Ductal carcinoma in situ

Source: Wikipedia, the free encyclopedia.

Breast cancer in situ
Other namesIntraductal carcinoma
Ducts of the mammary gland, the location of ductal carcinoma
SpecialtyOncology
Histopathologic image from ductal cell carcinoma in situ (DCIS) of breast (hematoxylin and eosin stain)

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the

screening mammography.[4][5] It has been diagnosed in a significant percentage of men (see male breast cancer).[6]

In DCIS, abnormal cells are found in the lining of one or more

invasive cancer). In some cases, DCIS may become invasive and spread to other tissues, but there is no way of determining which lesions will remain stable without treatment, and which will go on to become invasive.[7]
DCIS encompasses a wide spectrum of diseases ranging from low-grade lesions that are not life-threatening to high-grade (i.e. potentially highly aggressive) lesions.

DCIS has been classified according to the architectural pattern of the cells (solid, cribriform, papillary, and micropapillary),

mammograms by examining tiny specks of calcium known as microcalcifications. Since suspicious groups of microcalcifications 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.[10][11] DCIS is the most common type of pre-cancer in women. There is some disagreement on its status as cancer; some bodies include DCIS when calculating breast cancer statistics, while others do not.[12][13]

Terminology

Ductal carcinoma in situ (DCIS) literally means groups of "cancerous"

malignant) condition,[15] because the biologically abnormal cells have not yet crossed the basement membrane to invade the surrounding tissue.[14][16] When multiple lesions (known as "foci" of DCIS) are present in different quadrants of the breast, this is referred to as "multicentric" disease.[8]

For statistical purposes, DCIS is sometimes counted as a "cancer", but this is not always the case.[13][17] When classified as a cancer, it is referred to as a "non-invasive" or "pre-invasive" form.[14][18] It is described by the National Cancer Institute as a "noninvasive condition".[13]

Signs and symptoms

A drawing of ductal carcinoma in situ in the anatomical context of the whole breast
A drawing of a breast duct containing ductal carcinoma in situ

Most of the women who develop DCIS do not experience any symptoms. The majority of cases (80-85%) are detected through screening mammography. The first signs and symptoms may appear if the cancer advances. Because of the lack of early symptoms, DCIS is most often detected at

screening mammography
.

In a few cases, DCIS may cause:

  • A lump or thickening in or near the breast or under the arm
  • A change in the size or shape of the breast
  • Nipple discharge or nipple tenderness; the nipple may also be inverted, or pulled back into the breast
  • Ridges or pitting of the breast; the skin may look like the skin of an orange
  • A change in the way the skin of the breast,
    swelling, redness or scaliness.[20]

Causes

The specific causes of DCIS are still unknown. The risk factors for developing this condition are similar to those for invasive breast cancer.[21]

Some women are however more prone than others to developing DCIS. Women considered at higher risks are those who have a

children
or had them 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

chemicals may also contribute in the development of the condition.[22]
Nonetheless, the risk of developing noninvasive cancer increases with age and it is higher in women older than 45 years.

Diagnosis

80% of cases in the United States are detected by mammography screening.[23] More definitive diagnosis is made by breast biopsy for histopathology.

  • Mammogram microcalcifications in ductal carcinoma in situ
    Mammogram
    microcalcifications in ductal carcinoma in situ
  • Histopathology of dystrophic microcalcifications in DCIS, H&E stain.
    Histopathology of dystrophic
    microcalcifications
    in DCIS, H&E stain.
  • Histopathologic architectural patterns of DCIS.[24]
    Histopathologic architectural patterns of DCIS.[24]
  • Histopathology of high-grade DCIS. H&E stain. RBC = red blood cell.[25]
    Histopathology of high-grade DCIS. H&E stain.
    RBC = red blood cell.[25]
  • DCIS with microinvasion, defined as focus of invasive cancer measuring up to 1.0 mm in size.[26]
    DCIS with microinvasion, defined as focus of invasive cancer measuring up to 1.0 mm in size.[26]
  • Immunohistochemistry for calponin in ductal carcinoma in situ, highlighting myoepithelial cells around all tumor cells, thereby ruling out invasive ductal carcinoma.
    invasive ductal carcinoma
    .
  • Ductal carcinoma in situ with comedo necrosis spanning 30% of its diameter, which is generally regarded as the minimal size to classify it as comedo.[27]
    Ductal carcinoma in situ with comedo necrosis spanning 30% of its diameter, which is generally regarded as the minimal size to classify it as comedo.[27]

Treatment

There are different opinions on the best treatment of DCIS.

hormonal therapy if the cells show estrogen receptor positivity.[13] Research shows that survival is the same with lumpectomy as it is with mastectomy, whether or not a woman has radiation after lumpectomy.[31] Chemotherapy is not needed for DCIS since the disease is noninvasive.[32]

While surgery reduces the risk of subsequent cancer, many people never develop cancer even without treatment and the associated side effects.[30] There is no evidence comparing surgery with watchful waiting and some feel watchful waiting may be a reasonable option in certain cases.[30]

Radiation therapy

Use of

toxic effects.[33] While the authors caution that longer follow-up will be required before a definitive conclusion can be reached regarding long-term toxicity, they point out that ongoing technical improvements should further restrict radiation exposure in healthy tissues.[33] They do recommend that comprehensive information on potential side effects is given to women who receive this treatment.[33] The addition of radiation therapy to lumpectomy appears to reduce the risk of local recurrence to approximately 12%, of which approximately half will be DCIS and half will be invasive breast cancer; the risk of recurrence is 1% for women undergoing mastectomy.[36]

