Medullary breast cancer

Medullary breast cancer is an uncommon type of breast cancer.

It may also be called invasive breast cancer of no special type with medullary features or medullary-like cancer.

It’s called medullary because the cancer is soft, fleshy and grey, which looks a bit like a part of the brain called the medulla.

You can get medullary breast cancer at any age but it’s more often diagnosed in younger women. It’s also more common in women who have inherited an altered BRCA1 gene.

Men can get it too, but this is very rare.

Medullary breast cancer is an invasive type of cancer. Invasive means it has the potential to spread to other parts of the body, although this is less common than with some other types of invasive breast cancer.

While each case is different, the outlook (prognosis) for this type of breast cancer is often good.

As with most types of breast cancer, the symptoms of medullary breast cancer can include:

• A lump or thickening of the breast tissue
• A change in the size of the breast
• Changes to the nipple
• A change in the texture of the skin, such as puckering or dimpling

Medullary breast cancer is diagnosed using a range of tests. These may include:

• A mammogram
• An ultrasound scan
• A core biopsy of the breast and sometimes lymph nodes

The treatments you’re offered will depend on the features of the medullary breast cancer such as its:

• Size
• Grade
• Hormone receptor status
• HER2 status

Treatment aims to remove the cancer and reduce the risk of it coming back or spreading to other parts of the body.

Surgery

Surgery is usually the first treatment for medullary breast cancer.

There are 2 main types of surgery:

• Breast-conserving surgery – removal of the cancer with a margin (border) of normal breast tissue around it. It’s also known as wide local excision or lumpectomy
• Mastectomy – removal of all the breast tissue, usually including the nipple area

The type of surgery recommended depends on:

• Where the cancer is in the breast
• The size of the cancer relative to the size of the breast
• Whether more than 1 area in the breast is affected

You may need more surgery if the margin of normal tissue surrounding the cancer that was removed during the first operation is not clear. This is to make sure all the cancer has been removed. In some cases, this second operation will be a mastectomy.

Most women who have a mastectomy will have the option to have breast reconstruction.

Surgery to the lymph nodes

Medullary breast cancer is less likely to spread to the lymph nodes (glands) under the arm than other types of breast cancer.

Your treatment team will still want to check if any of the lymph nodes under the arm contain cancer cells. This, along with other information about your breast cancer, helps them decide whether you will benefit from any additional treatment after surgery.

To do this, your surgeon is likely to recommend an operation to remove either some of the lymph nodes (a sentinel lymph node biopsy or sample) or all of them (a lymph node clearance).

Other treatments

After surgery, you may need other treatments. These can include:

These treatments aim to reduce the risk of breast cancer returning in the same breast or spreading somewhere else in the body.

Which treatments are recommended will depend on your individual situation.

Treatments given after surgery are called adjuvant treatments.

Some of these treatments may be given before surgery. This is known as neo-adjuvant or primary treatment.

Radiotherapy

If you have breast-conserving surgery you will usually be offered radiotherapy to the breast to reduce the risk of the cancer coming back in the same breast.

Radiotherapy is sometimes given to the chest wall after a mastectomy.

Chemotherapy

Chemotherapy destroys cancer cells by affecting their ability to divide and grow.

Chemotherapy also affects other cells throughout the body, which causes side effects.

Chemotherapy is given to reduce the risk of breast cancer returning or spreading.

Hormone (endocrine) therapy

Some breast cancers use the hormone oestrogen in the body to help them to grow. These are known as oestrogen receptor positive or ER-positive breast cancers.

Hormone therapies block or stop the effect of oestrogen on breast cancer cells. Different hormone therapy drugs do this in different ways.

If your cancer is ER-positive, your treatment team will discuss with you which hormone therapy they think is most appropriate.

If oestrogen is not helping your breast cancer grow, it’s ER-negative and hormone therapy will not be of benefit.

Medullary breast cancers are more likely to be ER-negative.

Targeted (biological) therapy

Targeted therapy is the name given to a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow. 

The most widely used targeted therapies are for HER2 positive breast cancer. HER2 is a protein that helps cancer cells grow.

Medullary cancers are less likely to be HER2 positive than some other types of breast cancer.

Your treatment team can tell you whether a targeted therapy drug would be suitable for you, based on the features of your cancer.

Bisphosphonates

This group of drugs can reduce the risk of breast cancer spreading in women who have been through the menopause. They can be used if the menopause happened naturally or because of breast cancer treatment.

Your treatment team can tell you if bisphosphonates would be suitable for you.

Triple negative breast cancers

Most medullary breast cancers are triple negative. This means they are HER2-negative, ER-negative and PR-negative.

Some breast cancer treatments, such as hormone (endocrine) therapy and HER2 targeted therapies, are of no benefit to people with triple negative breast cancer.

However, people diagnosed with medullary breast cancer generally have a better outlook (prognosis) than people with some other types of breast cancer.

If you’ve been diagnosed with breast cancer, you might be feeling lonely or isolated. It’s completely natural to have these feelings.

You might find it helps to talk to someone who has been diagnosed with breast cancer. Find out about our Someone Like Me service at the bottom of this page.

You can also visit our confidential online forum and talk to other people affected by breast cancer.

You can also speak to our nurses on our free helpline. See the bottom of this page for ways to get in touch.