Why Does Dcis Need To Be Removed
At the time of this writing, doctors dont know which instances of DCIS will turn into invasive breast cancer. Some DCIS might stay entirely in place and never pose a threat. However, some DCIS will grow and spread. If it isnt removed and spreads, the patient will need more aggressive treatments.
There is currently a study going on to evaluate whether active surveillance would be appropriate for DCIS patients. If you would like to follow the progress of the COMET study, I have included the link here.
During my research about DCIS, I came across many sources of information to help me better understand this type of cancer. I have included links below so that you can be more informed about the different types and stages of breast cancer.
In a future post, I plan to discuss the various treatment options available for patients with DCIS. Ill link to it once it is live.
Have any questions? Feel free to comment below.
What Does Stage 3 Mean
Because stage 3 breast cancer has spread outside the breast, it can be harder to treat than earlier stage breast cancer, though that depends on a few factors.
With aggressive treatment, stage 3 breast cancer is curable however, the risk that the cancer will grow back after treatment is high.
Doctors further divide stage 3 cancer into the following stages:
Breast Cancer Survival Rates For All Types Of Breast Cancers
Breast cancer survival rates and prognosis are determined by so many different factors that it is always difficult to make generalizations.
NOTE: this page has been recently updated with the most up-to-date statistics. Prognosis has improved so much because breast cancer treatments have become more effective since this page was first created. Remember that survival is better than listed here. Most importantly, ask your oncologist and specialist team, who keep current with the latest statistics and best treatments.
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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 nodes.
Having a sentinel node biopsy during a mastectomy helps some people with DCIS avoid an axillary dissection. 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, a sentinel node biopsy will have already been done.
If a sentinel node biopsy wasnt done and invasive breast cancer is found, an axillary dissection may be needed. An axillary dissection removes more axillary lymph nodes than a sentinel node biopsy. Because it disrupts more of the normal tissue in the underarm area, axillary dissection is more likely to affect arm function and cause lymphedema.
So, even though a sentinel node biopsy may not be needed with DCIS, most people who have a mastectomy for DCIS will have a sentinel node biopsy done at the same time.
Grade 3 Breast Cancer Life Expectancy
Breast CancerBreast Cancer SurvivorsCancer Life ExpectancyBreast cancerRisk factorsAtypical cancers
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Cancer Staging And How Dcis Fits In
First, we need to discuss how DCIS fits into the current cancer staging system.
All cancers, no matter what type, are staged and given a number. These numbers range from 0-IV . Stage IV cancers have become metastatic or have spread to other locations in the body. At this stage, cancer can be considered terminal.
Stage IV breast cancer is also called metastatic breast cancer, or MBC. There are treatments available to help slow the progression of MBC and prolong life for patients. Unfortunately, at this time, MBC is not curable.
If you have read in the news or know someone who has died of breast cancer, it is highly likely that person died of metastatic breast cancer.
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.
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Hormone Therapy After Surgery
If the DCIS is hormone receptor-positive , treatment with tamoxifen or an aromatase inhibitor for 5 years after surgery can lower the risk of another DCIS or invasive cancer developing in either breast. If you have hormone receptor-positive DCIS, discuss the reasons for and against hormone therapy with your doctors.
Our Final Thoughts About The Treatment Of Dcis
Were certain that treatment should not be the same for all patients, and that we should carefully consider each individual case before treating DCIS. One of our big concerns is that invasive cancer may potentially require additional therapies such as chemotherapy, which could have been avoided for some women if they had been treated when they were diagnosed with DCIS only. We must look at the patient characteristics and the tumor characteristics carefully to determine the best therapeutic approach.
It will be beneficial to patients and providers when, through continual research, we can clearly characterize genes in those cancers that never progress versus the genes of those that become aggressive. DCIS is a complex condition, and one thing is certain: DCIS is a type of breast cancer that needs to be evaluated in greater depth before we can say its acceptable to watch and wait.
Have you or a loved one gone through DCIS treatment? Which side of the debate are you on? Share your opinion with us on or .
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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.
Cancer Staging Before 2018
Before 2018, cancer staging included less information about the tumor than it does now.
Pre 2018 stagingincluded information about the physical characteristics of the tumor but didnt take into account any additional information about the biology of the cancer.
- T- Tumor Size
- M- Metastases (whether it has spread to other parts of the body
These three pieces of information are combined to determine a cancer stage between 0-IV.
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What Are The Symptoms Of Breast Cancer Recurrence
You may experience different signs of breast cancer recurrence depending on where the cancer forms.
Local breast cancer recurrence may cause:
- Breast lump or bumps on or under the chest.
- Nipple changes, such as flattening or nipple discharge.
- Swollen skin or skin that pulls near the lumpectomy site.
- Thickening on or near the surgical scar.
- Unusually firm breast tissue.
- Biopsy of the site of suspected recurrence.
Surgery To Remove Lymph Nodes
Most women with invasive breast cancer have surgery to remove some of the lymph glands from their axilla . We know that if invasive cancer spreads, it is likely to spread to the lymph glands first, so these are removed for testing.
