Assessment Of Grade And Er Status
For the ICICLE study, information on cytonuclear grade of DCIS was available for 2,578 cases, mostly from the local histopathology reports. In 200 cases where the grade data were missing from the report but the tumor block was available, an H& E section was cut and the DCIS was graded by the study histopathologist according to UK and College of American Pathologists guidelines . Data on grade of DCIS were available from histopathology reports for 828 BCAC cases.
A subset of 81 ICICLE cases, graded in the pathology report and with a tumor block available, were examined to assess the reliability of the cytonuclear grade provided by the pathology reports. In the majority of cases grade was concordant with the pathology report. Nine cases were re-graded as low/intermediate grade and two cases as high grade. As the study pathologist re-graded the samples on a single H& E section, rather than all the blocks from an individual case, and in some cases on re-excision specimens with residual disease rather than the original excision specimen, the grade reported in the pathology report, if available, was used for the purposes of this study.
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.
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.
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What Types Of Treatment Are Available For Ductal Carcinoma In Situ
If a biopsy has confirmed that there are cancer cells within the breast, treatment for DCIS includes:
Lumpectomy with radiation after surgery: This is the most common treatment for DCIS. A lumpectomy is surgery that removes all of the DCIS along with a bit of the surrounding healthy breast tissue that borders the cancer growth. This is to make sure that all of the abnormal cancer cells have been removed. With a lumpectomy, the surgeon will leave the majority of the breast intact. The amount of tissue removed depends on the size and location of the DCIS.
Radiation therapy, a common cancer treatment, is a process that typically follows a lumpectomy. It is usually combined with surgery to make sure that all abnormal cells are gone. This treatment also reduces the risk of the cancer coming back.
Mastectomy: This surgery removes the entire breast and is recommended if the DCIS is found in a large area or seen throughout the breast. No radiation therapy follows a mastectomy.
Chemotherapy, or medicine that is used to kill cancer cells throughout the body, is usually not needed to treat DCIS.
Each individual case is different. The patient and doctor will decide what treatment is best for the situation.
Carcinoma In Situ Cervix
In carcinoma in situ cervix is also called cervical intraepithelial neoplasia grade 3 or high-grade squamous intraepithelial lesions , the full thickness of the lining covering the cervix has abnormal cells. These abnormal cells may become cancer and spread into nearby normal tissue.
Cervical intraepithelial neoplasia grade 3 is defined by nuclear pleomorphism involving the full thickness of the squamous epithelium with mitotic activity at all levels. Cervical intraepithelial neoplasia grade 3 and severe dysplasia equates to carcinoma in situ , which term is seldom used nowadays.
Risk of progression is highest for cervical intraepithelial neoplasia grade 3 and inter-observer variation is considerably less than for CIN1 or CIN2 1). Microinvasive carcinoma is almost always seen in a background of widespread CIN3 further demonstrating its malignant potential. The exact risk is difficult to calculate because most cervical intraepithelial neoplasia grade 3 /carcinoma in situ is treated when diagnosed.
Treatment of carcinoma in situ cervix or cervical intraepithelial neoplasia grade 3 may include the following:
- Conization, such as cold-knife conization, loop electrosurgical excision procedure , or laser surgery.
- Hysterectomy for women who cannot or no longer want to have children. This is done only if the tumor cannot be completely removed by conization.
- Internal radiation therapy for women who cannot have surgery.
Figure 4. Carcinoma in situ cervix
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Comedo Dcis Usually Shows Small Groups Of Dead Cells
What typically happens in a breast comedo carcinoma is that some of the cells die off and form small groups. . It is a fast growing type of breast cancer with some risk of future invasive cancer status, but most of the time comedo breast carcinoma is considered to be intraductal, meaning, that it will be confined to the breast ducts. DCIS-comedo is generally diagnosed when at least one duct in the breast is filled and expanded by large, markedly atypical cells, and which also has abundant central luminal necrosis.
Squamous Carcinoma In Situ Of The Larynx
What is squamous carcinoma in situ of the larynx?
Squamous carcinoma in situ is a non-invasive type of laryngeal cancer. Squamous carcinoma in situ starts from the squamous cells that cover the inner surface of the larynx. Squamous carcinoma in situ can start in any part of the larynx although the most common location is the vocal cord. If left untreated, squamous carcinoma in situ almost always turns into a type of invasive cancer called squamous cell carcinoma. Another name for squamous carcinoma in situ is severe squamous dysplasia.
