Sex Life And Fertility
Breast cancer treatments can have a direct effect on your sex life.
For example, surgery may affect how you think and feel about your body . It can take time to adjust to changes to your body. If you have a partner, it can help to talk openly with them about your feelings.
Some treatments for DCIS may cause menopausal symptoms. Doctors do not recommend hormone replacement therapy . This is because it contains oestrogen, which could encourage breast cancer cells to grow.
Your cancer doctor or breast care nurse will also advise you not to use contraception that contains hormones.
How Common Is Ductal Carcinoma In Situ
The American Cancer Society expects that 63,960 new cases of DCIS will be found in 2018. Today more and more women are aware of the importance of early detection and are getting mammograms each year. Because of this, the number of cases of DCIS has increased. In addition, mammography technology has greatly improved as well and is better able to detect problems at an earlier stage. An estimated 12.4% of women in the U.S. will develop invasive breast cancer at some time in their lives.
Whats The Most Effective Treatment For Dcis
Surgery is typically the first treatment for DCIS, and it is very effective. There are two types of surgery used for DCIS. The less-invasive option is a lumpectomy, in which a surgeon removes the area of DCIS as well as a little bit of the normal tissue around it, also referred to as a margin. The other option is a mastectomy, which involves removing the entire breast.
Most people with DCIS undergo a lumpectomy, possibly followed by additional treatments. In some cases, a mastectomy is recommended, especially if the DCIS covers a large area or appears in multiple spots throughout the breast. With either of these surgeries, the survival rate is excellent. Our job is to figure out which type of surgery is best for each patient.
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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.
There Is No Accepted Correlation Between Type And Grade Of Dcis And Probability Of Future Invasive Breast Cancer Status
In the ongoing attempt to discover and treat breast cancer at the earliest possible stage, there have been a number of studies that speculate on the features of DCIS that are most likely to evolve into an invasive breast cancer.
The two factors specialists most commonly discuss in this regard are the nuclear grade of malignant cells and the presence of necrosis. Which of these two factors is of greater importance is still a subject of debate and interpretation.
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What If My Report On Ductal Carcinoma In Situ Mentions Margins Or Ink
When the entire area of DCIS is removed, the outside surface of the specimen is coated with ink, sometimes even with different colors of ink on different sides of the specimen. The pathologist looks at slides of the DCIS under the microscope to see how close the DCIS cells get to the ink . If DCIS is touching the ink , it can mean that some DCIS cells were left behind, and more surgery or other treatments may be needed. Sometimes, though, the surgeon has already removed more tissue to help make sure that this isnt needed. If your pathology report shows DCIS with positive margins, your doctor will talk to you about what treatment is best.
Ductal Carcinoma In Situ Biology Biomarkers And Diagnosis
- 1Cancer Genomics Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- 2The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- 3Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Ductal carcinoma in situ is an often-diagnosed breast disease and a known, non-obligate, precursor to invasive breast carcinoma. In this review, we explore the clinical and pathological features of DCIS, fundamental elements of DCIS biology including gene expression and genetic events, the relationship of DCIS with recurrence and invasive breast cancer, and the interaction of DCIS with the microenvironment. We also survey how these various elements are being used to solve the clinical conundrum of how to optimally treat a disease that has potential to progress, and yet is also likely over-treated in a significant proportion of cases.
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What Causes Noninvasive Breast Cancer
Scientists do not have a full understanding of what causes cancer, including breast cancer. Cancer starts when normal body processes fail to limit cell growth. Accumulated genetic mutations throughout a persons life can disrupt these so-called checkpoints, changing cells to the point they become very abnormal. They do not grow or look like normal breast cells, and they begin growing out of control. The specific trigger, or triggers are unclear, but there are some gene mutations and other risk factors known to increase the risk of breast cancer.
What Is Noninvasive Breast Cancer
Noninvasive breast cancer is cancer that remains in the same location where it started. It has not spread anywhere else in the breast. The two places this type of breast cancer can develop are the milk ducts and the milk-producing glands, or lobules. Breast cancer in the cells lining the milk ducts is ductal carcinoma. Cancer that starts in the milk glands is lobular carcinoma. LCIS is not technically cancer. Doctors consider it a precancerous warning sign. Having LCIS increases the risk of developing in the future. It is a very uncommon finding.
Noninvasive ductal carcinoma is stage 0 breast cancer, the earliest form. Another name for it is ductal carcinoma in situ . The cancer cells start growing in the milk ducts and remain therethe cancer cells have not grown through the duct wall or spread anywhere else in the breast. DCIS accounts for about 20% of new breast cancer diagnoses. Invasive accounts for the majority of breast cancer diagnoses.
