What Is Ductal Carcinoma Breast Cancer

Who Gets Invasive Ductal Carcinoma Of Breast

• Invasive Ductal Carcinoma of Breast is a very common type of breast cancer. Almost 70-80% of breast cancers are Ductal Carcinoma NOS types
• Middle-aged and older women past the age of 40 years are affected, though women over 65 years have the highest risk
• Although both women and men are capable of developing the condition, it is much more common in women
• All racial and ethnic groups are affected and no specific predilection is seen
• Developed countries show higher prevalence rate for breast cancer than developing countries average of 80 cases per 100,000 populations, as against 18 cases per 100,000 populations seen in the developing countries. Thus, America, Europe, Australia have greater incidences than Asia and Africa

Invasive Carcinoma Of No Special Type

Invasive carcinoma of no special type also known as invasive ductal carcinoma or ductal NOS and previously known as invasive ductal carcinoma, not otherwise specified is a group of breast cancers that do not have the “specific differentiating features”. Those that have these features belong to other types.

In this group are: pleomorphic carcinoma, carcinoma with osteoclast-like stromal giant cells, carcinoma with choriocarcinomatous features, and carcinoma with melanotic features. It is a diagnosis of exclusion, which means that for the diagnosis to be made all the other specific types must be ruled out.

Molecular Features Of Dcis

Invasive breast cancer can be categorized into a number of different subtypes based on molecular features, including immunohistochemical markers, genetic features, and gene expression profiles. The most fundamental of these categories is related to the hormonal status of the tumor. Historically, DCIS has not been routinely evaluated for ER status, but research studies have found that the proportion of ER positivity at 6276% is similar to that observed in IBC . ER status is not currently used prognostically for DCIS, but current guidelines in the US indicate endocrine therapy for ER positive cases after WLE , and rates of ER testing have increased in recent years . Cancer registry data in the US suggests that at least 39% of women receive endocrine therapy . However, in the UK, NICE guidelines do not recommend endocrine therapy for DCIS , thus it is rarely prescribed.

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Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:

Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .

AND EITHER No actual tumor is found in the breast.

OR The tumor is smaller than the approximate size of a peanut .

Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.

Is Surgery Always Necessary For Dcis

We almost always recommend surgery. Even though DCIS is noninvasive and not life-threatening, it has the potential to turn into something more serious. When we do surgery for DCIS, 20% of the time we find an invasive cancer in the tissue that we did not know about from the needle biopsy. For this reason, the only time we dont do surgery for DCIS is when we think the risks of the surgery dont outweigh the benefits. For example, some patients might not be able to tolerate the procedure because of their age or other health problems.

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How Is Dcis Diagnosed

DCIS doesnt usually appear as a breast lump or breast change. As a result, most women with DCIS do not show any signs or symptoms of having breast cancer.

Mammograms and ultrasounds are the most common ways in which DCIS is diagnosed. If DCIS is suspected, a biopsy is usually required to confirm whether DCIS is present.

Pathologists usually attribute a grade to DCIS. The grade indicates the patterns of cancer cell growth and how fast the cells are growing. Based on what the DCIS cancer cells look like under a microscope, DCIS can be graded as high, intermediate or low.

If left untreated, high grade DCIS is likely to develop into invasive breast cancer. Low or intermediate grades of DCIS may remain as they are for many years. In some cases, however, low or intermediate grades of DCIS can develop into invasive breast cancer.

While the size and grade of DCIS can help doctors predict whether the cancer is likely to become invasive, there are no certain answers. Unfortunately it is not currently possible to know for certain if a woman will go on to develop invasive breast cancer.

What Clinical Trials Are Available For Women With Inflammatory Breast Cancer

NCI sponsors clinical trials of new treatments for all types of cancer, as well as trials that test better ways to use existing treatments. Participation in clinical trials is an option for many patients with inflammatory breast cancer, and all patients with this disease are encouraged to consider treatment in a clinical trial.

Descriptions of ongoing clinical trials for individuals with inflammatory breast cancer can be accessed by searching NCIs list of cancer clinical trials. NCIs list of cancer clinical trials includes all NCI-supported clinical trials that are taking place across the United States and Canada, including the NIH Clinical Center in Bethesda, MD. For information about how to search the list, see Help Finding NCI-Supported Clinical Trials.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from NCIs Cancer Information Service at 18004CANCER and in the NCI booklet Taking Part in Cancer Treatment Research Studies. Additional information about clinical trials is available online.

Selected References

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What Medication Treat Ductal Carcinoma In Situ

Tamoxifen may be prescribed for woman of all ages who have been treated for DCIS. In those women past menopause, the doctor may prescribe an aromatase inhibitor. These medications help lower the risk of DCIS or another type of cancer developing in either breast. If either is prescribed, it is suggested that these drugs be taken for five years after surgery.

