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Breast Cancer Ductal In Situ

How Is Ductal Carcinoma In Situ Diagnosed

Ductal carcinoma in situ (DCIS): Mayo Clinic Radio

A mammogram can reveal abnormalities in your breast tissue that your healthcare provider can investigate further during a biopsy.

Mammogram

A mammogram uses a low-dose X-ray to take images of breast tissue. As old cells die and collect within your milk ducts, they leave tiny hardened calcium deposits called breast calcifications. Calcifications appear as a shadow or white spot on a mammogram. Abnormal calcifications may indicate abnormal cell growth, which may mean DCIS or other types of breast cancer.

Your healthcare provider may order an additional mammogram, called a diagnostic mammogram, if they find suspicious areas on a screening mammogram. A diagnostic mammogram provides more detailed views of your breast tissue. The procedure takes longer than a screening mammogram.

Mammograms used to detect DCIS include:

  • 2D mammograms: A traditional mammogram takes at least two images of your breast from different angles to provide a two-dimensional view of your breasts. A 2D mammogram is the most common imaging procedure used for detecting DCIS.
  • 3D mammograms : A three-dimensional mammogram takes multiple images of your breast to create a 3D view. This type of mammogram detects breast cancer more accurately than traditional mammograms, especially in dense breast tissue.

Biopsy

Why Is Dcis Treated

The aim of treating DCIS is to prevent invasive breast cancer from developing. If DCIS is not treated it may develop into invasive breast cancer, which can spread outside the ducts into the breast tissue and then possibly to other parts of the body.

We dont know for certain how many women with DCIS would develop invasive breast cancer if they were not treated. Also, it is not possible to predict which women with DCIS will develop invasive breast cancer if they were not treated or how long after the diagnosis of DCIS an invasive breast cancer would develop. Some women with DCIS may never develop any problems if they are not treated. However, some women with DCIS may develop invasive breast cancer.

Because DCIS may develop into invasive breast cancer and invasive breast cancer can spread and cause death, women with DCIS are generally recommended to have treatment. Treatment for DCIS aims to help prevent invasive breast cancer from developing and DCIS from coming back in the breast.

DCIS can be treated successfully and most women diagnosed and treated for DCIS will not later develop invasive breast cancer.

What Does It Mean If My Report Mentions Paget Disease

Paget disease is when cells resembling the cells of ductal carcinoma in situ are found in the skin of the nipple and the nearby skin . Paget disease of the nipple is usually associated with DCIS or invasive carcinoma in the underlying breast tissue. If Paget disease is found on needle or punch biopsy, more tissue in that area usually needs to be removed with the goal of entirely removing the area of Paget disease. Talk to your doctor about the best treatment for you.

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Risk Of Developing Invasive Breast Cancer After Dcis

After treatment for DCIS, theres a small risk of:

  • DCIS recurrence
  • Invasive breast cancer

These risks are higher with lumpectomy plus radiation therapy than with mastectomy . However, overall survival is the same after either treatment .

Higher grade DCIS appears more likely than lower grade DCIS to progress to invasive cancer after treatment .

With close follow-up, invasive breast cancer is usually caught early and can be treated effectively.

Learn more about tumor grade.

If youve been recently diagnosed with DCIS or feel too overwhelmed to know where to begin to gather information, it may be helpful to download and print some of Susan G. KomenĀ®s resources. For example, we have Questions to Ask Your Doctor About Breast Cancer Surgery and Questions to Ask Your Doctor About Radiation Therapy and Side Effects.

You can write on them at your next doctors appointment. Or, you can download, type and save it on your computer, tablet or phone during a telehealth visit using an app such as Adobe. Plenty of space and a notes section are provided to jot down answers to the questions.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.

Proposed Mechanisms For The Development Of Invasive Breast Cancer

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Although the natural course of the intraductal process is unknown, DCIS is considered to be a non-obligate precursor of invasive breast cancer. Four evolutionary models have been proposed to describe the progression of DCIS into invasive breast cancer .

