Ductal carcinoma in situ ( DCIS ), also known as intraductal carcinoma , is a pre-cancerous or non-invasive cancer lesion of the breast. DCISs are classified as Stage 0. Rarely produce symptoms or breast lumps that can be felt, and are usually detected through mammography screening.
In DCIS, abnormal cells are found in layers of one or more milk channels in the breast. In situ means "in place" and refers to the fact that abnormal cells have not come out of the mammary channel and to surrounding tissues in the breast ("pre-cancer" refers to the fact that it has not become invasive cancer). In some cases, DCIS can become invasive and spread to other tissues, but there is no way to determine which lesions will remain stable without treatment, and which will continue to be invasive. DCIS covers a wide range of diseases ranging from non-life-threatening low-grade lesions to high-level lesions (ie, potentially very aggressive lesions).
DCIS has been classified according to the pattern of cell architecture (solid, cribiform, papillary, and micropapillary), tumor levels (high, medium, and low), and presence or absence of comedo histology. DCIS can be detected on a mammogram by examining small calcium spots known as microcalcifications. Because a suspicious microgroup can appear even in the absence of DCIS, a biopsy may be necessary for diagnosis.
About 20-30% of those who do not receive treatment develop breast cancer. This is the most common type of pre-cancer in women. There is some disagreement as to whether, for statistical purposes, should be counted as cancer: some include DCIS when calculating breast cancer statistics while others are not.
Video Ductal carcinoma in situ
Terminology
Ductal carcinoma in situ (DCIS) literally means the group of cancerous epithelial cells that remain in their normal location within the ducts and lobules of the mammary glands. Clinically, this is considered a premalignant condition (ie potentially malignant), because biologically abnormal cells have not crossed the basement membrane to invade surrounding tissue. When multiple lesions (known as "focus" of DCIS) present in different quadrants of the breast, this is referred to as "multicentric" disease.
For statistical purposes, some count DCIS as "cancer", while others do not. When classified as cancer, this is referred to as a non-invasive or pre-invasive form. The National Cancer Institute describes it as a "non-invasive condition".
Maps Ductal carcinoma in situ
Signs and symptoms
Most women who develop DCIS do not experience any symptoms. Most cases (80-85%) were detected through mammography screening. The first signs and symptoms may appear if the cancer develops. Because of the lack of early symptoms, DCIS is most often detected in mammography screening.
In some cases, DCIS may cause:
- A lump or thickening in or near the breast or under the arm
- Changes in breast size or shape
- Puting out or tenderness of the nipple; nipples can also be reversed, or pulled back into the breast
- Swipe or grind the breasts; the skin may look like an orange peel
- Changes in the way the skin of the breast, areola, or nipple look or feel like warmth, swelling, redness or turbidity.
Cause
The specific cause of DCIS is still unknown. The risk factor for developing this condition is similar to invasive breast cancer.
However some women are more vulnerable than others to develop DCIS. Women who are considered high-risk are those who have a family history of breast cancer, those who have menstruated at an early age or who have late menopause. Also, women who have never had children or have those who are late in life are also more likely to get this condition.
Long-term use of estrogen-progestin hormone replacement therapy (HRT) for more than five years after menopause, genetic mutations (BRCA1 or BRCA2 genes), atypical hyperplasia, as well as exposure to radiation or exposure to certain chemicals may also contribute to the development of the condition. However, the risk of developing non-invasive cancer increases with age and is higher in women older than 45 years.
Diagnosis
80% of cases in the United States are diagnosed with mammography screening.
Treatment
There are different opinions about the best care from DCIS. Surgical removal, with or without additional radiation therapy or tamoxifen, is the recommended treatment for DCIS by the National Cancer Institute. Surgery may be a conservative breast-lumpectomy or mastectomy (partial or complete removal of affected breasts). If lumpectomy is used, it is often combined with radiation therapy. Tamoxifen may be used as a hormonal therapy if cells exhibit positive estrogen receptors. Chemotherapy is not necessary for DCIS because the disease is not invasive.
While surgery reduces the risk of subsequent cancer, many people never develop cancer even without treatment and associated side effects. There is no evidence comparing surgery with vigilant waiting and some people feeling waiting alert may be a reasonable option in certain cases.
Radiation therapy
The use of radiation therapy after lumpectomy provides an equivalent survival rate for mastectomy, although there is a slightly higher risk of recurrent disease in the same breast in the form of further DCIS or invasive breast cancer. A systematic review (including Cochrane's review) suggests that the addition of radiation therapy to lumpectomy reduces DCIS recurrence or the onset of newer invasive breast cancer compared to surgery that only protects the breast, without affecting mortality. The Cochrane review found no evidence that radiation therapy has long-term toxic effects. While the authors caution that longer follow-up will be needed before definitive conclusions can be achieved regarding long-term toxicity, they suggest that ongoing technical improvement should further limit radiation exposure to healthy tissue. They recommend that comprehensive information on potential side effects be given to women receiving this treatment. The addition of radiation therapy to lumpectomy appears to reduce the risk of localized recurrence by about 12%, of which approximately half are DCIS and half are invasive breast cancer; the risk of recurrence is 1% for women undergoing a mastectomy.
Mastectomy
There is no evidence that mastectomy decreases the risk of death from lumpectomy. Mastectomy; however, may decrease DCIS or invasive cancer rates occurring in the same location.
Mastectomy remains a general recommendation to those with persistent microscopic involvement after local excision or with a diagnosis of DCIS and suspicious and spreading proof of microcalsification. Some institutions that have experienced high levels of recurrent invasive cancer after mastectomy for DCIS have endorsed routine sentinel node biopsy (SNB). Others order SNB only for certain people. Most agree that SNB should be considered with a diagnosis of high risk DCIS tissue (level III with palpable mass or larger size in imaging) as well as in people undergoing mastectomy after a core biopsy diagnosis or excision of DCIS.
Prognosis
Because DCIS is usually found early and treated or managed, it is difficult to say what happens if it is not handled. About 2% of women diagnosed with this condition and treated died within 10 years. Biomarkers can identify women initially diagnosed with DCIS as being at high or low risk of subsequent invasive cancers.
Epidemiology
DCIS is often detected with mammographies but rarely can be felt. With the increased use of mammography screening, noninvasive cancer is more commonly diagnosed and is now 15% to 20% of all breast cancers.
The DCIS case has increased 5-fold between 1983 and 2003 in the United States due to the introduction of screening mammography. In 2009 about 62,000 cases were diagnosed.
References
Source of the article : Wikipedia
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