Women who develop DCIS rarely notice symptoms, such as a lump, because it is in such an early stage of growth. Instead, almost all DCIS breast cancers show up on screening mammograms. Finding it so early makes noninvasive breast cancer treatment highly successful.
If you do feel a lump or notice any other changes in a breast, see your doctor promptly.
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What Does It Mean If My Report Mentions Microcalcifications Or Calcifications
Microcalcifications or calcifications are calcium deposits that can be found in both non-cancerous and cancerous breast lesions. They can be seen both on mammograms and under the microscope. Because certain calcifications are found in areas containing cancer, their presence on a mammogram may lead to a biopsy of the area. Then, when the biopsy is done, the pathologist looks at the tissue removed to be sure that it contains calcifications. If the calcifications are there, the treating physician knows that the biopsy sampled the correct area .
Tests To Determine The Need For Chemotherapy
If the cancer is early-stage and has certain characteristics, you may be eligible for a genomic test, which looks at specific genes in the cancer to predict how likely the cancer is to recur . If a cancer is not very likely to come back, you might not need chemotherapy. If the cancer is more likely to come back, you and your doctor might decide that chemotherapy is right for you. Oncotype DX, MammaPrint, and the Prosigna Breast Cancer Prognostic Gene Signature Assay are some examples of genomic tests. Learn more about breast cancer tests.
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Ethics Approval And Informed Consent
We obtained permission to access the SEER research data files using the reference number 15223-Nov2019. The data released by the SEER database do not require informed patient consent, and our study was approved by the Ethical Committee of Shenzhen Second Peoples Hospital. The methods were performed in accordance with the principles stated in the Declaration of Helsinki.
Patient And Public Involvement
This study comprises a statistical analysis conducted on routinely collected data that had been depersonalised. No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for the study. The results have already been presented to representatives of appropriate patient groups. After publication, they will be freely available both to stakeholders and to the broader public.
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Additional Types Of Invasive Ductal Carcinoma:
There are four types of invasive ductal carcinoma that are less common:
- Medullary Ductal Carcinoma This type of cancer is rare and only three to five percent of breast cancers are diagnosed as medullary ductal carcinoma. The tumor usually shows up on a mammogram and it does not always feel like a lump rather it can feel like a spongy change of breast tissue.
- Mucinous Ductal Carcinoma This occurs when cancer cells within the breast produce mucous, which also contains breast cancer cells. The cells and mucous combine to form a tumor. Pure mucinous ductal carcinoma carries a better prognosis than more common types of IDCs.
- Papillary Carcinoma This is a very good prognosis breast cancer that primarily occur in women over the age of 60.
- Tubular Ductal Carcinoma This is a rare diagnosis of IDC, making up only two percent of diagnoses of breast cancer. The name comes from how the cancer looks under the microscope like hundreds of tiny tubes. Tubular breast cancer has an excellent prognosis.
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What Is A Breast Cancers Grade
Cancer cells are given a grade when they are removed from the breast and checked in the lab. The grade is based on how much the cancer cells look like normal cells. The grade is used to help predict your outcome and to help figure out what treatments might work best.
A lower grade number usually means the cancer is slower-growing and less likely to spread.
A higher number means a faster-growing cancer thats more likely to spread.
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Additional Immunohistochemical Markers For Infiltrative Ductal Carcinoma With Central Necrosis
Most invasive breast cancers will lack both a basement membrane and myoepithelial cells.
However, in actuality, there are many breast cancers that produce basement membrane components.
In addition, there are several invasive cancer that have myoepithelial cell elements. So, when trying to determine if a suspicious breast cancer lesion featuring central necrosis is comedo DCIS or an infiltrative breast carcinoma with central necrosis, there are a number of myoepithelial markers that may help.
Common myoepithelial cell markers include:-
- S-100, smooth muscle actine
- SMM-HC, Calponin: Is probably the most specific myoepithelial cell marker
- HMW-CK. SMM-HC .
- CD10, p63
- P63: Is quite a useful marker in breast cancer differentiation because it stains the myoepithelial nuclei only, and also has high sensitivity and specificity.
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.
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Idc Type: Mucinous Carcinoma Of The Breast
Mucinous carcinoma of the breast sometimes called colloid carcinoma is a rare form of invasive ductal carcinoma . In this type of cancer, the tumor is made up of abnormal cells that float in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus.
