Some People With Dcis Get Radiation
Healthcare providers and patients should decide together whether further treatment is needed to reduce the risk of another DCIS or an invasive cancer, including medications or radiation. This can be determined through genomic testing or by looking at factors like the patient’s age, family history, and tumor size and grade.
“Several years ago, radiation would have been given to everyone who had DCIS, period,” said Dr. Meyers. “But now, it’s a little more tailored to the type of DCIS and the type of patient, and there’s been a downward trend of getting less radiation or avoiding it completely, if possible.”
In general, radiation is typically part of treatment after breast-conserving surgery . However, radiation does come with side effectsand it has not been shown to extend survival in patients with DCIS. Instead, it’s only been shown to reduce the risk of another cancer occurring.
Therefore, patients should weigh the pros and cons carefully, added Dr. Meyers, and make the best individual decision for them.
What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.
What If My Report On Ductal Carcinoma In Situ Mentions Margins Or Ink
When the entire area of DCIS is removed, the outside surface of the specimen is coated with ink, sometimes even with different colors of ink on different sides of the specimen. The pathologist looks at slides of the DCIS under the microscope to see how close the DCIS cells get to the ink . If DCIS is touching the ink , it can mean that some DCIS cells were left behind, and more surgery or other treatments may be needed. Sometimes, though, the surgeon has already removed more tissue to help make sure that this isnt needed. If your pathology report shows DCIS with positive margins, your doctor will talk to you about what treatment is best.
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Current Diagnosis And Imaging
DCIS is usually straightforward to detect by mammography because of its association with calcifications the proliferation of cells itself is not visible on the mammogram. However, as only 75% of all DCIS lesions contain calcifications,15 a substantial percentage of DCIS lesions will not be detected by mammography, implying that some lesions might be mammographically occult or that the diameter of the area containing calcifications underestimates the extent of DCIS.16,17 This suggests that DCIS might be left behind following breast-conserving treatment in a proportion of cases.
What Does It Mean If My Report Mentions Microcalcifications Or Calcifications
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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What Are Some Advantages Of Receiving Treatment For Dcis At Msk
At MSK, we have a very thoughtful approach to personalizing treatment for each person with DCIS. The doctors and patients make treatment decisions as a team. Much of the research determining risk factors for DCIS-related recurrence was done at MSK, and we have a computerized prediction model that can help calculate an individuals risk of recurrence, which helps us decide what treatments are best. Weve tried to figure out who really needs additional treatments, such as radiation or hormone therapy, and who may be able to avoid certain treatments. Our goal is to find the right treatment for each patient, so that they can remain cancer free with an excellent quality of life moving forward.
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.
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Learn More About Dcis And How Bcrf Is Advancing Research To Understand And Treat Stage 0 Breast Cancer
Breast cancer is the most common cancer in women living in the U.S. Of all breast cancer diagnoses in the country, 20-25 percent are ductal carcinoma in situ . The American Cancer Society estimates that about 51,400 new cases of DCIS will be diagnosed in women this year.
Though it can be very stressful and alarming, DCIS is not life-threateningpractically all patients with stage 0 breast cancer can be cured. Having DCIS can, however, increase ones risk of developing invasive breast cancer. Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated.
Read on to learn what DCIS is and its symptoms, how it is diagnosed and treated, and how BCRF researchers are improving care and learning more about this form of breast cancer.
What is Ductal Carcinoma in Situ ?
Ductal carcinoma in situ is the earliest stage of breast cancer, which is why its sometimes referred to as stage 0 breast cancer. DCIS, by definition, is cancer that starts in the cells lining the milk ducts and remains in the area where it originates . DCIS remains in the milk duct and does not spread through the duct walls into the surrounding breast tissue. Stage 0 breast cancer is considered to be a precursor to invasive, stage 14 breast cancers.
DCIS vs. LCIS
Are there DCIS symptoms? How is DCIS diagnosed?
Is DCIS cancer? Should DCIS be treated like invasive breast cancer?
