What Is Breast Cancer
This diagram of the breast shows the location of the lobules, lobe, duct, areola, nipple, and fat.
Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.
Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.
Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.
What Is The Difference Between Invasive Ductal Carcinoma And Ductal Carcinoma In Situ
DCIS means the cancer is still contained in the milk duct and has not invaded any other area. IDC is cancer that began growing in the duct and is invading the surrounding tissue. Cancer staging done by a physician, along with a physical exam and medical history can help identify the best treatment options.
Materials on this page courtesy of National Cancer Institute
Medically Reviewed on April 15, 2020
Breast Duct Treatment For Early Breast Cancer Eliminates All Signs Of Disease In Laboratory Experiments
Next step is to study in women receiving mastectomy
Dr. Guannan Wang performs intraductal injection under a microscope. Credit: Qinxin Jiang
Delivering a targeted immunotoxin into breast ducts via openings in the nipple wiped out all visible and invisible precancerous lesions in laboratory studies, led by researchers at the Johns Hopkins Kimmel Cancer Center, of very early stage breast cancers.
A description of the work performed on mice, which the authors say provides a strong pre-clinical foundation for conducting feasibility and safety trials with patients who have stage 0 breast cancers, is published in the June 8 issue of the Proceedings of the National Academy of Sciences.
Stage 0 breast cancer, also known as ductal carcinoma in situ , is characterized as the presence of abnormal, precancerous cells inside milk ducts in the breast, and it affects about 69,000 women each year in the United States. Many women have breast removal surgery and radiation treatments for these very early cancers, and in some cases, they receive chemotherapy or hormone therapies, says senior study author Saraswati Sukumar, Ph.D., a Johns Hopkins professor of oncology and pathology.
In our research, we proposed an alternative treatment in which injecting the immunotoxin drug through the duct could result in cleaning out the DCIS, says Sukumar. To our big surprise, the drugs killed every single lesion present in that breast duct. I had never seen such dramatic results in my life.
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What Is The Difference Between A Clogged Milk Duct And Mastitis
A plugged duct is an obstruction of milk flow in a portion of the breast, either at the nipple or further back in the ductal system.Mastitis is inflammation and infection of the breast. These conditions happen most often in the first six to eight weeks postpartum, but they can occur at any time during breastfeeding.
Checking For Ductal Breast Cancer In Lymph Nodes
The goal of invasive ductal carcinoma treatment is to get the cancer out of the breast. But we also may need to remove lymph nodes if the cancer has spread there, Wright explains.
Your lymph nodes are part of your immune system. Lymph fluid from the breast drains into the axillary lymph nodes. The number and location of axillary lymph nodes may be different from person to person.
A sentinel lymph node biopsy is a test that can help your doctor determine if removing lymph nodes may be part of your cancer surgery.
The sentinel lymph node is where cancer from invasive ductal carcinoma is likely to show up first. Your doctor can identify the sentinel lymph node by injecting dye into the breast and seeing which node takes up the dye first: This is the sentinel. A sample of tissue from this node can reveal if cancer has spread there.
If theres no cancer in the sentinel node, the other nodes are OK and dont need to be removed, says Wright. If theres a small amount of cancer present, well leave nodes in place and treat the area with radiation or use chemotherapy.
If we see a lot of cancer in the lymph nodes or if four or more lymph nodes are affected, we perform an axillary lymph node dissection: surgery to remove the nodes.
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Sentinel Node Biopsy And Mastectomy For Dcis
A sentinel node biopsy is a procedure used to check whether or not invasive breast cancer has spread to the lymph nodes in the underarm area . The surgeon removes 1-5 axillary lymph nodes.
Having a sentinel node biopsy during a mastectomy helps some people with DCIS avoid having more axillary lymph nodes removed.
