Ductal Carcinoma In Situ (Dcis)

Ductal carcinoma in situ (DCIS) is considered an early type of breast cancer or is sometimes referred as a pre-cancerous or non-invasive cancer. Several women around the world are diagnosed with DCIS. This is the most common cancer among women. The ACS (American Cancer Society) estimates that in the United States only, there are 60,000 cases of DCIS reported each year.

What is Ductal Carcinoma in Situ?

Ductal carcinoma in situ of the breast or intraductal carcinoma contains the clonal increase of cells that became malignant and that builds up in the lumens of the mammary duct. No indication of incursion outside the epithelial basement membrane to the adjacent breast stroma. Lesion, an antecedent to invasive ductal carcinoma, is normally diagnosed using the screening mammography. There’s an increase of ductal carcinoma in situ incidence in the past 20 years, and with the use of screening mammography, the data from large cohort studies and unsystematic trials came out to guide treatment. Moreover, the significant awareness between the relationship of ductal carcinoma in situ and invasive breast cancer was provided by the advances in the molecular biology.

Risk Factors

The precise causes of DCIS are unknown, although several women happen to be at a higher risk of having it. Women who never had any children, or who gave birth later in their lives, women who had an early menstruation at a young age, or had late menopause, and those whose family have a history of breast cancer, have the tendency to acquire DCIS. The risk factors in the process of emerging DCIS are equivalent to those of emerging invasive breast cancer. The clear family history was demarcated as a diagnosis in a mother or sister. The part of hormone replacement therapy in the cause of DCIS is questionable (Gapstur, et al.). It’s still vague whether or not postmenopausal hormone therapy place you at the higher risk of having DCIS, although almost all reports has not established a link between the two.

Family history is very significant in determining the risk for breast cancer. Any women with a family history of breast cancer have the higher risk in developing breast cancer. Moreover, genetic mutations which increase the risk of breast cancer are apparent in several families; these involve mutations in the genes BRCA and BRCA2. From 3% to 10% of breast cancers is probably connected to the changes in one of the BRCA genes. These mutations are inherited from the woman’s parents. For any woman with a strong family history of breast cancer, a genetic testing for mutations is recommended. If by any chance the woman is assed to have either mutation, there’s a 50% change of getting breast cancer before she turns 70. Therefore, family members may opt for testing in order to see if they carry the mutation as well. However, if a woman found to have the mutation, she has the option to undergo a more rigorous screening or also undergo preventive mastectomies to lessen her chance of having breast cancer. It is a personal choice in choosing to undergo genetic testing and should be discussed with a doctor who is well-trained in counseling patients regarding genetic testing.

With the use of exogenous estrogens, frequently in the form of hormone replacement treatment (HRT) might increase the risk for breast cancer, although with the use of oral contraceptives the likelihood to increase the risk is unlikely.

Diagnosis

In diagnosing DCIS, there are no physical signs or symptoms. Several women may find a lump in their breast or several discharges coming out of their nipple.

Mammography is commonly used tool in diagnosing DCIS. This shows a bunch of microcalcifications or small white dots of calcium. The mammogram will display in the ducts the build up cancer cells inside it as a bunch of these lumps. If the result of your mammogram is suspicious, your doctor will recommend a biopsy.

Biopsy will be conducted if there’s a suspected DCIS in which a tiny sample of cells is removed to further examine with the use of microscope. There are types of minimally invasive breast biopsy: Fine needle aspiration biopsy (FNAB) is a very tiny needle which gets rid of the fluids and tiny portion of breast tissue for microscopic examination purpose; and the Core needle biopsy (CNB) is a large needle that gets rid a cylindrical sample of breast tissue for microscopic examination purpose also.

Ultrasound is sometimes the imaging tool used to assess the in situ dimensions of a malignant tumor. This actually measures the tumor size in comparison with the size established by pathological examination (Yang, et al.).

Stages

When the diagnosis is confirmed, before any treatment is performed, several tests should be conducted in order to determine if the cancer has multiplied beyond the breast. Several tests may include chest X-ray and blood count with liver function tests, alkaline phosphatase, an enzyme from bole, is also established. There are also instances where radionuclear bone scan is required. Usually, this test examines the places in the body where breast cancer usually spread wildly. A CT-scan may be recommended also. The physician will conduct a thorough examination of the axilla to evaluate the probability of regional metastasis, although this was proven to be inaccurate. Given that the axillary node status is the preeminent reflection of potential extensive disease, several or all of these nodes at the time of the surgery treatment will be removed. New studies revealed that with the use of sentinel lymph node biopsy, removes the lymph node that accepts the fluid drainage primarily from the part where the cancer is situated. However, if this node is free of cancer, an appropriate staging is recommended. This method helps women from the discomfort and side effects in relation with eliminating extra lymph nodes in her armpit.

With the results being established already, clinical stage will be provided for the patient. With this procedure, the treatment protocol and prognosis helps in determining what kind of treatment is appropriate for the patient. After the treatment, the last stage is demarcated as the true axillary lymph node status is identified. From the American Joint Commission on Cancer Manual, the detailed staging criteria are generalized as follows:

• Stage 1 вЂ" no cancer cells are seen in the lymph nodes and are not larger than 2 cm or 0.8 in.

• Stage 2 вЂ" the cancer has spread to the lymph nodes and the size is between 2 cm to 5 cm.

• Stage 3A вЂ" the size of the tumor is larger than