Hormone Therapy After Breast Surgery
If the DCIS is hormone receptor-positive , treatment with tamoxifen or an aromatase inhibitor, such as exemestane or anastrozole, 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 doctor.
Symptoms Of Invasive Ductal Carcinoma
Invasive breast cancer doesn’t always have obvious signs or symptoms that affect your daily life. This is why regular screenings are essential to detect this type of cancer in its early stages.
Common symptoms of invasive ductal carcinoma include:
- Lump in the breast
- Red skin or rash on the breast
- Pain or changes in the appearance of the nipple
How Is Invasive Ductal Carcinoma Of Breast Treated
Treatment options available for individuals with Invasive Ductal Carcinoma of Breast are dependent upon the following:
- Type of cancer
- The staging of the cancer
- Whether the cancer cells are sensitive to certain particular hormones, and
- Personal preferences
In general, breast cancer stages range from 0 to IV. 0 may indicate a small and non-invasive cancer, while IV indicates that the cancer has spread to other areas of the body. Briefly, as per US National Cancer Institute , breast cancer is staged as follows:
- Stage 0 : The abnormal cancer cells are confined to their site of origin
- Stage I: The tumor is 2 centimeters in diameter or less, and has not spread outside the breast
- Stage II: The tumor may be up to 5 centimeters in diameter and may have spread to lymph nodes. Another criteria is that the tumor may be larger than 5 centimeters in diameter, but has not spread to surrounding lymph nodes
- Stage III: The tumor may be more than 5 centimeters in diameter and may have spread to several axillary lymph nodes, or to the lymph nodes near the breastbone. The cancer may also have spread to the breast skin/chest wall, causing ulcer-like sores, or a swelling
- Stage IV: The tumor has spread outside the breast and to other organs, such as the bones, liver, lungs, or brain, regardless of its size
If breast cancer is diagnosed, staging helps determine whether it has spread and which treatment options are best for the patient.
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Living With Invasive Ductal Carcinoma
Invasive ductal carcinoma is a type of tumor that originates in a milk duct in the breast and is one of the most common types of breast cancer. The tumor penetrates the wall of the duct and turns into fatty tissue in the breast. After the tumor penetrates the milk duct it may spread into the lymphatic system. Around 80% of breast cancer is IDC. The difference between ductal carcinoma and IDC is that the invasive cancer has spread through the wall ducts, while the ductal carcinoma is centralized in the ducts.
The first sign of IDC is a hard lump in the breast that has an irregular outline. Since IDC is the most common type of breast cancer, the greatest risk is in women over the age of 45 however, half of the cases of IDC occur in women over the age of 65. Risk factors often include ignoring treatment for ductal carcinoma, but they also include early menstruation, not having children, having a first child after the age of 30, and having more than three alcoholic drinks daily. If the tumor is relatively small, then the most common treatment is a lumpectomy however, if the tumor is bigger, then a mastectomy is common and reduces the risk of the cancer returning. Treatments may also include chemotherapy, hormonal, and radiation therapy.
Testing For Her2 Status
There are several tests used to find out if breast cancer is HER2-positive. How your results appear in the report will depend on the test you have. Two of the most common tests are:
- IHC test: The IHC test uses a chemical dye to stain the HER2 proteins. The IHC gives a score of 0 to 3+ that measures the amount of HER2 proteins on the surface of cells in a breast cancer tissue sample. If the score is 0 to 1+, its considered HER2-negative. If the score is 2+, itâs considered borderline. A score of 3+ is considered HER2-positive. If the IHC test results are borderline, its likely that a FISH test will be done on a sample of the cancer tissue to determine if the cancer is HER2-positive.
- FISH test: The FISH test uses special labels that attach to the HER2 proteins. The special labels have chemicals added to them so they change color and glow in the dark when they attach to the HER2 proteins. This test is the most accurate, but it is more expensive and takes longer to return results. This is why an IHC test is usually the first test done to see if a cancer is HER2-positive. With the FISH test, you get a score of either positive or negative .
Itâs important to know which HER2 test you had. Generally, only cancers that test IHC 3+ or FISH positive respond to the medicines that target HER2-positive breast cancers. An IHC 2+ test result is called borderline. If you have an IHC 2+ result, ask to have the tissue retested with the FISH test.
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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?
