Ductal carcinoma in situ, otherwise known as DCIS, refers to the presence of anomalous cells inside the breast milk duct. It is considered as the initial stage of breast cancer. It is noninvasive, which means that it does not spread from the milk duct to other breast parts. While this condition is not life threatening, prevention and treatment is required to halt it from becoming invasive. Women who have DCIS undergo radiation and breast-conserving surgery as effective treatment methods.
Symptoms of Ductal Carcinoma in Situ
Symptoms
Ductal carcinoma in Situ is a condition that is said to occur in about 26% of all women in America who have been diagnosed with breast cancer. In many cases, DCIS cannot be detected early as it has no symptoms and signs. However, there are those rare times when there is presence of some symptoms and signs including;
- Discharge from the nipple
- Breast lump
When to See a Doctor
You should seek medical attention if you notice the following changes in your breasts:
- You can feel a lump
- There is a puckered area around the breast
- There is nipple discharge
- The skin has thickened
- There is unusual skin color in the breast region
You should also ask your doctor whether you should get screening for breast cancer and how often you should get the screening. Most doctors recommend habitual screening for breast cancer when a person is in her 40’s.
Causes of Ductal Carcinoma in Situ
Causes
The causes of DCIS are unclear. DCIS is formed when the breast duct cell’s DNA undergoes genetic mutation. Genetic mutation causes abnormal appearances of cells, but the cells do not have the ability to break from the ducts of the breast.
Researchers do not know the exact trigger of this irregular cell growth which causes DCIS. There are several factors that may cause DCIS including genetic inheritance, a person’s lifestyle and the environment.
Risk Factors
Factors that are said to increase the DCIS risk include:
- Presence of breast cancer in the family history
- Increasing age
- Being pregnant for the first time at the age of thirty or above
- When a person has a personal history with malevolent breast disease like atypical hyperplasia.
- When a person takes progestin and estrogen hormone combination as replacement therapy following menopause.
Diagnosis of Ductal Carcinoma in Situ
Breast Imaging
In most cases, DCIS is discovered when a mammogram is used for breast cancer screening. If, during the screening, suspicious areas are discovered like white specks (microcalcification) or shadows the radiologist will most likely recommend further breast imaging. Diagnostic mammogram takes higher magnification views from several different angles so that the radiologist can see the microcalcification and effectively appraise both breasts. If the specific area requires further evaluation then an ultrasound, breast biopsy or MRI (magnetic resonance imaging) can be done.
Breast Tissue Samples
- Stereotactic biopsy. It involves using a hollow needle to remove tissue samples. Stereotactic biopsy is carried out with the help of stereo images.
- Core needle biopsy. A surgeon or radiologist uses a concave needle to get tissue samples from the area of concern. The samples are then sent to a lab for further evaluation.
- Surgical biopsy (lumpectomy or wide local excision). If the core needle and stereotactic biopsy’s show DCIS areas, the patient is referred to a surgeon for further discussion on the surgical options for having a wider breast tissue area removed for analysis.
Treatment for Ductal Carcinoma in Situ
1. Mastectomy
This is the removal of the breast skin, areola, tissue, nipple and if possible the lymph nodes (underarm). If the patient requires breast reconstruction, then it is done. Since radiation combined with lumpectomy is just as effective, mastectomy is not as common as it once was for DCIS treating.
2. Lumpectomy
This is surgery done to have the areas affected with DCIS removed. The surrounding healthy tissues around the area are also removed. This procedure makes it possible for the patient to keep much of the breast, but it depends on the amount of tissue removed. As a result, breast reconstruction is not needed. Radiation therapy is what follows after the Lumpectomy.
3. Radiation Therapy
This is the use of high-energy shafts of light like X-rays to destroy the cancer cells. When radiation therapy follows lumpectomy, the chances of a recurring DCIM and/or chances of the DCIM progressing to invasive cancer are drastically reduced. Women with DCIS that has only spread to a small area do not necessarily need radiation as the DCIS might have been removed during surgery.
4. Tamoxifen
This is a drug that blocks estrogen action. Estrogen is a hormone known to fuel growth of tumors and/or breast cancer cells. Tamoxifen is used in cancers that grow in reaction to hormones. This drug should not be used for DCIS treatment all by itself but as adjuvant (additional) therapy after radiation or therapy.
5. Anxiety Management
Women diagnosed with DCIS may experience some anxiety which in turn make it hard for them to concentrate or sleep. To cope with anxiety, the patient should try massage, music therapy, meditation, hypnosis, Tai chi and Yoga or relaxation techniques like guided imagery.
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