How Is Invasive Ductal Carcinoma Diagnosed

Same Day Results

At the Johns Hopkins Breast Center, we know how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer. We follow strict guidelines for biopsies and pathology reports. Most of our patients will receive the probability of cancer immediately following their biopsy procedure and a pathology confirmation within 24 hours.

Learn more about the steps of diagnosis, including:

• Digital mammography

• Biologic targeted therapy

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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.

Diagnosis And Pathology Of Dcis

Ductal carcinoma in situ is a proliferation of atypical epithelial cells that is contained within the lumen of the breast ductal system. Nowadays, it is usually detected in the context of a mammographic screening program, but can occasionally present as a palpable lump or with other physical symptoms like nipple discharge . Approximately 8% of core needle biopsies are initially diagnosed as DCIS , and this diagnosis is confirmed in ~74% of cases after excision. A recent meta-analysis found that under-diagnosis on core biopsy was associated with large tumor size, palpable mass, a mammographic mass lesion, use of image guidance other than stereotactic, and high mammographic density .

In addition to nuclear atypia, a range of different architectural patterns are observed, including cribriform, solid, comedo , micropapillary, and papillary . Multiple patterns are often observed within the same tumor , which may explain the low level of concordance of studies using these categories as prognostic markers. The prognostic value of these architectural features has been found to be limited comedo necrosis is associated with high grade and worse breast cancer-specific survival but only inconsistently with recurrence . The increase in incidence of DCIS after the introduction of mammographic screening has been more strongly associated with an increase in the non-comedo subtypes .

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Can Dcis Develop Into Invasive Breast Cancer

If DCIS is not treated, the cancer cells may develop the ability to spread outside the ducts, into the surrounding breast tissue. This is known as invasive breast cancer. Invasive cancer has the potential to also spread to other parts of the body.

In some cases, DCIS will never develop further or grows so slowly that it would never cause harm during a persons lifetime. Although the size and grade of the DCIS can help predict if it will become invasive, there is currently no way of knowing if this will happen. is more likely to become an invasive breast cancer and to do so over a shorter time than low-grade DCIS.

Additional Histological Characteristics Of Breast Comedo Carcinoma

There is some histological evidence to support the observation that breast comedo carcinomas in situ are usually estrogen receptor negative. As a result, there would generally be little benefit to treated comedo breast carcinoma with anti-estrogen chemotherapy . Chemical therapy for DCIS is a controversial area anyways, but is almost certainly not advised for breast comedo DCIS. Comedo breast carcinoma in situ is also frequently associated with a higher HER2/neu gene amplification or protein over expression, and a higher proliferation rate. Researchers suggest that apoptosis, which means programmed cell death is one reason for the clinically more aggressive behavior of comedo breast carcinoma in situ. It is suggested that the genetic control mechanisms which regulate proliferation and apoptosis have somehow been compromised in comedo DCIS.

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More About Invasive Breast Cancer With Central Necrosis

Sometimes medics refer to an infiltrative breast carcinoma with central necrosis as a centrally necrotizing breast carcinoma, . Historically, centrally necrotizing breast carcinomas have an aggressive course.

Histologically, the composition of infiltrating ductal carcinoma with central necrosis is a well-circumscribed nodule with an extensive region of central necrosis. This area of necrosis is usually surrounded by a narrow rim of high-grade tumor cells. But these tumor cells usually show only minimal if any ductal differentiation, ie. they tend not to form into tubules.

The average age of development of an infiltrative ductal carcinoma with central necrosis is hard to estimate, but generally occurs in the mid 50s. Most infiltrative breast carcinomas with central necrosis are estrogen and progesterone receptor negative, making them more resistant to treatment.

What Is Stage 1 Breast Cancer

Stage 1 breast cancer is the earliest stage of invasive breast cancer. The breast cancer has spread from its original location to the surrounding tissue but it is still contained in a relatively small area.

If you are diagnosed with Stage 1 breast cancer, this means that the tumour is less than 2 centimetres in size. No cancer cells have been found in the lymph nodes or other parts of the body at this stage.

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What Is The Staging For Invasive Ductal Carcinoma

Staging refers to the extent of a cancer. A cancer is always referred to by the stage it was determined to be at diagnosis, even if it spreads.

Stages of invasive ductal carcinoma include:

• Stage I: Breast tumor is smaller than 2 centimeters in diameter and the cancer has not spread beyond the breast
• Stage II: Breast tumor measures 2 to 4 centimeters in diameter or cancerous cells have spread to the lymph nodes in the underarm area
• Stage III: Cancer is more extensive but it is confined to the breast, surrounding tissues, and lymph nodes
• Stage IV: Breast cancer has spread to lymph nodes beyond the underarm area or to distant sites, such as the lungs, liver, bones, or brain

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Diagnosing Invasive Breast Cancer

In many people the cancer is found during breast screening.

