Ductal Carcinoma in Situ or ‘DCIS’
Ductal carcinoma in-situ (DCIS), is the word used, when a biopsy shows that some breast cells appear to be cancer cells but are still confined within the breast duct or ducts.
Sometimes DCIS is described as a ‘pre-cancerous‘ condition, but this is not really the case. DCIS means there are malignant cells present (carcinoma or cancer), but these have not yet infiltrated any areas beyond the affected duct (carcinoma in-situ).
Ductal carcinoma in situ is very early stage breast cancer but if left untreated the malignant effects will most likely migrate into the breast tissue surrounding the milk ducts. If DCIS is detected before invasive cancer has a chance to develop the rates of survival are considerably higher.
Visit our new and improved page on Ductal Carcinoma in Situ. It has more up-to-date information. Although, however, this page is still great for research as well.
DCIS is a ‘more advanced’ stage of atypical ductal hyperplasia
DCIS is considered a more serious and escalated version of a condition known as atypical ductal hyperplasia (ADH).
Whilst Atypical Ductal Hyperplasia (ADH) is considered a benign (non-cancerous) finding it is a high risk indicator but not an imminent threat. DCIS is considered a malignant finding and should be treated by surgical removal ( or excisional biopsy) right away.
From least risky to most ‘histological risk‘:
- starting the Ductal Hyperplasia (DH), (lowest risk)
- then Atypical ductal hyperplasia (ADH),
- then Ductal Carcinoma in situ (
- then infiltrating ductal carcinoma and invasive ductal carcinoma. (highest risk)
There are a number of factors influencing the diagnosis of DCIS, but initially DCIS is a follow-up diagnosis after initial screening mammography reveals the development of microcalcifications of some kind.
In fact, most microcalcifications turn out not to be cancerous or precancerous, but certain kinds of microcalcifications have a higher probability of accompanying cellular findings of DCIS or cancer.
Many women with DCIS show no obvious clinical signs
Whilst most women with a diagnosis of DCIS have no obvious signs or symptoms of the condition, some women with DCIS may present with a breast lump or a discharge from the nipple. Any signs of a breast tumor such as a lump or nipple discharge should be investigated immediately.
Under the microscope, DCIS diagnosis by the pathologist
The pathologist generally likes to look for microcalcifications and then may find some abnormal cells building up inside ducts. It’s the possible cancer cells in the breast ducts that matter – not the microcalcifications.
Those tumor cells piling up in the breast ducts, near the microcalcifications, have to look like cancer cells. If they are not then the diagnosis will ease back to the lesser case of atypical ductal hyperplasia or ADH.
The ‘grey area‘ between a diagnosis of ADH and DCIS uses at least these two factors:-
- If the cells are dividing in an uncontrolled, unpredictable way
- If the cancer cells are now affecting the ‘stroma‘ or supporting tissues of the duct and not just the epithelial lining. Then it is DCIS and it is breast cancer.
‘Grading’ of DCIS
DCIS is often classified or graded as either low, medium, or high stage cancer. The distinctions are usually determined by histological differences and findings, which can predict how quickly cells are developing and how likely it is that DCIS cells will come back following surgery. Basically, the type and grade of DCIS is based on the pattern of cancer cells distribution and their rate of growth.
Reminder, that a New page on DCIS grading has more information on grading.
Treatment of DCIS
DCIS treatment is described in more detail on other pages within this website, and as is the case with all cancer-related treatments there are many, many factors to consider, over and above specific medical considerations. However,the ‘first-order‘ standard of treatment for DCIS will be surgical removal of the affected breast tissue. For the decision-making process of which treatment options are best for each individual case the whole multidisciplinary team should be involved.
My page on cancer treatment has a section on DCIS treatment halfway down the page at section 8.7.1. Surgery for everyone with radiation added only for high grade DCIS and no chemotherapy, apparently. I say, apparently, because, there’s no way I can stay up-to-date with current treatment. You’ll be asking your oncologist.
DCIS is usually treated with surgery
Surgery usually involves removing not just the affected cells, but also an expanded area (called a ‘margin’) of the normal breast tissue surrounding it. This is sometimes referred to as a ‘wide local excision‘, or WLE for short. If DCIS is already affecting a large portion of the breast, breast removal (mastectomy) is recommended. Breast removal might also be undertaken if more than one region of the breast is affected.
Radiation therapy for DCIS might be used for high grade tumors
Radiation therapy is sometimes used after surgery for women with high grade DCIS, as it is thought to reduce the likelihood of the condition recurring.
