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Non-Invasive Breast Cancer - Ductal Carcinoma in Situ (DCIS)

Ductal Carcinoma in Situ, known as DCIS, is the earliest form of breast cancer, and accounts for about 12% of all breast cancers worldwide. In DCIS cases, the cancer cells develop within the milk ducts and remain within these breast ducts (in Situ). Because of its confinement to the breast ducts, it is considered non-invasive, giving minimal probability of becoming invasive.

Symptoms of Ductal Carcinoma in Situ (DCIS)

Most of the times, DCIS doesn’t show any signs or symptoms. It is mostly diagnosed during a routine mammogram or breast screening. However, it can present signs such as:

  1. Lump on the breast
  2. Discharge from the nipple
  3. Thickened area under the breast skin

Diagnosis of Ductal Carcinoma in Situ

During diagnosis, which is done through a mammogram, the affected region appears to be shadowy, or some tiny white dots are seen, which are as a result of calcification (calcium salts in the breast), although not all calcifications are DCIS. In this case, your doctor will order a number of tests and examinations to confirm the presence of breast cancer, and to check how much of it has affected the breast. These tests include:

  1. Further breast examination
  2. MRI or Ultrasound scan
  3. Biopsy (tissue sample is removed from breast for analysis)

Treatment of Ductal Carcinoma in Situ

Treatment for non-invasive breast cancer is recommended, even if there is no way of predicting if it will progress to invasive breast cancer and spread to other areas of the breast and body.

Based on the test results, the doctor will customize the treatment plan. The goal of the treatment is to remove all the cancer cells within the breast ducts to minimize the risk of it becoming invasive and spreading. The first step in treating DCIS is through surgery. But before the surgery, the doctor has to consider:

  • The aggressiveness of the cancer
  • Tumor size and location
  • History of breast cancer in the family
  • Gene mutation test results

There are two types of surgery when it comes to treating DCIS. These are:

Breast-conserving surgery (BCS)

Also known as a lumpectomy, the surgeon removes the cancer cells, as well as a minimal amount of healthy breast tissue surrounding the tumor. After the lumpectomy, radiation therapy is recommended to reduce the chances of the cancer returning.

Mastectomy

This is the surgical removal of the entire breast, and it would be recommended if:

  1. The area of the DCIS is large
  2. The DCIS is in multiple areas of the breast
  3. There is a gene mutation which increases the likelihood of breast cancer
  4. There’s a history of breast cancer in the family
  5. The patient cannot stand radiation

If one undergoes a mastectomy, radiation therapy may not be required, and depending on each case, the patient might undergo a breast reconstruction surgery immediately after, or at a later date.

Additional Treatments for DCIS

After the lumpectomy or mastectomy, you may need additional treatments, known as adjuvant treatments. These include:

  • Radiation therapy: As mentioned, if you go through a lumpectomy, you may need radiation therapy to destroy any cancer cells and reduce the chances of it recurring. This is done on an outpatient basis for a duration of 4 to 6 weeks.
  • Hormone therapy: This is considered if the DCIS tests positive for hormone receptors. This reduces the chance of the cancer returning or developing invasive breast cancer.

Recovery After DCIS Treatment

After the breast cancer treatment, your doctor will keep a close watch on you. This is because there is a very minimal risk of the DCIS recurring, or progressing to invasive breast cancer. Follow-up appointments are required every few months where the doctor will do tests for signs of recurrence. A mammogram and screening might be required every 6 to 12 months (usually after a lumpectomy).

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