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.
How Is Dcis Graded
DCIS is graded based on what the cells look like under the microscope. DCIS is graded as low, intermediate, or high grade.
- low grade the cancer cells look most like normal cells and are usually slow-growing
- intermediate grade the cancer cells look less like normal cells and are growing faster
- high grade the cancer cells look most changed and are usually fast-growing
Will Dcis Return Or Spread
- Since DCIS is a noninvasive form of cancer, it does not spread throughout the body .
- For patients having a lumpectomy with radiation, the risk of local recurrence ranges from 5% to 15%.
- For those having mastectomy, the risk of local recurrence is less than 2%. Patients who receive hormonal therapy after surgery further reduce their risk of recurrence by half.
- Breast cancer may develop in the patients other breast, but only in about 5% of cases. If this happens, the cancer in the second breast is not considered a recurrence, but a new primary breast cancer. It can also be a different type of breast cancer.
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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.
What Is The Prognosis For Patients Who Have Ductal Carcinoma In Situ
Because DCIS is contained within a specific area of the breast and has not spread, the disease can be controlled and cured with appropriate treatment. After treatment, the outcome for the patient with DCIS is usually excellent.
However, those patients who have had DCIS, even if treated successfully, are at a greater risk than people who have never had breast cancer to have the cancer return or for another type of breast cancer to develop.
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Stage Of Cancer Carcinoma In Situ And Additional Terms
A common question is, “What stage of cancer is carcinoma in situ?” Carcinoma in situ is referred to as stage 0 cancer. At this stage, cancer is considered non-invasive. Stage 1 cancers and beyond are considered invasive, meaning that even if low, there is a potential they could spread. Other terms that may be used in defining the same thing as carcinoma in situ or stage 0 cancer include:
Natural History Of Dcis
Ductal carcinoma in situ is considered a precursor of invasive breast cancer. There is a 3050% risk of untreated DCIS progressing to invasive carcinoma in the ipsilateral breast 1020 years after initial diagnosis. The cumulative risk of contralateral breast cancer is low .
When there is occult invasion or lymph vessel or node involvement, the tumour is considered to be an invasive carcinoma. Occult invasion may be present in up to 20% of cases up to 50% when the tumour is 50 mm or more.
In some cases, DCIS will never develop further or grows so slowly that it would never cause harm during that 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. High-grade DCIS is more likely to become an invasive breast cancer than low-grade DCIS and do so more quickly.
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How Is Dcis Diagnosed
If a doctor sees the calcifications on your mammogram, he or she will recommend more tests, which could include a breast biopsy. During the biopsy, a doctor or other health care provider takes samples of cells or tissues from your body. The cells are examined by a pathologist a doctor who checks for signs of disease in body tissues. The pathologist looks at the cells under a microscope to see if cancer is present.
A particular kind of biopsy called a stereotactic core needle biopsy can diagnose DCIS. This is a nonsurgical, outpatient procedure. After giving you medicine to numb the breast area, the doctor or technologist collects cells from the area of concern using a needle guided by mammography.
What Should I Expect After A Dcis Diagnosis
The outlook after DCIS diagnosis, Sun says, is encouraging. With continued, rigorous monitoring, the prognosis for DCIS is excellent, she explains. Your doctor will recommend a regular screening schedule to guard against recurrence in the original breast, and to monitor the other breast for any signs of malignancy.
Our expectation is for a complete resolution of the problem with proper treatment. This is a local disease and treatment by surgery can be sufficient. Chemotherapy isnt necessary, and in some cases, hormone medication and radiation arent either.
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Is Dcis A Type Of Cancer
This is a controversial topic, partly due to the language. It has the word carcinoma in the name, and it is classified as stage 0 cancer. So DCIS isnt life-threatening, but it has the potential to become invasive cancer.
You may hear DCIS described in different ways such as a pre-invasive, intraductal, non-invasive cancer.
Surgery Can Reveal Additional Cancer
There is a small possibility that invasive cancer will be found during the final pathology examination after surgical removal of DCIS. When that happens, Sun says, the diagnosis would be upgraded and additional surgery and other treatments may be needed. We take each situation individually and the most optimal treatment will be tailored. This is important because each tumor and each patient is different.
She notes that at Johns Hopkins Medicine, the pathologists with whom she works are especially skilled in identifying any invasive cancer that might be present. Having DCIS treated at a comprehensive breast center ensures you are in the best possible hands, Sun says.
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Why Is Dcis Treated
The aim of treating DCIS is to prevent invasive breast cancer from developing. If DCIS is not treated it may develop into invasive breast cancer, which can spread outside the ducts into the breast tissue and then possibly to other parts of the body.
We dont know for certain how many women with DCIS would develop invasive breast cancer if they were not treated. Also, it is not possible to predict which women with DCIS will develop invasive breast cancer if they were not treated or how long after the diagnosis of DCIS an invasive breast cancer would develop. Some women with DCIS may never develop any problems if they are not treated. However, some women with DCIS may develop invasive breast cancer.
Because DCIS may develop into invasive breast cancer and invasive breast cancer can spread and cause death, women with DCIS are generally recommended to have treatment. Treatment for DCIS aims to help prevent invasive breast cancer from developing and DCIS from coming back in the breast.
DCIS can be treated successfully and most women diagnosed and treated for DCIS will not later develop invasive breast cancer.
Is Ductal Carcinoma In Situ Really Cancer
Ductal carcinoma in situ means the cells that line the milk ducts of the breast have become cancer, but they have not spread into surrounding breast tissue. DCIS is considered non-invasive or pre-invasive breast cancer.