Once a mastectomy has been done, a person cant have a sentinel node biopsy. If it turns out theres invasive breast cancer in the tissue removed during the mastectomy, and a sentinel node biopsy wasnt done, another surgery to remove more axillary lymph nodes may be needed. If a sentinel node biopsy was already done, surgery to remove more nodes may be avoided.
So, even though a sentinel node biopsy may not be needed with DCIS, many people who have a mastectomy for DCIS will have a sentinel node biopsy done at the same time.
How Can I Reduce My Risk For Invasive Ductal Carcinoma
Like most cancers, knowing your family history can help you take preventative steps, such as early screenings and mammograms. Even though invasive ductal carcinoma cant be prevented altogether, there are steps you can take to lower your risk:
- Maintain a healthy body weight.
- Eat a healthy, well-balanced diet.
- Undergo genetic testing for gene mutations if recommended based on family history.
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Lobular Carcinoma In Situ
Lobular carcinoma in situ refers to an area of abnormal cells confined to the breasts milk-producing glands.
Because these cells do not spread to surrounding tissues, doctors do not lobular carcinoma situ to be cancer. However, it can increase the chances of developing other types of invasive breast cancer.
This condition rarely causes symptoms. Doctors lobular carcinoma in situ during a breast biopsy for another problem in the breast area. In some cases, tiny white specs of calcium called microcalcifications appear on a routine mammogram.
What Does Ductal Carcinoma Feel Like
The most common symptom of ductal carcinoma is a firm or hard lump that feels very different from the rest of the breast. It may feel like it is attached to the skin or the surrounding breast tissue. The lump doesnt get smaller or come and go with your period. It may be tender, but its usually not painful.
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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.
How Is Ductal Carcinoma In Situ Diagnosed
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
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Invasive Ductal Carcinoma Treatment
Most women with IDC have surgery to remove the cancer. The treatment options are usually:
- Lumpectomy: The surgeon only removes the tumor and a bit of the tissue around it to help make sure all the cancer cells have been removed. You might hear it called breast-conserving surgery
- Mastectomy: The surgeon removes an entire breast.
Which one you get depends on the size of your tumor and how much it has spread throughout your breast and surrounding lymph nodes.
In addition to surgery, other treatments may include:
- Radiation: This usually follows your surgery.
- Hormone therapy: Youâll get it if your cancer is hormone receptor-positive . These drugs block or lower the amount of estrogen in your body.
- Chemotherapy: These medications target cancer cells throughout your body. Doctors may also use It before surgery to shrink tumors and after to kill any cancer cells left behind.
- Targeted therapy: These medications block cancer cell growth. You might get them along with chemotherapy.
You might get one treatment or a combination.
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.
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Coping With A Diagnosis Of Dcis
Being told you have DCIS can be a difficult and worrying time. Everyone reacts differently to their diagnosis and have their own way of coping.
Although DCIS is an early form of breast cancer with a very good prognosis, people understandably may feel very anxious and frightened by the diagnosis. People can often struggle to come to terms with being offered treatments such as a mastectomy, at the same time as being told their DCIS may never do them any harm.
Some people are reluctant to say theyre anxious about a diagnosis of DCIS because they worry others will see it as less important than other types of breast cancer. Because of this they might feel less able to ask for support. But there are people who can support you so dont be afraid to ask for help if you need it. By letting other people know how you feel, particularly your family and friends, they can be more supportive.
Some people find it helpful to discuss their feelings and concerns with their breast care nurse or specialist. If youd like to talk through your feelings and concerns in more depth over a period of time, a counsellor or psychologist may be more appropriate. Your breast care nurse, specialist or GP can arrange this.
Find out more about coping emotionally with breast cancer.
If you want to talk you can also call our Helpline on 0808 800 6000.
Nonsurgical Invasive Ductal Carcinoma Treatment
Radiation. Radiation therapy might be part of your treatment plan if you are undergoing a lumpectomy. Studies show that lumpectomy followed by radiation can be as effective in treating IDC as mastectomy. We dont usually treat patients with radiation after a mastectomy unless theres some cancer in the lymph nodes, Wright says.