In DCIS, the cancer cells are contained in the milk ducts and do not invade into the breast tissue and spread to the lymph glands. It is therefore not usually necessary to remove the glands. However, if there is a large area of DCIS or lots of small clusters of DCIS, the chances of finding invasive cancer in the DCIS is higher and your surgeon may recommend sentinel node biopsy of the lymph glands. When mastectomy is recommended for DCIS, a sentinel node biopsy is frequently recommended.
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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.
Conventional Treatment For Dcis
Surgery followed by radiation and possibly hormone-blocking drug treatment is considered normal protocol for treating DCIS in mainstream medicine. Surgery can either be a relatively minor procedure, such as lumpectomy, or a major procedure, such as mastectomy . Radiation is well-known to be carcinogenic and can potentially cause a secondary cancer down the line. It can also in some cases damage blood vessels to the heart and predispose the woman to a heart attack. Hormone-blocking drugs can cause unpleasant and sometimes life-threatening side effects, so they should be carefully evaluated as well. Overall, it is extremely important that women with a DCIS diagnosis carefully weigh the risk factors of conventional treatment side effects versus the risk of their benign condition turning into a life-threatening cancer some day.
Rather than simply treat every DCIS case the same way, I like Dr. John R. Lees recommendation that treatment for each DCIS case should be evaluated individually. On page 55 of his book, What Your Doctor May Not Tell You About Breast Cancer, Dr. Lee explains this concept:
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Type And Grading Of Ductal Carcinoma In Situ Or Dcis
NOTE: This article is a little bit old now but does have some relevant information still to offer on the grading of Ductal Carcinoma in-situ .
However, the American Joint Committee on Cancer has very recently, , updated the grading system of breast cancer. Feel free to click HERE for a summary of the major changes.
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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And Tumor Grade And Necrosis At Diagnosis Of Dcis
There are 3 grades of Ductal Carcinoma In-Situ . If you have been diagnosed with DCIS you will be able to find the Grade on your Pathology Report.
1.Low Grade DCIS 2. Moderate Grade DCIS 3. High Grade DCIS
A Brazilian medical study examined 403 cases of Ductal Carcinoma In-Situ between the years of 2003 to 2008.
This study found that a solid morphology was the most common feature found in 42.2% of the cases. Furthermore, high-grade DCIS was also common and discovered in 72.7% of patients.
A subtype of DCIS, comedo necrosis, associated with necrosis was present in just over half of the cases . In addition, this feature was more common in solid tumors.
Both high-grade DCIS and comedo necrosis were identified more often in younger patients.
In conclusion, this study found high-grade DCIS to be associated with progression to invasive breast cancer.
It’s Usually Found On A Mammogram
For most women, DCIS is picked up on routine mammograms. “Typically, the mammogram finds a calcificationa small cluster of cells with abnormal shapes and sizesand then it is diagnosed after a biopsy,” says Dr. Meyers.
Occasionally, though, DCIS grows large enough that it forms a noticeable lump. Some people with DCIS may also have unusual nipple discharge, or a condition called Paget’s disease that causes skin around the nipple to become thick and dry.
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Hormonal Therapy After Surgery
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 5 years after surgery.
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.
Think About What Is Important To You
After you have talked with a breast cancer surgeon and learned the facts, you may also want to talk with your spouse or partner, family, friends, or other women who have had breast cancer surgery.
Surgery Choices: Theresa, Cindy, Paula
Three women describe how they decided which type of breast cancer surgery was right for them.
Then, think about what is important to you. Thinking about these questions and talking them over with others might help:
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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.
Signs That Dcis Is Likely To Become Invasive Breast Cancer
Bottom Line: New research shows when it may be safe to watch and wait.
Source:
Study titled Predictors of an Invasive Breast Cancer Recurrence after DCIS: A Systematic Review and Meta-Analyses by researchers at the Netherlands Cancer Institute, Amsterdam, published in Cancer Epidemiology, Biomarkers & Prevention.
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Mostductal carcinoma in situ breastcancer will never become life-threatening, even if left untreated. However,there hasnt been a good way to tell when DCIS should be treated and when treatment can be safely skippeduntilnow. A new study has identified six factors that determine when DCIS is mostlikely to become invasive breast cancer.
DCISis cancer that starts in a milk duct and has not spread outside the duct. Oftencalled stage 0, its such an early stage of cancer that some experts believeits actually a precancerous condition rather than actual cancer. DCIS has becomeincreasingly commonpossibly because women are living longer, more women aregetting screening mammograms, and mammograms have become better at findingthese small breast cancers. About 20% of all breast cancers are DCIS.
Mostwomen with DCIS have a lumpectomy, and some also have radiation. The risk forDCIS recurrence after lumpectomy alone is about 25% to 30%adding radiation therapydrops the risk to about 15%. Only half of recurrences are invasive cancertherest are DCIS again.
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