Is ductal carcinoma in situ hereditary? Scientists funded by Breast Cancer Now have confirmed inherited genetic links between non-invasive cancerous changes found in the milk ducts known as ductal carcinoma in situ and the development of invasive breast cancer, meaning that a family history of DCIS could be as important to assessing a womans risk
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How Is Cervical Cis Diagnosed
A Pap smear can collect abnormal cells that are then identified in a lab. An HPV test may be performed on the sample to check for the virus and to see whether high-risk or low-risk strains are present.
A colposcopy is an in-office procedure that allows your doctor to view your cervix with a special magnifying tool called a colposcope. Your doctor will apply a solution to the surface of your cervix to show any abnormal cells. They can then take a small piece of tissue called a biopsy. Theyll send this to a lab for a more definitive diagnosis.
If the biopsy shows CIS, your doctor might want to remove a larger piece of your cervix. If they remove the area with abnormal cells, theyll also remove a surrounding margin of healthy tissue.
The treatment for cervical CIS is similar to that for cervical dysplasia. Although its called carcinoma in situ, its often treated like a precancerous growth because its not invasive.
Possible treatments include the following:
Talk with your doctor about your treatment options to find the best one for you. Your treatment will depend on your age, desire to preserve your fertility, general health, and other risk factors.
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 The Diagnosis Made
- Biopsy of clinically suspected oral leukoplakia is mandatory to: exclude recognised diseases, and to assess for the absence or presence and grade of dysplasia.
- It is appropriate to wait two weeks after the first presentation to assess clinical response to initial treatment, for example, for candida, change in tooth brushing habit, cessation of smoking, etc.
- The biopsy may be incisional or excisional, single or multiple and may be done under local or general anaesthetic depending on site, the number of biopsies required and the type of biopsy.
- Biopsies should be taken from either a symptomatic area or if asymptomatic then from red or indurated areas.
- The presence of dysplasia, carcinoma-in-situ and invasive carcinoma cannot always be predicted clinically.
The histopathology of oral leukoplakia is not always diagnostic. Epithelial changes range from atrophy to hyperplasia and it may show hyperkeratosis. Dysplasia may be mild, moderate, severe, carcinoma in situ or invasive carcinoma. The pathology report must comment on the absence or presence of dysplasia, and the severity.
How Likely Is Dcis To Come Back
The chance of the DCIS coming back depends on various factors. But after mastectomy DCIS almost never comes back. In women who have just the area of DCIS removed the chance of it coming back is a bit higher. But it depends on the grade and type of DCIS.
Your doctor can give you more information about the chance of the DCIS coming back in your case.
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What Is High Grade Ductal Carcinoma In Situ
Treatments:Radiation therapy Mastectomy
Should I have a mastectomy for DCIS? Most women with DCIS or breast cancer can choose to have breast-sparing surgery, usually followed by radiation therapy. Most women with DCIS or breast cancer can choose to have a mastectomy. A mastectomy may be a better choice for you if: You have small breasts and a large area of DCIS or cancer.
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, 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., This suggests that DCIS might be left behind following breast-conserving treatment in a proportion of cases.
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Expert Review And References
- King TA, Pilewskie M, Muhsen S, Patil S, Mautner SK, Park A, Oskar S, et al. Lobular carcinoma in situ: a 29-year longitudinal experience evaluating clinicopathologic features and breast cancer risk. Journal of Clinical Oncology. 2015.
- Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 79: 1117-1156.
- National Cancer Institute. Breast Cancer Treatment for Health Professionals . 2015.
- Oppong BA, King TA. Recommendations for women with lobular carcinoma in situ . Oncology . 2011.
What Is The Treatment For Dcis
Lumpectomy with radiation. The standard treatment is breast-preserving surgery with radiation therapy, which results in successful outcomes for most patients. Cancers can be larger than expected, so about 20% of the time, patients need a re-excision lumpectomy another surgery to remove all of the cancer. Typically, the remaining breast will then have radiation therapy to reduce the risk of local recurrence. Lumpectomy plus radiation is a good alternative to mastectomy for treatment of DCIS.
Mastectomy. Some patients have ductal carcinoma in situ in more than one quadrant of the same breast . Sometimes, the DCIS is very large relative to the patients breast size. In these situations, a mastectomy is required to address malignant cells that are more widespread. Radiation therapy is not needed for DCIS treated with mastectomy.
Chemotherapy. Chemotherapy is not needed for DCIS since the disease is noninvasive.
Hormonal therapy. Hormonal therapy may be appropriate for those whose ductal carcinoma in situ is hormone receptor positive.
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Reducing Breast Cancer Risk Or Finding It Early
Women with LCIS are at higher risk for breast cancer, so close follow-up is very important. Close follow-up of both breasts is important because women with LCIS have the same increased risk of developing cancer in both breasts. Women should also talk to a health care provider about what they can do to help reduce their breast cancer risk. Options for women at high risk of breast cancer because of LCIS may include:
- Seeing a health care provider more often for a breast exam along with the yearly mammogram. Additional imaging with breast MRI may also be recommended.
Who Is Affected By Ductal Carcinoma In Situ
Most women who get DCIS do not have a family history of breast cancer. Only about 5-10% of breast cancer cases are related to a genetic mutation or family history. Red flags for this include having a family history of breast cancer, especially if the cancer was discovered at a younger age, or before 50 years old. Other red flags for breast cancer that may be related to a genetic mutation include a family history of ovarian cancer, male breast cancer, multiple other cancers in the family and Ashkenazi Jewish ancestry. The most common risk factors for breast cancer include being female and getting older, and these are risk factors that cannot be changed.
Because the tissue in mens breasts do not fully develop the way that the tissue in womens breasts do, men do not usually get breast cancer of this type.
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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.