Ductal carcinoma in situ (DCIS)
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Ductal carcinoma in situ (DCIS) is a type of breast cancer that the abnormal cells occur at the milk duct of the breasts. It is common among women. Each breast has milk ducts which are tubes that allow milk to move from the lobes to the nipple for breastfeeding.
DCIS is a non-invasive type of cancer, therefore the cancer cells are confined at the milk ducts and have not spread through to the wall ducts to affect other surrounding breast tissues.
DCIS needs to be evaluated and the treatment options must be considered, even though the disease is not an emergency case. Surgecal removal of all the breast tissues, or radiation therapy are two possible procedures for breast-conserving treatments. Alternatives to surgery may include a clinical trial looking at active monitoring.
Symptoms
DCIS usually doesn’t have any signs and symptoms. Imaging examinations, including mammogram is frequently used to detect DCIS. However, some patient may have the following signs:
- Lump at the breast
- Discharge from the nipples
If you notice any signs and symptoms at the breast, then you could make an appointment with your doctor.
Causes
Cause of the disease have not yet been determined by the specialists, but risk factors had been identified that increase the risk of having a DCIS.
The lifestyles, the environment that the person live in, and the genes from the parents are all potential contributing factors.
Risk factors
Factors that may increase DCIS risk includes.
- Age: all ages are at risk to develop DCIS. The risk increases with age.
- Family History: It is possible to develop a DCIS if there is a history of breast cancer or breast diseases from the mother or siblings. History of atypical hyperplasia could also increase the risk.
- Late pregnancy: those who has their first pregnancy at the later age such as 30 years and above, have higher risk to develop DCIS.
- Never been pregnant: those who never been pregnant are high risk of DCIS
- Age of menstruation: early menstruation before the age of 12 or late menopausal at the age of 55 and above may increase the risk of having DCIS.
- Genetic Mutations: such as those in the breast cancer genes BRCA1 and BRCA2 that increases the risk of breast cancer
Diagnosis
The following procedures are recommended to properly diagnose DCIS:
- Breast examination: the specialist will conduct a thorough assessment of the breast to feel for any abnormal growth of lump at the breast, or any abnormal discharge at the nipples.
- Mammography: usually DCIS is discovered through a mammography. It is a process of using low-energy x-rays to examine the breast for diagnosis and screening.
- Core needed biopsy: a significant sample of the breast tissue that seemed suspicious on the mammography will be removed and send to the laboratory to determine if it is cancer and what type of cancer.
- Imaging: Specialist may use an ultrasound or an x-ray to precisely locate the abnormal tissue, and these procedures could also be used during biopsy. Breast biopsies that are guided by ultrasound are known as ultrasound-guided biopsies, while stereotactic breast biopsy refers to a biopsy that makes use of X-rays, similar to mammogram.
Staging
Once the specialist confirmed the diagnosis of DCIS, then the following step is to know the extent (stage) of the cancer. The stages of breast cancer are indicated by Roman numerals ranging from 0 to IV. Despite that the DCIS is always stage 0, the tumor can be of any size and may be situated inside of many milks ducts the breast. The prognosis of DCIS had been improved with treatment.
Treatment
Treatment for patient with DCIS is still needed despite that the disease is not developing aggressively or spreads quickly. Close monitoring of the condition is recommended by the specialist.
DCIS can progress in some cases if left untreated. This indicates that the cancer has spread outside of the milk ducts and into the surrounding breast tissue.
Breast-conserving surgery (lumpectomy) combined with radiation therapy or a mastectomy are the two most popular therapies for DCIS. The treatment for DCIS are as follows:
Surgery
- Lumpectomy or Breast-conserving surgery (BCS): surgical removal of DCIS, along with some of the healthy breast tissue that surrounds the tumor. Most of the breast will remain intact following a lumpectomy, depending on the size and location of the DCIS.
- Mastectomy: If DCIS is in a significant area or is visible across the breast, then mastectomy is recommended, which is the removal of the entire breast. After a mastectomy, radiation therapy may not be needed.
Mastectomy surgical removal of the affected breast or all breasts (double mastectomy). Mastectomy is the definite treatment if the BCS is not possible. If the disease has progressed to the several milk ducts or if a tumor has grown large, then mastectomy would be the preferred option. Radiation therapy may not be needed if the patient undergo mastectomy, this makes the procedure preferable by most patient with DCIS. If patient underwent mastectomy, they could still have breast reconstruction.
Radiation therapy
It is a common breast cancer treatment after a lumpectomy to ensure that all abnormal cells are removed. High-energy beams, such X-rays or protons, are used in radiation therapy to eliminate abnormal cells. Radiation therapy lessens the possibility that DCIS will reoccur or develop into an aggressive cancer.
Hormone Therapy
The tumors that grow and respond to hormones will benefit from hormone therapy, which prevents hormones from reaching cancer cells (hormone receptor positive breast cancer).
Hormone therapy is not the treatment of choice for DCIS, however it could be an additional therapy after surgery, or it could increase the chances in preventing the recurrence of DCIS after radiation therapy, or it could avoid the invasiveness of breast cancer.
Women who are at the menopausal stage may also consider using aromatase inhibitors in hormone therapy because these drugs reduce the estrogen production of the body and can be used for up to five years.
In order to lower the risk of getting invasive breast cancer, the medicine tamoxifen blocks the function of estrogen. Women who have not yet experienced menopausal and those who have, can utilize it for up to five years.
Patient who underwent mastectomy will most likely do not need hormone therapy. Due to the limited amount of breast tissue that remains after a mastectomy, there is a very low risk of developing invasive breast cancer or recurrent DCIS. The opposite breast would only experience any potential advantages from hormone therapy.
It is highly advisable to discuss with the healthcare professional the advantages and disadvantages of hormone therapy.