Note that DCIS does not generally spread into the lymph nodes, this is more typical for loubluar carcinoma in situ (LCIS) or ‘lobular neoplasia‘), but some kind of lymph node biopsy might be undertaken just to be sure. (see sentinel node biopsy)
Hormonal treatment for DCIS
Hormonal therapy is also sometimes employed for DCIS treatment. DCIS cells typically have ‘estrogen receptors‘, that help to signal and regulate cell growth. If this tendency for the cells to grow and divide can be attenuated, the cancer cells themselves will often stop growing or grow at a much slower rate. Tamoxifen is a chemical agent which specifically attacks the estrogen receptors and may be of some benefit for women with DCIS, but it doesn’t work well for all women and is not thought to be effective at all for women who have had radiotherapy.
Cure rate of DCIS is near 100%
The incidence of DCIS has increased dramatically, mostly due to a greater participation in breast cancer screening programs. There is some risk of ‘over diagnosis‘ or at least ‘over-treatment‘ of DCIS. The cure rate of DCIS is now close to 100 % and there is virtually no conclusive evidence to indicate risk of lymph node metastasis with DCIS. Nonetheless, left untreated, DCIS will usually progress to invasive ductal breast cancer. A larger tumor size, the younger the age at time of diagnosis and the presence of comedo necrosis have been identified as potential factors for ‘increased risk‘ of eventual invasive breast carcinoma. Additionally micropapillary carcinoma (DCIS) has been identified as a particularly aggressive form of the disease. For full prognostic factors and survival rates for DCIS click HERE.
But, with early diagnosis, breast cancer DCIS is almost always cured.
Even with a late diagnosis, lets speak even more broadly, for just about every DCIS it is almost always cured except the ones that are discovered very late with DCIS all over the place (invasive ductal carcinoma).
Here are a bunch of common Q&A’s…
- How is ductal carcinoma in situ found? DCIS is usually found during a mammogram done as part of breast cancer screening or when there is another concern with a woman’s breast. The rate at which DCIS is diagnosed has increased dramatically over the recent years, not because the DCIS is becoming more common, but because the mammogram technology can see the microcalcifications better.
- Is ductal carcinoma in situ life threatening? No, in the early stages it is confined to the breast duct or ducts so at this point it is a non-invasive breast cancer. DCIS does require treatment to prevent the condition from becoming invasive however.
- How is ductal carcinoma in situ treated? Most women with DCIS are effectively treated with breast-conserving surgery and some will undergo radiation too.
- What are the ductal carcinoma in situ symptoms? DCIS sometimes can cause signs and symptoms such as a breast lump and/or blood nipple discharge. However, it doesn’t cause any signs or symptoms in the majority of cases.
- What does ductal carcinoma in situ look like on a mammogram? It appear as clusters of calcifications that have irregular shapes and sizes.
- What causes ductal carcinoma in situ? It is not clear what causes DCIS. It forms when genetic mutations occur in the DNA of breast duct cells. The genetic cell mutations cause the epithelial cells in the lining of the breast duct to appear abnormal, but the cells do not yet have the ability to break out of the breast duct.
- What triggers ductal carcinoma in situ? Researcher’s don’t know exactly what triggers the abnormal cell growth that leads to DCIS. It is most likely that a number of factors may play a part, including genes passed to you from your parents, your environment and your lifestyle.
- What are the risk factors? Increasing age, personal history of benign disease such as atypical hyperplasia, family history of breast cancer, first pregnancy after age 30, taking combination estrogen-progestin hormone replacement therapy for more than 3-5 years after menopause, genetic mutations that increase the risk of breast cancer, such as in the breast cancer genes BRCA1 and BRCA2, and/or obesity.
- What are the tests/diagnosis done? It is often discovered during a mammogram. Additional breast imaging is recommended if there are any suspicious areas are shown. If the area of concern needs further evaluation, the next step may be an ultrasound and breast biopsy. To collect breast tissue for testing, you may undergo one or more types of biopsy procedures such as core needle biopsy, sterotactic biopsy, or surgical biopsy (wide local excision or lumpectomy).
- What are the ductal carcinoma in situ treatment and drugs that are needed? In most cases – lumpectomy and radiation therapy and simple mastectomy. In some cases – lumpectomy only or lumpectomy and the drug tamoxifen.
- Are there any alternative medicines that are recommended? No, alternative medicine treatments have not been found to cure DCIS or reduce the risk of being diagnosed with an invasive carcinoma. But most women may experience anxiety, and to cope with that you might want to try massage, meditation, music therapy, hypnosis, relaxation techniques, tai chi, yoga, aromatherapy and exercise.
- Are there any ways I can cope with my diagnosis? Yes, a diagnosis of DCIS can be overwhelming and frightening, however to better cope with your diagnosis, it may be helpful to learn enough about DCIS to make decisions about your care, get support when needed (join a support group, or talk with a counsellor). Remember DCIS is very early-stage breast cancer, you can start getting in top health and making lifestyle changes if you need to. Control what you can about your health (make helthy changes to your lifestyle so you can feel your best choose a healthy diet (focus most on fruits, vegetables and whole grains), try to be active for 30 minutes most days of the week, and get enough sleep each night.
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