Normally, mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver, and other vital organs. Many types of cancer cells including most breast cancer cells produce some mucus. In mucinous carcinoma, however, mucin becomes part of the tumor and surrounds the breast cancer cells. Under a microscope, it looks like the cancer cells are scattered throughout pools of mucus.
Research suggests that only about 2-3% of invasive breast cancers are pure mucinous carcinomas meaning that this is the only type of cancer present within the tumor. About 5% of invasive breast cancers appear to have a mucinous component within them, with other types of cancer cells present as well. Mucinous carcinoma is extremely rare in men.
Although mucinous carcinoma can be diagnosed at any age, it tends to affect women after theyve gone through menopause. Some studies have found that the average age at diagnosis is in the 60s or early 70s.
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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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Radiation Therapy For Idc
Radiation therapy directs high-energy rays at the breast, chest area, under the arm, and/or the collarbone area to destroy any cancer cells that may be left behind after surgery. This treatment also reduces the risk of recurrence .
Radiation therapy is most often recommended after surgeries that conserve healthy breast tissue, such as lumpectomy and partial mastectomy. Radiation therapy may be recommended after mastectomy as well, especially if the tumor was large and/or the lymph nodes were involved.
Like surgery, radiation is considered a local treatment because it treats just the tumor and surrounding area.
There are different ways of giving radiation therapy, including:
Researchers are studying partial-breast radiation for use after lumpectomy to see how the benefits compare to the current standard of radiation to the whole breast. Because this technique is still under investigation, it is not yet widely available.
You and your doctor can work together to determine what form of radiation therapy is best for you.
Immunohistochemistry Determines Between Invasive And In
Though somewhat rare, physicians who specialize in breast cancer diagnosis will tell you that it is quite possible for a breast carcinoma to present with both in situ and infiltrative characteristics. A mix.
An infiltrative ductal carcinoma with a central necrosis will so closely mimic a DCIS with central comedo necrosis that the initial morphological evaluation might well mislabel the lesion as high grade comedo DCIS.
In order to determine the true extent and potential threat of the breast carcinoma, one has to perform additional biopsies and imaging studies from various locations. Also, doctors must pay very close attention to the immunohistochemical analysis of the biopsy specimen.
There are certain proteins present in an infiltrating ductal carcinoma that are distinct from comedo breast carcinoma in situ. The key feature is an assessment of the myoepithelial lining of the duct. So, myoepithelial cell involvement tends to be indicative of an infiltrative or pre-invasive status for breast cancer.
Immunohistochemical evidence for either a deficient or absent basement membrane and myoepithelial cell layer will generally confirm a diagnosis of infiltrative breast carcinoma with central necrosis, rather than a comedo type DCIS.
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Lobes Lobules And Ducts
Each breast typically has around 15 to 20 sections called lobes and many smaller sections called lobules. The lobules produce breast milk. The breast milk is secreted into the breast ducts and then carried towards the nipple.
Most breast cancers start in either the breast ducts or the lobules. For this reason, both ductal and lobular breast cancers are referred to as breast adenocarcinomas.
The earliest forms of breast cancer are ductal carcinoma in-situ and lobular carcinoma in-situ . In DCIS, the abnormal cells are present but still contained in the milk ducts. Likewise, with LCIS the abnormal cells are found in the breast lobules but have not yet spread to surrounding tissues.
Hence, the term in-situ means that the abnormal cells are in the same place or have not spread yet. The prognosis for both DCIS and LCIS is excellent.
The two main types of adenoma-carcinoma are:-
What Does It Mean If My In
There are 2 main types of in-situ carcinoma of the breast: ductal carcinoma in-situ and lobular carcinoma in situ . Intraductal carcinoma is another name for ductal carcinoma in-situ.
LCIS is discussed on a different page.
Sometimes DCIS and LCIS are both found in the same biopsy.
In-situ carcinoma with duct and lobular features means that the in-situ carcinoma looks like DCIS in some ways and LCIS in some ways , and so the pathologist cant call it one or the other.
If DCIS is left untreated, it can go on to become an invasive cancer, so it is often called a pre-cancer. Still, we dont really understand it well. We dont think that all DCIS would go on to become invasive cancer, but we cant tell which DCIS would be safe to leave untreated. Treatment is aimed at getting rid of all the DCIS, usually by surgery. In some cases, radiation or hormone therapy is given after surgery to lower the chance that it will come back later or that invasive carcinoma will occur.