Normal Breast Structure

In order to understand breast cancer, it is helpful to have some basic knowledge about the normal structure of the breasts, as shown in the picture below.

A woman’s breast is made up of glands that make breast milk (lobules), ducts (small tubes that carry milk from the lobules to the nipple), fatty and connective tissue, blood vessels, and lymph (pronounced limf) vessels. Most breast cancers begin in the cells that line the ducts (ductal cancer), some begin in the lobules (lobular cancer), and the rest in other tissues.

The Lymph System

The lymph system is important because it is one of the ways in which breast cancers can spread. This system has several parts.

Lymph nodes are small, bean-shaped collections of immune system cells that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.

Most lymph vessels of the breast lead to lymph nodes under the arm. These are called axillary (ax-uh-lair-ee) nodes. If breast cancer cells reach the underarm lymph nodes and continue to grow, they cause the nodes to swell. Once cancer cells have reached these nodes they are more likely to spread to other organs of the body too. Knowing whether cancer cells have spread to lymph nodes is important because if they have, there is a higher chance that the cells have also gotten into the bloodstream and spread to other places in the body. This could affect the treatment plan.

Benign Breast Lumps

Most breast lumps are benign (be-nine); that is, they are not cancer. Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman’s risk of getting breast cancer.

Most lumps turn out to be caused by fibrocystic (fi-bro-sis-tik) changes. Cysts are fluid-filled sacs. Fibrosis is the formation of scar-like tissue. Such changes can cause breast swelling and pain. The breasts may feel lumpy, and sometimes there is a clear or slightly cloudy nipple discharge. For more detail, please see the document, Non-cancerous Breast Conditions.

Breast Cancer Terms

Understanding key words as they relate to breast cancer can be a challenge. Here are the key words used to describe breast cancer:

Carcinoma (car-sin-o-muh)

This is a term used to describe a cancer that begins in the lining layer of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).

Adenocarcinoma (ad-uh-no-car-sin-O-muh)

An adenocarcinoma is a type of cancer that starts in glandular tissue (tissue that makes and secretes a substance). The ducts and lobules of the breast are glandular tissue (they make breast milk), so cancers starting in these areas are sometimes called adenocarcinomas.

Carcinoma In Situ (in si-too)

This term is used for the early stage of cancer, when it is still only in the layer of cells where it began. In breast cancer, in situ means that the cancer cells are only in the ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). They have not spread into deeper tissues in the breast or to other organs in the body. They are sometimes referred to as non-invasive breast cancers.

Invasive (Infiltrating) Carcinoma

An invasive cancer is one that has already gone beyond the layer of cells where it started (unlike carcinoma in situ). Most breast cancers are invasive carcinomas -- either invasive ductal carcinoma or invasive lobular carcinoma.

Sarcoma

Sarcomas are cancers that start from connective tissues such as fat tissue or blood vessels. Sarcomas of the breast are rare.

Types of Breast Cancers

There are many types of breast cancer, though some of them are very rare. Sometimes a breast tumor can be a combination of these types and to have a mixture of invasive and in situ cancer.

Ductal carcinoma in situ (DCIS): This is the most common type of non-invasive breast cancer. DCIS means that the cancer is only in the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram.

Lobular carcinoma in situ (LCIS): This condition begins in the milk-making glands but does not go through the wall of the lobules. Although not a true cancer, having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS to follow the screening guidelines for breast cancer (these are discussed later in this document).

Invasive (infiltrating) ductal carcinoma (IDC): This is the most common breast cancer. It starts in a milk passage or duct, breaks through the wall of the duct, and invades the tissue of the breast. From there it can spread to other parts of the body. It accounts for about 8 out of 10 invasive breast cancers.

Invasive (infiltrating) lobular carcinoma (ILC): This cancer starts in the milk glands or lobules. It can spread to other parts of the body. About 1 out of 10 invasive breast cancers are of this type.

Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The breast may become larger, firmer, tender, or itchy. IBC is often mistaken for an infection in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It usually has a higher chance of spreading and a worse outlook than invasive ductal or lobular cancer.

There are also many other less common types of breast cancer. You can get information about these through our toll-free number or on our Web site.