BCRF Research into DCIS
Ductal Carcinoma In Situ Survival Rates
The ductal carcinoma in situ survival rates are generally positive. More than 98 percent of patients who are diagnosed with stage 0 breast cancer survive at least five years after their original diagnosis. While a few patients will experience recurrences, the survival rates are still encouraging. Early detection and prompt, comprehensive treatment has helped countless patients live long, high-quality lives.
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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.
What Is The Significance Of The Reported Size Of The Ductal Carcinoma In Situ
If the entire tumor or area of DCIS is removed , the pathologist will say how big the DCIS is by measuring how long it is across , either by looking at it under the microscope or by gross examination of the tissue taken out at surgery. Another way to measure DCIS is to note the number of microscopic slides that contain DCIS. For example, the report may say that DCIS was found in 3 slides.
On needle biopsy, measurements of the area of DCIS are not often reported because this type of biopsy only samples a part of the tumor. Later, when the entire area of DCIS is removed , an accurate measurement can be done.
The larger the area of DCIS, the more likely it is to come back after surgery. Doctors use information about the size of the DCIS when recommending further treatments.
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What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
Tennis Legend Martina Navratilova Diagnosed With Double Whammy Of Breast And Throat Cancer
Martina Navratilova, who is widely regarded as one of the greatest tennis players of all time, has been diagnosed with two forms of cancer, she revealed to Tennis.com in an article published Monday. The 66-year-old said doctors diagnosed her with Stage 1 throat cancer as well as an unrelated form of breast cancer.
“This double whammy is serious but still fixable, and I’m hoping for a favorable outcome,” she told the outlet. “It’s going to stink for a while, but I’ll fight with all got.”
Navratilova said she first noticed a sign of cancer during the Women’s Tennis Association finals in Fort Worth, Texas, last November. It was there she noticed a lymph node in her neck was enlarged, and when it didn’t reduce on its own, she got a biopsy.
She was diagnosed with Stage 1 throat cancer stemming from human papillomavirus, or HPV. HPV is a common sexually transmitted infection that is thought to cause about 70% of oropharyngeal cancers in the U.S., according to the Centers for Disease Control and Prevention.
Navratilova told Tennis.com that doctors issued a strong prognosis and that she will begin treatment this month.
She underwent a lumpectomy and six weeks of radiation following that diagnosis and announced later that year that she was “cancer-free.”
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Surgery That Removes All Of The Breast
Mastectomy procedures include:
- Total or simple mastectomy, which is the removal of the whole breast.
- Modified radical mastectomy, which is the removal of the whole breast and the lymph nodes under the arm .
- Radical mastectomy, which is the removal of the breast, chest muscles, and all of the lymph nodes under the arm . This surgery is rarely used.
Depending on the location of the tumour in the breast or other factors, some women may be able to have a skin-sparing or nipple-sparing mastectomy. Skin-sparing mastectomy leaves most of the skin, except for the nipple and the areola. Nipple-sparing mastectomy saves the skin as well as the nipple and areola.
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What Is Risk After Lumpectomy And No Radiation For Dcis
- Tags:Early-stage: Stage 0 DCIS , Ductal Carcinoma In Situ, Radiation to the Breast, Radiation After Surgery , Planning/Considering Radiation, Lumpectomy, Planning/Considering Surgery, and Preparing for/Undergoing Surgery
DCIS is the most common form of non-invasive breast cancer and is considered stage 0 cancer. While DCIS isnt considered life threatening, it does increase the risk of developing invasive breast cancer later in life.
DCIS usually is treated with surgery to remove the cancer lumpectomy in most cases. After surgery, hormonal therapy may be recommended if the DCIS is hormone-receptor-positive . Radiation therapy also is recommended for many women. Both hormonal therapy and radiation help reduce the risk of the DCIS recurring , as well as the risk of invasive cancer.
Routine radiation therapy after DCIS was common in the past, but some newer DCIS treatment guidelines say that women at low-risk for recurrence may be able to skip radiation therapy after surgery. Still, the definition of low-risk isnt always clear.
