy, which uses X-rays or other particles, plays a crucial role in breast cancer treatment, effectively targeting cancer cells while sparing healthy tissue.
  4. Treatment for secretory carcinoma involves surgery, possibly followed by radiation and, in some cases, targeted therapy. Although it can have a good prognosis, long-term follow-up is essential due to the possibility of recurrence.

FAQs

Is there a link between birth control pills and breast cancer?

Women who use birth control pills for more than five years may have a slightly higher risk of breast cancer. However, today's pills have low hormone levels, so the risk is relatively small. If a young woman has a strong family history of breast cancer, her doctor might suggest taking a break from the pill for a year after five years of use and then starting again. This practice is becoming more common, even though there isn't strong proof that it's necessary.

How often should I do a breast self-exam?

  • You should do a breast self-exam once a month. Check for any changes in your breasts, like size changes, feeling a lump, skin dimpling, nipple changes, or unusual discharge.
  • If you find a persistent lump or any changes, see a doctor right away. Most lumps are not cancer, but it's essential to get them checked to be sure.
  • Women should do this exam 7-10 days after their period starts when their breasts are less tender and lumpy. If you're not menstruating, pick a specific day each month to remind yourself. Look for changes compared to the previous month.
  • Know the layout of your breasts, and if it helps, draw a diagram to remember where you felt lumps or other changes. Doing breast self-exams more often than monthly isn't necessary and might not give you accurate results. Also, your findings might vary depending on where you are in your menstrual cycle.

References

  1. Aktepe F, Sarsenov D, Özmen V. Secretory Carcinoma of the Breast. J Breast Health 2016; 12: 174–176.
  2. LEE SG, JUNG SP, LEE HY, et al. Secretory breast carcinoma: A report of three cases and a review of the literature. Oncol Lett 2014; 8: 683–686.
  3. Li D, Xiao X, Yang W, et al. Secretory breast carcinoma: a clinicopathological and immunophenotypic study of 15 cases with a review of the literature. Mod Pathol 2012; 25: 567–575.
  4. Tang H, Zhong L, Jiang H, et al. Secretory carcinoma of the breast with multiple distant metastases in the brain and unfavourable prognosis: a case report and literature review. Diagnostic Pathology 2021; 16: 56.
  5. Gong P, Xia C, Yang Y, et al. Clinicopathologic profiling and oncologic outcomes of secretory carcinoma of the breast. Sci Rep 2021; 11: 14738.

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