The larynx
When we breathe, air travels from our mouth and nose to our lungs. On its way to the lungs, air passes through a part of the throat called the larynx. You cannot see your larynx because it starts at the very back of the tongue.
Most of the larynx is a hollow tube filled with air. The larynx helps us breathe and create sound when we talk. For this reason, diseases involving the larynx often make it difficult to breathe or talk normally. The inside surface of the larynx is lined by specialized cells called squamous cells. These cells form a barrier called the epithelium. The tissue below the epithelium is called the stroma.
The larynx is divided into three sections from top to bottom and each section is made up of smaller parts. Most pathology reports will describe the sections or parts of the larynx examined.
Supraglottis
- Epiglottis.
- Ventricle.
Glottis
- True vocal cords.
- Anterior commissure.
Subglottis
Tumour size
Lymph nodes
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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.
After Surgery What Other Treatments Might Be Needed
For those who have a mastectomy for DCIS, there is usually no need for additional treatment because the risk of the cancer coming back is very low. After a lumpectomy, there is still a risk that the DCIS may come back or become invasive cancer. To reduce this risk, the two main treatments are radiation therapy and, if the DCIS cells have the estrogen receptor, hormone therapy. These hormone-blocking drugs include tamoxifen, which blocks the estrogen receptor, and aromatase inhibitors, which block estrogen production.
Probably the hardest decision faced by people with DCIS is whether to have one of these additional treatments after a lumpectomy. A lot of factors must be considered, including the size and grade of the DCIS, how close the DCIS cells were to the final margin, and the age of the person at diagnosis. Younger patients tend to have a higher risk of recurrence compared to older individuals. And then as a doctor, I need to consider how each of my patients thinks about risk. For example, a 10% risk of recurrence in the next ten years can mean completely different things to two different people. Some patients want to do everything to lower their risk, while others are happy to just have it watched closely.
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Can Cancer In Situ Tumors Become Malignant Tumors
First, we understand what is malignant?Malignant is a term for a disorder in which bizarre cells divide without control and can invade nearby tissues, although they may later spread into normal tissue and become cancer. Mostly in the case of a malignant tumor that localized, its state and divide without control and can overrun nearby tissues.
Treatment Of Carcinoma In Situ
In general, the treatment of carcinoma in situ depends on the location of abnormal cells appearing, the type of cancer and also the health condition of the sufferer. Handling this early-stage cancer can be with chemotherapy drugs, radiation therapy, to surgery. The earlier this condition is handled, the higher the rate of hope for recovery.
Dont hesitate to consult a doctor if you have a family member who has cancer, and do routine screening.
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What Is Lobular Carcinoma In Situ
Lobular carcinoma in situ is a rare condition in which abnormal cells form in the milk glands in the breast. LCIS isnt cancer. But occurring diagnosed with LCIS implies that you have an increased risk of formulating breast cancer.
Treatments
Having LCIS does boost your hazard of developing pushy breast cancer later on. But LCIS is not true cancer, its called pre-cancer, often no medication is obliged after the biopsy.
What Stage is Cancer in Situ or How Serious is Carcinoma in Situ?
Ductal Carcinoma In Situ May Be Classified By Many Subtypes
Breast DCIS is really not considered a single disease, but rather a heterogenous collection of diseases. The different types and grades of ductal carcinoma in situ have different tendencies regarding their potential to become invasive breast cancer. There are various factors that influence the type of grade associated with DCIS, but generally speaking it is determined by the nuclear grade of the tumor cells and the presence or absence of intraductal comedo-type necrosis.
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Squamous Carcinoma In Situ Of The Skin
What is squamous carcinoma in situ?
Squamous carcinoma in situ is a type of non-invasive skin cancer. The tumour starts from the cells normally found on the surface of the skin. Another name for squamous carcinoma in situ in the skin is Bowens disease. If left untreated, most tumours will eventually turn into a type of cancer called invasive squamous cell carcinoma.
What is skin?