Its important that you see your GP if you have any symptoms. They may refer you to a specialist breast clinic. At the breast clinic the doctor or specialist nurse takes your medical history and examines your breasts. They also feel for any swollen lymph nodes under your arms and at the base of your neck.

You may have some or all of the following tests:

• a mammogram
• an ultrasound
• a biopsy a small sample of cells or tissue is taken from your breast and looked at under a microscope

Changes seen on the mammogram or ultrasound could be due to cancer, so you may have a biopsy of the breast. You might also have an ultrasound of the lymph nodes under your arm. You may also have lymph node biopsies if they look abnormal.

You should get your results within 1 or 2 weeks at a follow up appointment.

• drugs that help prevent or slow down bone thinning or bone damage
• a combination of these treatments

You may have surgery to your armpit called a sentinel lymph node biopsy. This means having about 3-5 lymph nodes removed. Sometimes surgeons have to remove more lymph nodes. Your doctor will let you know whether you need this.

You might have chemotherapy or hormone therapy before surgery called neoadjuvant therapy. The aim is to shrink the cancer down. This means that some people may be able to have breast conserving surgery, who might have needed removal of the breast .

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What Is Invasive Ductal Carcinoma

Invasive Ductal Carcinoma is an invasive cancer where abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body. It is also sometimes called infiltrative ductal carcinoma.

• IDC is the most common type of breast cancer, making up nearly 70- 80% of all breast cancer diagnoses.
• IDC is also the type of breast cancer that most commonly affects men.

How Is Noninvasive Breast Cancer Treated

The standard treatment for DCIS is surgery. In most cases, women can opt for lumpectomy, which is breast-conserving surgery. It only removes the area with the cancer and some healthy tissue surrounding it. Radiation therapy is usually necessary after to decrease the risk of the cancer returning. Sometimes, doctors recommend mastectomy, which removes the entire breast. This may be the best choice if the DCIS is large or there are multiple spots within the breast.

Your preference also plays a role in the extent of surgery. A second opinion can help you make this decision. The process can give you another point of view or verify what you have already heard. In either case, you will be making an informed decision, which can increase your confidence.

Hormone therapy will be a treatment option for hormone receptor-positive tumors. Your pathology report will tell your doctor whether or not this treatment is appropriate.

LCIS does not require treatment, but it does increase your risk of breast cancer in the future. Your doctor may recommend additional screening exams, estrogen blocking, or preventive mastectomy.

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Comedo Carcinoma Of The Breast

Comedo carcinoma of the breast is actually a type of ductal carcinoma in situ. It is considered to be an early stage of breast cancer, and it is characterized by the presence of central necrosis, or evidence of cell death and decay. A diagnosis of this particular kind of breast cancer is somewhat fortuitous as it is confined to the breast ducts and usually does not spread beyond. However, in terms of the various kinds of DCIS, comedo carcinoma is considered to be of a higher grade and a little more aggressive than the others, and may be treated a little more aggressively.

This page is still has some very helpful information, but check out our new and improved up-to-date page on Comedo Carcinoma.

Symptoms Of Breast Cancer

Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should also see a GP if you notice any of these symptoms:

• a change in the size or shape of one or both breasts
• discharge from either of your nipples, which may be streaked with blood
• a lump or swelling in either of your armpits
• dimpling on the skin of your breasts
• a rash on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast

Breast pain is not usually a symptom of breast cancer.

Find out more about the symptoms of breast cancer.

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Design Of Future Studies Of The Progression Of Dcis To Ibc

To obtain conclusive answers as to whether progression from DCIS to IBC is a result of intralesional genetic heterogeneity and clonal selection, it will be necessary to enter the rapidly expanding field of massively parallel sequencing. Over the past few years the cost and speed of DNA sequencing has plummeted facilitating an increase in the depth of sequencing . The unprecedented level of genetic information provided by massively parallel sequencing has allowed for a progressively more detailed picture of inter and intratumor genetic heterogeneity and the process of tumor evolution. On an intraindividual scale studies have found the existence of genetic differences between primary breast cancers and metastases that support the hypothesis of clonal evolution . Shared genomic aberrations exist between primary breast tumors and their metastatic deposits suggesting common ancestry, however the prevalence of specific mutations in the cells within each lesion have been shown to differ. This indicates that in the tumors studied, a subpopulation of cells from the primary tumor gave rise to the metastasis. In addition, aberrations have been found that were specific to the metastasis potentially indicating continued evolution . On an intratumor level multiregion sequencing of tumors has confirmed the existence of intratumor genetic heterogeneity , which is a prerequisite of clonal evolution.