The American Cancer Society estimates that more than 62,000 news cases of carcinoma in situ will
be diagnosed this year. A common type of carcinoma in situ called DCIS (ductal carcinoma in situ
or intraductal carcinoma) accounts for nearly 25% of all breast cancer diagnoses. An estimated
178,400 cases of invasive breast cancer are diagnosed each year, and approximately 20% to 30%
of breast cancers detected by mammography are carcinoma in situ.
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What is DCIS and
How is it Diagnosed?
Ductal carcinoma in situ
(or DCIS) refers to the most common type of
noninvasive breast cancer in women. In situ, or "in place," describes a
cancer that has not moved out of the area of the body where it originally developed. With
DCIS, the cancer cells are confined to milk ducts in the breast and have not spread into
the fatty breast tissue or to any other part of the body (such as the lymph nodes). DCIS
is often first detected by a mammogram (an x-ray examination
of soft breast tissues used to identify lumps, cysts, tumors, and other abnormalities).
DCIS may appear on a mammogram as tiny specks of calcium (called microcalcifications), generally too small to
notice by physical examination.
Suspected DCIS is often confirmed by a breast biopsy in which a small sample of cells is removed for further
examination under a microscope. Types of minimally invasive breast biopsy include:
DCIS is a Stage 0
cancer—the earliest form of breast cancer. Stage 0 breast cancer is a contained
cancer that has not spread beyond the ductal system (to the lymph nodes or other areas of
the body). The cure rate for DCIS is close to 100% provided that an accepted standard
method of treatment is followed.
Note: Though DCIS is a serious
condition requiring careful attention, it is not an emergency medical situation. Women
have a sufficient period of time to educate themselves and weigh all possible treatment
and reconstructive options before any decisions need to be made. Women should
maintain an open dialogue with their physicians to best understand the disease and the
variety of treatment options.
Types of Ductal
Carcinoma in Situ
The term, ductal carcinoma in situ
(DCIS), refers to a family of cancers that occur in the breast ducts. There are two categories of DCIS: non-comedo and
comedo. The term, comedo, describes the
appearance of the cancer. When comedo type
breast tumors are cut, the dead cells inside of them (necrosis) can be expressed out just
like a comedo or blackhead on the skin.
The most common non-comedo types of
DCIS are:
- Solid DCIS: cancer cells completely
fill the affected breast ducts.
- Cribiform DCIS: cancer cells do not
completely fill the affected breast ducts; there are gaps between the cells.
- Papillary and micropapillary DCIS: the
cancer cells arrange themselves in a fern-like pattern within the affected breast ducts;
micropapillary DCIS cells are smaller than papillary DCIS cells.
Comedo type DCIS (also referred to as
Comedocarcinoma) tends to be more aggressive than the non-comedo types of DCIS. Pathologists are able to easily distinguish
between comedo type DCIS and other non-comedo types when examining the cells under a
microscope because comedo type DCIS tends to plug the center of the breast ducts with
necrosis (dead cells). When necrosis is
associated with cancer, it often means that the cancer is able to grow quickly. Necrosis is often seen with microcalcifications (tiny calcium deposits
that can indicate cancer).
Overview
of DCIS Treatment Options
For patients with DCIS confined to one area within the breast, a patient and her doctor
often have the choice between:
- Breast conserving therapy (BCT),
typically a lumpectomy (removal of the mass and a small margin
of surrounding breast tissue) followed by radiation treatment.
- A simple mastectomy
(removal of the affected breast and often a small part of the underarm lymph nodes).
Factors
Used To Determine
Cancer Treatment |
- tumor size
- tumor type
- histologic grade
- lymph node status
- distant metastic cancer
- estrogen/progesterone
receptors
- her-2-neu receptor
|
If a biopsy reveals a high grade of cancer (determined by a pathologist who examines
tissues from the biopsy), the cancer may grow or spread more rapidly to other areas of the
body. DCIS patients with multiple areas of cancer within the breast are often encouraged
to choose a mastectomy. After a mastectomy, a woman may have
immediate or delayed breast reconstruction.
Physicians do not typically remove the
axillary (underarm) lymph nodes in DCIS patients because the
cancer is usually confined to the breast ducts. Thus,
a lumpectomy (followed by radiation) or a simple mastectomy is usually standard treatment. Rarely, however, larger or more aggressive DCIS
tumors have the potential to travel to the lymph nodes or into the bloodstream.
Though not common at this time, some centers are offering
sentinel node biopsy to women who have very large DCIS tumors or who have more
aggressive "comedo" type tumors. Early studies of these specific DCIS
tumors at major institutions such as Memorial-Sloan Kettering Cancer Center
in New York, do show that sentinel lymph node biopsy may be beneficial for
some DCIS patients since a small area of microinvasion in some area of the
breast is possible when DCIS is extensive and or has a high grade. Sentinel
lymph node biopsy is a new procedure that involves removing only the first
one to three lymph nodes in the lymphatic chain. By removing fewer lymph
nodes, the chances of pain and lymphedema (chronic swelling) of the arm are
reduced. For patients with DCIS who undergo mastectomy (see below), the
lymph node(s) can, in almost all cases, be removed through the same
incision.
CONTINUED
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