Chemotherapy. Deciding on whether to treat invasive ductal breast cancer with chemotherapy, or chemo, depends on features of the tumor cells themselves their genes and proteins. The more the doctor can learn about the characteristics of the cancer cells, the easier it is to determine what type of chemotherapy is likely to be effective.
Hormone therapy. Breast cancers with positive hormone receptors can be treated with estrogen or progesterone. These medications come in pill form, and may be prescribed for several years.
Biologic therapy. This approach uses antibodies or small molecule drugs to activate your bodys immune system to fight the invasive ductal cancer cells.
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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.
I Have Dcis Will I Develop Invasive Breast Cancer In The Future
Not every woman with DCIS will develop invasive breast cancer. Your risk of developing invasive breast cancer is, however, increased if you have been diagnosed with DCIS.
Recent results from an Australian study found that between 1995 and 2005, 13,749 women were diagnosed with DCIS and that, by the end of 2005, 706 of those women had developed invasive breast cancer even though they had received treatment for DCIS.2
According to the study, women who are diagnosed with DCIS are, on average, 3.9 times more likely to develop invasive breast cancer than Australian women of a similar age who have not had DCIS.
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Inserting A Metal Marker
If you have a biopsy, sometimes a small metal clip called a marker is placed in the breast where the biopsy samples were taken. This is so the area can be found again if another biopsy or surgery is needed. It can safely be left in the breast and does not need to be removed, even if no further procedures are needed.
Will I Get Breast Cancer If I Have Adh
If youve been diagnosed with ADH, you have an increased risk of developing breast cancer in the future. Specifically, at five years after the diagnosis of ADH, 7% of women will develop breast cancer, and at 10 years post-diagnosis, 13% of these women will develop breast cancer.
Over time, if enough atypical cells encroach upon the ducts empty space so it expands past a certain threshold, or if two adjacent ducts contain ADH, then the pathologist labels it breast cancer, says Brown.
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Stage 0 Vs Stage 1 Breast Cancer
In stage 1 breast cancer, the cancer is invasive, though its small and contained to breast tissue , or a small amount of cancer cells are found in your nearest lymph nodes .
As we explore stage 0 breast cancer, were talking about DCIS, not stage 1 invasive breast cancer or lobular carcinoma in situ .
Sex Life And Fertility
Breast cancer treatments can have a direct effect on your sex life.
For example, surgery may affect how you think and feel about your body . It can take time to adjust to changes to your body. If you have a partner, it can help to talk openly with them about your feelings.
Some treatments for DCIS may cause menopausal symptoms. Doctors do not recommend hormone replacement therapy . This is because it contains oestrogen, which could encourage breast cancer cells to grow.
Your cancer doctor or breast care nurse will also advise you not to use contraception that contains hormones.
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Causes Of Invasive Ductal Carcinoma
Unfortunately, doctors have yet to figure out the exact cause of invasive ductal carcinoma. When you get this type of cancer, it means something damaged your cells’ DNA and caused it to change. The result is that the cells grow abnormally and uncontrollably in your breast tissue.
Doctors are still looking for genetic and environmental factors that damage the DNA. They have determined that caffeine, deodorant, microwaves and cell phone use do not lead to this type of cancer.
Can Dcis Be Left And Not Treated
Because theres no way of knowing when or if DCIS will become invasive, treatment is usually recommended. Its possible this may lead to unnecessary treatment for some people.
The aim of treatment is to remove all the DCIS from within the breast to reduce the chance of it becoming an invasive cancer.
Research is looking at which cases of DCIS are more likely to develop into invasive breast cancer and which could be closely monitored instead of being treated. If you are diagnosed with low-grade DCIS, you may be invited to join a clinical trial.
If you have any questions or concerns about your diagnosis and treatment, talk to your treatment team.
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