Skin is made up of three layers: epidermis, dermis, and subcutaneous fat. The surface and the part you can see when you look at your skin is called the epidermis. The cells that make up the epidermis include squamous cells, basal cells, melanocytes, Merkel cells, and cells of the immune system. The squamous cells in the epidermis produce a material called keratin which makes the skin waterproof and strong and protects us from toxins and injuries. The dermis is directly below the epidermis. The dermis is separated from the epidermis by a thin layer of tissue called the basement membrane. The dermis contains blood vessels and nerves. Below the dermis is a layer of fat called subcutaneous adipose tissue.
What causes squamous carcinoma in situ?
Most tumours that occur in older adults develop as a result of the cells in the epidermis being damaged by UV light from the sun. Long-term exposure to UV radiation from tanning beds can cause similar damage. People who have immunosuppression due to organ transplantation or HIV infection are also at increased risk of developing squamous carcinoma in situ.
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:
- Non-infiltrating
- Intra-epithelial
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Future Directions In Dcis
DCIS research is directed mainly at improving treatment and, above all, at preventing progression to invasive disease. As researchers continue to study the pathology of DCIS, they are finding that certain tumor characteristics help predict the treatment most likely to reduce the chance of recurrence. For example, some forms of breast cancer require estrogen in order to grow tumors that do are termed estrogen receptorpositive . Tamoxifen belongs to a class of drugs called selective estrogen-receptor modulators , which act by blocking estrogen receptors. Tamoxifen is more likely to prevent a recurrence in women with ER-positive DCIS than in women with ER-negative disease.
The use of aromatase inhibitors, which block estrogen production in the peripheral tissues and breast tissue, is being investigated in a trial of postmenopausal women with ER-positive DCIS. For women whose DCIS is ER-negative but who have the HER-2/neu gene, researchers are exploring the use of trastuzumab and lapatinib , which block the tumor growth factors produced by that gene.
A new way to administer radiation that is showing some promise in clinical trials is accelerated partial breast irradiation, in which the tumor site alone is treated for five days with a lighter dose of radiation. In another approach, intraoperative radiation therapy, a one-time dose of radiation is delivered to the involved area of the breast after the tumor has been removed but before the incision is closed.
The Relationship Of Primary Dcis To Recurrences
Assessment of the clonal relationship between primary DCIS and later recurrent disease has been attempted in a number of different ways. Nuclear grade evaluation shows varying levels of concordance, with the same grade seen in 7085% of recurrences when returning as DCIS and 4953% when invasive , although better concordance with invasive grade is seen when the nuclear pleomorphism component only is considered . Immunophenotypic analyses of DCIS and recurrences have shown that recurrence as DCIS and invasive carcinoma both have high ER status concordance as well as high HER2 concordance . Immunostaining of p53 was also highly consistent .
Using such immunohistochemical and pathological features, clonality could be estimated as anywhere between 50 and 95%. However, the levels of concordance observed by these parameters do not accurately represent the clonality rate as: the assays can have poor reproducibility across time, with differing laboratory procedures and pathologist scoring leading to false non-clonality calls, caveats to using grade include that intermediate grade has low inter-observer reproducibility and that overall invasive grade is measured differently to DCIS grade, and most critically, measuring these common, low variability features is a blunt tool for positively assessing clonality: many tumors will share grade and ER status and be entirely independent tumors.
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Can Cancer In Situ Tumor Become Cancerous
Cancer in situ refers to cancer, however, they can occasionally become malignant cancerous tumors and scatter to other nearby localities. Usually, these cells are not malignant, or cancerous. Doctors also call these precancerous cells with stage 0 disease. It may become cancerous and spread to nearby normal tissue.
Who Gets Squamous Cell Carcinoma In
Risk factors for squamous cell carcinoma in-situ include:
- Sun exposure: Squamous cell carcinoma in-situ is most often found in sun damaged individuals.
- Arsenic ingestion: Squamous cell carcinoma in-situ is common in populations exposed to arsenic.
- Ionizing radiation: Squamous cell carcinoma in-situ was common on unprotected hands of radiologists early in the 20th century.
- Human papillomavirus infection: this is implicated in squamous cell carcinoma in-situ on fingers and fingernails.
- Immune suppression due to disease or medicines .
Up to 50% of patients with squamous cell carcinoma in-situ have other keratinocytic skin cancers, mainly basal cell carcinoma.
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