Ductal Carcinoma In Situ

1 What is Ductal Carcinoma in Situ (DCIS)?

Ductal carcinoma in situ (DCIS) is considered the earliest form of breast cancer. It is characterized by the presence of abnormal cells inside a milk duct.

These cells lack capacity to cross basement membrane, and therefore are incapable to produce distant metastases (noninvasive).

DCIS is usually diagnosed during regular breast cancer mammogram screening, or when other indications for the exam exist. After the introduction of regular screening with mammograms, the number of newly-diagnosed has substantially risen.

Even though DCIS it is not invasive, it needs to be treated in order to prevent it becoming invasive. Treatment includes surgery and radiation.

2 Symptoms

Usually, ductal carcinoma in situ (DCIS) does not cause any signs or symptoms. If it does, the most common ones include: breast lumps, bloody nipple discharge and unusual breast skin.

It is usually found during mammography, in most cases as asymmetrical casting type calcifications.

If you notice any of these symptoms, please make an appointment with your doctor.

You should seriously consider beginning mammograms in your 40s.

3 Causes

The causes of ductal carcinoma in situ (DCIS) still remain unclear.

One of the possible causes are DNA mutations in ductal epithelial cells that induce abnormal cell growth.

These cells lack capacity to cross basement membrane, and therefore are incapable to produce distant metastases (noninvasive).

These mutations are probably triggered by factors that have to do with your genes, environment and lifestyle.

4 Making a Diagnosis

Making a diagnosis of ductal carcinoma in situ (DCIS) is done by performing several tests and procedures.

In case you notice any of the above-mentioned symptoms, please make an appointment with your doctor.

If you make an appointment with the other doctor, for a second opinion, please bring all your previous medical documentation. Describe your current condition thoroughly. Mention all previous breast conditions, all other chronic conditions and all the therapies that you are receiving/have received.

Do not forget to speak about any existing family history of breast conditions.

Bring someone along with you when you visit your doctor. This person might be able to help you cope with various information that you will hear. Write down questions to ask your doctor.

If asymmetrical casting type calcifications are noticed on your mammogram, further breast imaging may be required. Because of further evaluation, the doctor may suggest an ultrasound or breast biopsy and sample microscopic examination.

There are more types of biopsy procedures:

  • Core needle biopsy – done with hollow needle which is guided by ultrasound.
  • Stereotactic biopsy – also done with hollow needle but with the help of stereo images (mammogram images from different angles)
  • Surgical biopsy – includes wide local excision of the lesion.

5 Treatment

Treatment of ductal carcinoma in situ (DCIS) is usually successful and tumor is surgically removed. Surgical treatment options for DCIS include:

  • Lumpectomy – it is a breast conserving surgical removal of the lump or suspicious tissue seen on the mammogram, and some surrounding tissue as well. Most people with DCIS have a lumpectomy followed by radiation therapy.
  • Simple mastectomy – the entire breast is removed sparing the lymph nodes. Radical mastectomy – lymph nodes are removed too. It is recommended when tumor covers large area of the breast, or is multi-centric. In most cases this intervention is followed by breast reconstruction. Because lumpectomy combined with radiation is equally effective, simple mastectomy is becoming less common than it once was.
  • Non – surgical treatment includes radiation and hormonal therapy (in tumors positive with hormonal receptors). The most widely used drug for hormonal therapy is Tamoxifen, which mimics estrogen and attaches to the receptors on the breast cancer cells.

6 Alternative and Homeopathic Remedies

Alternative remedies haven’t been found to cure or reduce the risk of ductal carcinoma in situ (DCIS).

On the other hand, these may help with anxiety that develops due to worrying about the diagnosis.

In order to help you cope with the existing condition, you might try: meditation, hypnosis, massage, music therapy, relaxation techniques, exercise, aromatherapy etc.

7 Lifestyle and Coping

A diagnosis of ductal carcinoma in situ (DCIS) may be frightening and seriously affect your lifestyle.

In order to better cope with this diagnosis, here are some useful pieces of advice:

  • Inform yourself about DCIS
  • Ask your doctor questions that interest you
  • Research your treatment options from relevant sources
  • Ask for support or your friends and family when needed
  • Look for support groups
  • Live healthy – regulate your diet and be active for at least 30 minutes a day.
  • Sleep enough

8 Risks and Complications

Risk factors for ductal carcinoma in situ (DCIS) include:

  • Older age
  • Family history of breast cancer
  • Personal history of benign breast changes
  • First pregnancy after the age of 30
  • Estrogen/progestin hormone replacement therapy
  • Obesity
  • Genetic mutations (BRCA1, BRCA2) etc.
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