A Family History Of Breast Cancer And Other Factors Increase The Risk Of Breast Cancer
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer.
Risk factors for breast cancer include the following:
- A personal history of benign breast disease.
- A family history of breast cancer in a first-degree relative .
- Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
- Breast tissue that is dense on a mammogram.
- Exposure of breast tissue to estrogen made by the body. This may be caused by:
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- Starting menopause at a later age.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
NCI’sBreast Cancer Risk Assessment Tool uses a woman’s risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 1-800-4-CANCER.
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How Is Dcis Detected And Diagnosed
Most DCIS is detected from a mammogram that shows abnormal calcifications in the breast. The doctor may need to conduct additional imaging tests, such as ultrasound or MRI. These are used to determine the full extent of the disease.
DCIS is diagnosed by a needle biopsy. Pathologists examine the abnormal cells to determine the grade of the DCIS and the hormone-receptor status. DCIS is classified as low, intermediate, or high grade, depending on how abnormal the cells look under a microscope. High-grade DCIS cells are the most abnormal and grow the fastest.
Hormone-receptor status refers to whether the cancer cells have receptors for estrogen, progesterone, or both. The presence of these receptors on the DCIS suggests that these hormones fuel the growth of the cells, which affects how well the DCIS responds to certain hormone-blocking drugs.
A Note About Statistics
Survival rates are statistics, and as such tend to tell us how the âaverageâ person will do with an âaverageâ triple-negative breast cancer but people and tumors arenât statistics. Some people will do better and some people will do worse.
Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior. And still there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.
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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.
- Dont smoke.
- Eat a healthy, well-balanced diet.
- Undergo genetic testing for gene mutations if recommended based on family history.
How Is Ductal Carcinoma In Situ Treated
No two patients are the same. Your doctor will customize your treatment plan based on your test results and medical history. Among other things, your doctor will consider:
- Tumor location
- Aggressiveness of the cancer cells
- Your family history of breast cancer
- Results of tests for a gene mutation that would increase the risk of breast cancer
Most women with DCIS don’t have the breast removed with a mastectomy. Instead, they have a lumpectomy.
Most common is a lumpectomy followed by radiation. The surgeon removes the cancer and a small area of healthy tissue around it. Lymph nodes under the arm donât need to be removed as they are with other types of breast cancer.
After a lumpectomy, radiation cuts the chances that the cancer will come back. If cancer does return, itâs called recurrence.
Some women may opt to have a lumpectomy only. Discuss the risks of not having radiation with your doctor before deciding against it.
You and your doctors may decide that a mastectomy to remove the breast is the best course of treatment if you have any of the following:
- A strong family history of breast cancer
- A gene mutation that makes having breast cancer more likely
- Very large areas of DCIS
- DCIS lesions in multiple areas throughout your breast
- Not being able tolerate radiation therapy
You and your treatment team may also consider the use of hormone therapy if the cancer tests positive for hormone receptors. It can cut the chance of getting another breast cancer.
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Molecular Cellular And Microenvironmental Aspects
Many studies have focussed on identifying molecular markers of the invasive process and recent studies have linked mutations in PIK3CA, TP53 and GATA3 genes with aggressive DCIS TP53 mutations were reported to be exclusively associated with high-grade DCIS., However, the requirement for fresh tissue and large amounts of DNA for whole-exome or genome sequencing has limited the extent of studies for determining the landscape of genetic mutations in DCIS.
One of the key molecular differences between DCIS and invasive breast cancer is the prevalence of HER2 amplification: 34% for DCIS versus 13% for invasive disease. HER2 amplification might be a prognostic factor in predicting an in situ recurrence after DCIS, but it seems not to be predictive for an invasive recurrence. That said, one study with a long follow-up counterintuitively demonstrated that HER2 positivity in primary DCIS was associated with a lower risk of late invasive breast cancer compared with HER2 negativity. In HER2-positive DCIS, TILs are present at higher levels, but an association with an invasive recurrence risk after DCIS has not been reported.
Evaluation Of Regional Lymph Nodes
The status of axillary lymph nodes determines the need for radiation therapy and adjuvant systemic therapy. ALN dissection at the time of surgery was standard care until the 1990s, but often resulted in pain, numbness, swelling, and decreased mobility in the affected arm. In patients with clinically negative nodes, a negative intraoperative sentinel lymph node biopsy precludes the need for ALN dissection.
