If you have a case that you feel has particular educational value, illustrating important points in diagnosis or treatment, you may send the concept to Dr. Crawford at david. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst.
The locoregional recurrence post-mastectomy for ductal carcinoma in situ: incidence and risk factors. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. Molecular phenotypes of DCIS predict overall and invasive recurrence.
Ann Oncol. Pilewskie M, Morrow M. Axillary nodal management following neoadjuvant chemotherapy: a review. Lancet Oncol. Oncology Williston Park. Breast Cancer Res Treat. Determinants of optimal mastectomy skin flap thickness. Br J Surg. July 15, Pathologists examine the abnormal cells to determine the grade of the DCIS and the hormone-receptor status.
DCIS is classified as low, intermediate, or high grade, depending on how abnormal the cells look under a microscope. High-grade DCIS cells are the most abnormal and grow the fastest. Hormone-receptor status refers to whether the cancer cells have receptors for estrogen, progesterone, or both.
The presence of these receptors on the DCIS suggests that these hormones fuel the growth of the cells, which affects how well the DCIS responds to certain hormone-blocking drugs. A person diagnosed with DCIS usually meets with a breast surgeon first. For example, should a patient get genetic testing for inherited mutations such as BRCA1 or BRCA2 , which are known to raise risk for future breast cancer? Do they have a strong family history of the disease? 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.
This shows that the cancer is growing slowly, because there is enough nourishment to feed all of the cells. When a tumor grows quickly, some of its cells begin to die off. If more cancer does develop, it typically takes longer for this to happen in cases of low-grade DCIS versus high-grade. Papillary Larger Version. Cribriform Larger Version. Solid Larger Version. In the high-grade pattern, DCIS cells tend to grow more quickly and look much different from normal, healthy breast cells.
They also have an increased risk of the cancer coming back earlier — within the first 5 years rather than after 5 years. Comedo Larger Version. High-grade DCIS is sometimes described as "comedo" or "comedo necrosis. These starved cells can die off, leaving areas of necrosis. This is so the area can be found again if another biopsy or surgery is needed.
It can safely be left in the breast and does not need to be removed, even if no further procedures are needed. The staff at the clinic will tell you how and when you will get your biopsy results. You will usually be given an appointment to return to the clinic for your results.
Find out more about understanding your test results. DCIS is graded based on what the cells look like under the microscope. They will be given a grade according to how different they are to normal breast cells and how quickly they are growing.
If DCIS is not treated, the cancer cells may develop the ability to spread outside the ducts, into the surrounding breast tissue. This is known as invasive breast cancer. Invasive cancer has the potential to also spread to other parts of the body.
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. The aim of treatment is to remove all the DCIS from within the breast to reduce the chance of it becoming an invasive cancer. Research is looking at which cases of DCIS are more likely to develop into invasive breast cancer and which could be closely monitored instead of being treated.
If you are diagnosed with low-grade DCIS, you may be invited to join a clinical trial. If you have any questions or concerns about your diagnosis and treatment, talk to your treatment team. This may be breast-conserving surgery also known as a wide local excision or lumpectomy or a mastectomy.
A nipple-sparing mastectomy may be possible in some cases. You may wish to ask your treatment team about this. You may be offered a choice between these types of surgery, depending on the size and location of the area affected. Your breast surgeon will discuss this with you. The breast tissue removed during surgery is examined by a doctor who analyses tissue and cells pathologist.
If any cancer cells are seen at or close to the margin of normal breast tissue, you may need more surgery. If a mastectomy is not required but you would prefer to have one, you can discuss this with your breast surgeon. A technique called wire localisation is used. In the x-ray department or breast clinic, a mammogram or ultrasound scan will be used as a guide to insert a fine wire into the breast under local anaesthetic.
The wire is then carefully secured under a small dressing and left in place until the operation to remove the area of DCIS. The operation is usually done under a general anaesthetic on the same day, and the wire will be removed during the operation.
Some hospitals are using a new localisation procedure. Instead of a fine wire, a tiny very low-dose radioactive seed about the size of a grain of rice or a small radiation-free magnetic marker known as a Magseed is inserted into the breast tissue.
This can be done up to two weeks before your operation.
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