A study has found that for women diagnosed with DCIS considered to have a low risk of recurrence treated with lumpectomy without radiation, the risk of DCIS recurrence or developing invasive disease in the same breast increased through 12 years of follow-up and didnt level off.
The study included 665 women diagnosed with DCIS that was considered low-risk based on the characteristics of the disease.
- 14.4% for group one
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I Was Diagnosed With Dcis Stage 0 Breast Cancer
Im religious about getting my annual mammogram. Thats because I have a history of fibrocystic disease and in my 20s had a fibroadenoma removed from my right breast. Every year, I worry that something not so benign will show up and every year I sigh with relief when I get a letter saying everything is normal. Not this year. Instead, I got a phone call from the Mammography Department at Mercy Hospital. The radiologist wanted me to come back for additional views. My heart sank.
My husband Barry took time off from work so he could go with me. If there was any bad news to be delivered, I didnt want to hear it alone. Renee, the kind and wonderful mammography tech who had done my screening mammogram told me she was going to take some magnification views so they could look at an area in my right breast more closely.
After she was done, Barry and I were ushered into the viewing room to talk with the radiologist, who pointed out a sprinkling of tiny white dots near the middle of my mammogram and explained that they were microcalcifications. Some of them looked normal, but others could go either way. Either way? I tried to remain calm and stared at the image intently. You can look too. The picture at the beginning of this post is a copy of the magnified view.
Stage 1 Breast Cancer Symptoms
- Hormone therapy
Some treatments are used in a specific order to either shrink a tumor before surgery or to minimize the risk of cancer recurrence after surgery. Treatments given before surgery are called neoadjuvant therapies, while post-surgical treatments are called adjuvant therapies.
Stage 1 breast cancer surgery typically includes removing and testing one or more lymph nodes to see whether the cancer has spread.
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Personalized Treatment Is Key For Stage 0 Breast Cancer
An early form of breast cancer called ductal carcinoma in situ has stirred controversy in the medical community nationwide.
DCIS, also known as Stage 0 breast cancer, is abnormal cells that are confined to the milk ducts of the breast. The debate is whether all cases of DCIS should be treated immediately with surgery and additional therapy, or if patients should be monitored instead and treated only if the cancer spreads.
A New York Times article from August 2015 has fanned the flames of this controversy. The article features DCIS patients reacting with a mix of gratitude and outrage about their cancer treatment. Some felt their treatment was unnecessary or too severe others were glad they received proactive care.
Both sides of the debate have a viable argument: of course we dont want to perform surgeries that arent needed or expose women to radiation or hormonal therapy unnecessarily, and DCIS in some women will never spread beyond the milk ducts.
But this is our concern: DCIS has a significant chance of turning into invasive cancer. There is currently no way to know which cases will become invasive. Until we have a way to determine that, we cant just sit back and watch women develop breast cancer. We favor a personalized, case-by-case approach to treating Stage 0 breast cancer over watching and waiting.
Ive asked four of our breast cancer experts to explain our position and clear up some misconceptions about the treatment of DCIS.
Are You Sure Your Patient Has Stage 0 Breast Cancer What Should You Expect To Find
Ductal carcinoma in situ
DCIS is usually asymptomatic and identified first with an abnormal mammogram. In modern times, DCIS will rarely present as a palpable mass. A spontaneous nipple discharge which is bloody, pink tinged, clear or serous in nature may be a presenting symptom.
Lobular carcinoma in situ
LCIS is usually asymptomatic and will be found as an incidental finding on biopsy of the breast for other findings. LCIS is found in approximately 1% of all excisional breast biopsy specimens. About 80% of LCIS occurs in pre-menopausal women .
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What Are The Symptoms Of Dcis
DCIS usually has no symptoms. Most cases of DCIS are found during routine breast screening or if a mammogram is done for some other reason.
Occasionally DCIS is found when someone has a breast change such as a lump or discharge from the nipple. However, if someone with DCIS has a breast change its more likely they will also have an invasive breast cancer.
Some people with DCIS also have a type of rash involving the nipple known as Pagets disease of the nipple, although this is rare.