SLN biopsy reduces arm symptoms compared with ALN dissection.911 SLN biopsy has a sensitivity of 95 to 100 percent, a false-negative rate of 5.5 percent,28 and a negative predictive value of 98 percent.29,30 A prospective analysis provides evidence that patients with early-stage breast cancer who have a negative SLN have improved disease-free and overall survival compared with patients who have a negative ALN dissection.31 This is most likely because of more accurate axillary staging in patients from the SLN group. ALN dissection is indicated for all women with palpable lymph nodes or a positive SLN.32
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Goldenseal Is An Age Old Cancer Remedy
People have been using goldenseal for treating cancer for ages. The herb was supplemented with licorice. It is an antiviral herb that even treats STDs like gonorrhea. Therefore, boil 1 gram of dry goldenseal root in a cup of water. Steep it for about 10 minutes and drink thrice every day for better results.
What Questions Should I Ask My Healthcare Provider About Invasive Ductal Carcinoma
Fully understanding your situation can empower you and help you take control of your health. Here are some questions you might want to ask your healthcare provider:
- What stage of invasive ductal carcinoma do I have?
- How far has my cancer spread?
- What are my treatment options?
- How long will my treatment take?
- Will I be able to work during my treatment?
- What are my chances of survival?
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Invasive Ductal Carcinoma Treatment
Invasive ductal carcinoma treatment is designed to address cancer cells that initially form in a milk duct and then grow beyond the walls of the duct into the surrounding breast tissue. In many cases, surgery is recommended to remove the affected breast tissue and determine whether the cancer has spread to nearby lymph nodes. Additionally, to treat a large tumor or cancer that has spread beyond the breast tissue and lymph nodes, a physician might recommend a systemic treatment, such as chemotherapy or hormonal therapy, to destroy cancerous cells or shrink the tumor prior to surgery.
To determine the best treatment approach, a physician will evaluate many factors, including the size and spread of the tumor. In general, most patients are advised to consider one or more of the following invasive ductal carcinoma treatment options:
In the Don & Erika Wallace Comprehensive Breast Program at Moffitt Cancer Center, we take a comprehensive, multispecialty approach to breast cancer treatment. Our fellowship-trained surgeons focus their practice exclusively on treating breast cancer patients, and we offer a complete range of treatment options in one location, including promising clinical trials. Each patients treatment plan is developed and managed by not one general oncologist, but rather by a collaborative tumor board of oncology specialists who make evidence-based recommendations that offer the most promise for each scenario.
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 diagnosed with DCIS, Susan G. Komen® has Questions to Ask Your Doctor resources that may be helpful. For example, we have a Questions to Ask Your Doctor About Breast Cancer Surgery resource and a Questions to Ask Your Doctor About Radiation Therapy and Side Effects resource.
You can download and print these resources and take them with you to your next doctor appointment. Theres plenty of space to write down the answers to these questions, which you can refer to later.
There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download. They are a nice tool for people recently diagnosed with breast cancer, who may be too overwhelmed to know where to begin to gather information.
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Invasive Ductal Carcinoma Surgery
Invasive ductal carcinoma surgery may be performed to remove a cancerous breast tumor, and also to find out if breast cancer has spread to nearby lymph nodes. There are several surgical techniques that can be used to accomplish this, and a physician can determine the best approach for a patient based on the stage, location and extent of the cancer and other individual factors. While surgery is typically the first treatment recommended for invasive ductal carcinoma, chemotherapy or radiation treatment may be given beforehand to shrink large tumors, or afterward to destroy any residual cells.
When planning for breast cancer surgery, a surgeon may discuss the need to remove one or more nearby lymph nodes to determine whether cancerous cells have migrated there. This is important because if they have, there is a greater likelihood that the cancer will spread to other areas of the body. Thats because in order to perform its role as the bodys filtration system for bacteria, the lymphatic system consists of a series of pathways that run throughout the body. Knowing whether or not the lymph nodes have been invaded by breast cancer is an important factor to consider when deciding on a course of treatment.
Some common invasive ductal carcinoma surgery procedures include:
A patient also may elect to undergo breast reconstruction during or after breast cancer surgery. This type of procedure is performed to rebuild the shape of a breast with implants or autologous tissue transfers.