Fig. 1

Overview of models showing four different theories of progression from ductal carcinoma in situ to invasive breast cancer

To address these priorities in DCIS, a multidisciplinary approach with scientific, clinical and patient expertise is needed. Data from large retrospective cohorts should be integrated with in vitro and in vivo studies and the results should be validated to transform clinical practise. To fund such a large multinational consortium, Cancer Research UK and the Dutch Cancer Society partnered to support the Grand Challenge award in 2017, the PREvent ductal Carcinoma In Situ Invasive Overtreatment Now initiative .

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Total Mastectomy With Breast Reconstruction

Almost all women undergoing mastectomy for DCIS have the option of having breast reconstruction. There are a number of ways that the breast can be reconstructed following mastectomy. Options include reconstruction with a breast implant or a reconstruction with a flap . If the DCIS is away from your nipple you may be able to have a mastectomy that preserves your nipple .

Breast reconstruction can be done immediately or delayed . Breast reconstruction may be performed by a breast cancer surgeon or by a plastic surgeon, or as a joint procedure by both surgeons. This will depend on your individual situation and the type of reconstruction that you choose.

Magnetic Resonance Imaging Of The Breast

Evaluation of Atypical Ductal Hyperplasia. An UpToDate review on “Atypia and lobular carcinoma in situ: High-risk lesions of the breast” states that “Magnetic resonance imaging of the breast is more sensitive than mammography in detecting invasive breast cancers in high-risk women, but it is less specific ….

https://www.aetna.com/cpb/medical/data/100_199/0105.html.

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Removal Of Part Of The Breast

Many women have surgery to remove the area of DCIS and a border of healthy tissue around it. This is called breast conserving surgery, or a wide local excision or sometimes a lumpectomy.

After this surgery, you might have radiotherapy to the rest of the breast tissue if the DCIS cells look very abnormal . The radiotherapy treatment aims to kill off any abnormal cells that might still be in the breast tissue. Your doctor or breast care nurse will discuss with you the possible benefits and risks of radiotherapy.

What Is The Optimal Treatment For A Local Recurrence

Ductal Carcinoma in Situ

Although local recurrences are uncommon after initial treatment for DCIS, they can be psychologically devastating for the patient, particularly if it is an invasive recurrence. The treatment of a recurrence depends on the initial treatment of DCIS, whether the recurrence is DCIS or invasive, and whether the patient has received radiotherapy to the breast. After diagnosis is confirmed histologically, a screen for distant metastatic disease is usually performed.

For a patient treated by BCS alone, management options may include re-excision followed by radiation or mastectomy with or without breast reconstruction. If BCS and XRT were used initially, then mastectomy is usually the only option available. If mastectomy alone was the original treatment modality, then surgical removal of a chest wall recurrence may be possible, followed by chest wall RT, but this situation is extremely rare. Treatment of the axilla and consideration of systemic therapy is also required. Most recurrences can be salvaged by mastectomy. One study showed that following mastectomy, subsequent freedom from chest wall recurrence was high .

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Removal Of The Whole Breast

You might have a mastectomy if:

  • the area of the DCIS is large
  • there are several areas of DCIS
  • you have small breasts and too much of the breast is affected by DCIS to make breast conserving surgery possible

You may have surgery to your armpit called a sentinel lymph node biopsy if you have a mastectomy. This means having about 1 to 3 lymph nodes removed.

If you want to, you can choose to have a new breast made at the time of the mastectomy, or some time afterwards.

Hormone therapy is recommended for 5 years if you have breast conserving surgery for DCIS and:

  • your cancer calls have oestrogen receptors
  • you do not have radiotherapy

Research shows that taking hormone therapy after breast conserving surgery for DCIS reduces the risk of it coming back .

Trials show that hormone therapy can reduce the number of further invasive breast cancers or DCIS. But in these trials, the people taking a hormone therapy tablet called tamoxifen did not live any longer than those who didn’t take it.