Mastectomy

There is no evidence that mastectomy decreases the risk of death over a lumpectomy.[37] Mastectomy, however, may decrease the rate of the DCIS or invasive cancer occurring in the same location.[7][37]

Mastectomies remain a common recommendation in those with persistent microscopic involvement of margins after local excision or with a diagnosis of DCIS and evidence of suspicious, diffuse microcalcifications.[38]

Sentinel node biopsy

Some institutions that have encountered high rates of recurrent invasive cancers after mastectomy for DCIS have endorsed routine

sentinel node biopsy (SNB).[39] However, research indicates that sentinel node biopsy has risks that outweigh the benefits for most women with DCIS.[40] SNB should be considered with tissue diagnosis of high-risk DCIS (grade III with palpable mass or larger size on imaging) as well as in people undergoing mastectomy after a core or excisional biopsy diagnosis of DCIS.[41][42]

Prognosis

With treatment, the prognosis is excellent, with greater than 97% long-term survival. If untreated, DCIS progresses to invasive cancer in roughly one-third of cases, usually in the same breast and quadrant as the earlier DCIS.[43] About 2% of women who are diagnosed with this condition and treated died within 10 years.[44] Biomarkers can identify which women who were initially diagnosed with DCIS are at high or low risk of subsequent invasive cancer.[45][46]

Epidemiology

Histopathologic types of breast cancer, with relative incidences and prognoses. "Ductal carcinoma in situ" is near top.

DCIS is often detected with mammographies but can rarely be felt. With the increasing use of screening mammography, noninvasive cancers are more frequently diagnosed and now constitute 15% to 20% of all breast cancers.[38]

Cases of DCIS have increased five-fold between 1983 and 2003 in the United States due to the introduction of screening mammography.[44] In 2009 about 62,000 cases were diagnosed.[44]

References

  1. PMID 24415964
    .
  2. ISBN 978-0-387-98348-6
    .
  3. ^ DePolo, Jamie (13 October 2023). "Breast Cancer Stages: Stage 0 breast cancer". Breastcancer.org.
  4. PMID 18270336
    .
  5. ISBN 978-0-387-21997-4
    .
  6. PMID 31880271
    .
  7. ^
    PMID 32461218
    .
  8. ^
    PMID 20629475
    .
  9. PMID 34537861
    .
  10. ISBN 978-0-7817-9516-6
    .
  11. PMID 20956824
    .
  12. ^ "Breast Cancer Treatment (PDQ®)". NCI. 11 April 2014. Retrieved 19 June 2014.
  13. ^ a b c d e "Breast Cancer Treatment (PDQ®)". NCI. January 1980. Retrieved 19 June 2014.
  14. ^
    PMID 20956817
    .
  15. ISBN 978-1-4419-6505-9
    .
  16. ISBN 9780470757796
    .
  17. ISBN 978-0-387-31056-5
    .
  18. ISBN 978-0-387-75246-4
    .
  19. ^ "Breast Cancer". Retrieved 28 June 2010.
  20. ^ "Signs and Symptoms". Retrieved 28 June 2010.
  21. ^ "After the mammogram". Archived from the original on 7 April 2010. Retrieved 28 June 2010.
  22. ^ "Intraductal Carcinoma of the Breast". Archived from the original on 11 June 2010. Retrieved 28 June 2010.
  23. ^ "Ductal Carcinoma In Situ". cancer.gov. 9 January 2015. Retrieved 5 March 2015.
  24. PMID 34734332
    .
    - "This article is licensed under a Creative Commons Attribution 4.0 International License"
  25. PMID 33363702
    .
  26. PMID 35464581.
    - "This is an open access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0."
    Source for microinvasion: "Protocol for the Examination of Resection Specimens from Patients with Ductal Carcinoma In Situ (DCIS) of the Breast, Version: 4.4.0.0. Protocol Posting Date: June 2021"
    (PDF). College of American Pathologists.
  27. PMID 30980039
    .
  28. PMID 26697227
    .
  29. ^ "Ductal Carcinoma In Situ: Treatment Options for Patients With DCIS". National Cancer Institute at NIH. National Institutes of Health. 11 July 2014.
  30. ^
    PMID 24600734
    .
  31. PMID 21145284
    .
  32. Johns Hopkins Medicine
  33. ^
    PMID 24259251
    .
  34. PMID 20071685
    .
  35. PMID 20956824
    .
  36. ^ "NIH DCIS Consensus Conference Statement". National Institutes of Health. September 2009. Archived from the original on 13 August 2011. Retrieved 19 June 2014.
  37. ^
    PMID 20629475
    . They found women undergoing mastectomy were less likely than women undergoing lumpectomy plus radiation to experience local DCIS or invasive recurrence. Women undergoing BCS alone were also more likely to experience a local recurrence than women treated with mastectomy. We found no study showing a mortality reduction associated with mastectomy over breast conserving surgery with or without radiation
  38. ^ a b "Intraductal carcinoma". Archived from the original on 10 April 2016. Retrieved 28 June 2010.
  39. S2CID 1924867
    .
  40. PMID 32337481
    .
  41. PMID 31388937
    .
  42. PMID 17300928
    .
  43. ISBN 978-0-323-35317-5
    .
  44. ^
    PMID 20956818
    .
  45. PMID 20427430
    .
  46. PMID 19502809
    .

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Ductal_carcinoma_in_situ&oldid=1217042064"