Breast Ductal Carcinoma In Situ

  • William B. ColemanCorrespondenceAddress correspondence to William B. Coleman, Ph.D., American Society for Investigative Pathology, 1801 Rockville Pike, Ste. 350, Rockville, MD 20852.

in SituThe American Journal of Pathologyin situ

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Lumpectomy With Radiation Therapy

In this procedure, the surgeon will remove the tumor and some healthy breast tissue close by as a precaution.

Sometimes they may also remove the lymph nodes and request a biopsy to confirm that the cancer has not spread. Healthcare professionals call this a sentinel lymph node biopsy . They are more likely to do this if the tumor is large.

After surgery a person will receive radiation therapy to destroy any remaining cells.

Hormonal Therapy After Surgery

Breast Carcinoma in Situ

If doctors know the cancer uses estrogen and progesterone to grow, they will likely suggest hormonal therapy.

This treatment blocks tumor receptors that bind to these hormones, or reduces the amount of estrogen and progesterone in the body. A person may continue hormonal therapy for

high because people receive their breast cancer diagnosis early and begin treatment before the cancer progresses to a more invasive type.

The vast majority of people with DCIS can expect to have a normal life expectancy. However, they are at a higher risk of developing invasive breast cancer in the future in comparison with the general population.

In instances where a person does not receive treatment for DCIS, the cancer could progress to an invasive type and spread to other parts of the body.

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Other Factors That May Affect Survival Rates For Ductal Carcinoma In Situ

Hormone Replacement Therapy and Age of Menarche

There has been extensive research in the past regarding the connection between women taking hormone replacement therapy after menopause and invasive breast cancer.

However, there are very few studies that have examined the risk of HRT associated with Ductal Carcinoma In-Situ. A 2012 study examined 1,179 post-menopausal women with Carcinoma-In-Situ.

The study found no association between DCIS and use of Hormone Replacement Therapy . Furthermore, there was no association with current use of HRT or the duration of use of these hormones.

However, the study concludes that larger clinical trials are needed to truly assess if there are any associations between HRT and DCIS.

In addition, the age of menarche has not been shown, so far, to be associated with DCIS incidence. Indeed, it is more likely for women over 60 to develop DCIS.

How Is Dcis Graded

DCIS is graded based on what the cells look like under the microscope. DCIS is graded as low, intermediate, or high grade.

  • low grade the cancer cells look most like normal cells and are usually slow-growing
  • intermediate grade the cancer cells look less like normal cells and are growing faster
  • high grade the cancer cells look most changed and are usually fast-growing

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Are There Any Adjuvant Treatments

After surgery, you may need other treatments. These are called adjuvant treatments and can include radiotherapy and, in some cases, hormone therapy.

The aim of these treatments is to reduce the risk of DCIS coming back or an invasive cancer developing.

Chemotherapy and targeted therapy are not used as treatment for DCIS.

What Does It Mean If My Report Mentions Microcalcifications Or Calcifications

Ductal carcinoma in situ (DCIS) and Paget Disease – Histopathology

Microcalcifications or calcifications are calcium deposits that can be found in both non-cancerous and cancerous breast lesions. They can be seen both on mammograms and under the microscope. Because certain calcifications are found in areas containing cancer, their presence on a mammogram may lead to a biopsy of the area. Then, when the biopsy is done, the pathologist looks at the tissue removed to be sure that it contains calcifications. If the calcifications are there, the treating physician knows that the biopsy sampled the correct area .

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Proton Beam Neutron Beam And Carbon Ion Radiotherapy

Carcinoma in situ of lip, oral cavity, and pharynx: D02.3: … pancreatic ductal adenocarcinoma of the head. Patients received radiation with proton beam. In dose level 1, patients received 3 GyE x 10 . … prognosis, and appropriate treatment of PTPR have yet to be fully defined. Clivio et ….

https://www.aetna.com/cpb/medical/data/200_299/0270.html.

When Should I See My Healthcare Provider

Follow your healthcare providers guidance so you receive check-ups and mammograms as frequently as you should. In the meantime, pay attention to your breasts so you dont miss signs of breast cancer.

Symptoms include:

  • Pain in your breast or nipple.
  • A nipple that pulls inward.
  • Nipple discharge.
  • Skin changes .

Many of these symptoms are also signs of benign conditions. Get any changes checked to be sure.

A note from Cleveland Clinic

Ductal carcinoma in situ is one of the most treatable cancers. It doesnt typically spread beyond your milk ducts and rarely returns after breast-conserving surgery. Talk with your healthcare provider about the benefits of your treatment options versus potential side effects or complications. Multiple factors will determine the type of surgery thats best for you. Similarly, weigh the pros and cons of receiving additional treatments, like hormone therapy, with your provider.

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What Stage Of Cancer Is Ductal Carcinoma In Situ

DCIS is a highly treatable and curable stage 0 breast cancer. Healthcare providers classify cancer into stages from 0 to 4. To stage cancer, providers look at the original cluster of cancer cells and determine where its located, the tumors size and if cancer cells have spread to other areas. The lower the number, the better chance for successful treatments.

Although DCIS is always stage 0, the tumor can be any size and may be located within several milk ducts inside of your breast. Regardless, the prognosis for DCIS with treatment is excellent.

Treatment Options For Dcis: Lumpectomy Or Mastectomy

New Technique Identifies Ductal Carcinoma In Situ, Breast Cancer ...

In most cases, the first line of treatment when DCIS is diagnosed is some form of breast surgery.

There are two basic surgical approaches for DCIS treatment:-

  • Breast Conserving Surgery
  • Mastectomy
  • Lumpectomy is usually adequate if the area of breast abnormality is very small or only one abnormality is found on a mammogram.

    Also, lumpectomy is usually recommended if the DCIS is of a less aggressive type such as non-comedo DCIS.

    Lumpectomy is most effective for DCIS patients with small, low-grade DCIS which is easily identifiable on mammogram. In some cases the amount of DCIS is so small that the first exploratory biopsy is enough to remove all of the carcinoma and a subsequent lumpectomy is not required.

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    What Does It Mean If My Report On Ductal Carcinoma In Situ Mentions Estrogen Receptor Or Progesterone Receptor

    ER and PR are special tests that the pathologist does that are important in predicting response of the DCIS to hormone therapy . Testing for ER is done for most cases of DCIS, but testing for PR is not typically needed. Results for ER and PR are reported separately and can be reported in different ways:

    • Negative, weakly positive, positive
    • Percent positive with something saying whether the staining is weak, moderate, or strong

    Ask your doctor how these results will affect your treatment.

    If Someone Has Dcis What Should Be The First Step In Deciding On Treatment

    A person diagnosed with DCIS usually meets with a breast surgeon first. The doctor will assess the tumors size, grade, and hormone-receptor status, as well as other risk factors that are important for treatment decisions. For example, should a patient get genetic testing for inherited mutations such as BRCA1 or BRCA2, which are known to raise risk for future breast cancer? Do they have a strong family history of the disease?

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    What Medication Treat Ductal Carcinoma In Situ

    After surgery, your healthcare provider may prescribe medications to prevent DCIS from recurring or a new type of cancer from forming in your breasts. The most common medicines are Tamoxifen and aromatase inhibitors . This treatment is called hormone therapy. The whole treatment course lasts for five years.

    • Tamoxifen can prevent hormones, like estrogen, from spurring cancer growth. Most types of DCIS are hormone receptor-positive. This means that the cancer cells have receptors that attach to hormones, like estrogen. Once attached, these hormones fuel their growth. Tamoxifen prevents hormones from attaching to cancer cells.
    • Aromatase inhibitors reduce estrogen production in post-menopausal people. Aromatase is an enzyme, or chemical, in your body that spurs your fat cells to produce estrogen. Before menopause, your ovaries make most of your bodys estrogen. After menopause, fat tissue makes the majority of your estrogen. By reducing estrogen production, aromatase inhibitors prevent the hormone from encouraging cancer cell growth.

    What are the treatment side effects?

    Radiation and hormone therapy can cause side effects that you should discuss with your provider as you weigh treatment benefits against potential negatives.

    Side effects of radiation may include:

    • Breast swelling.

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