Classification and external resources
|Histopathologic image from ductal cell carcinoma in situ (DCIS) of breast. Hematoxylin-eosin stain.|
Ductal carcinoma is the most common type of breast cancer in women. Breast cancer is a Cancer that starts in the cells of the Breast in women and men It comes in two forms: infiltrating ductal carcinoma (IDC), an invasive, malignant abnormal proliferation of cells in tissue known as neoplasm, and ductal carcinoma in situ (DCIS), a noninvasive neoplasm. Malignant (from the Latin roots mal- = "bad" and -genus = "born" is a medical term used to describe a severe and progressively worsening disease
Intraductal carcinoma of the breast (Ductal Carcinoma In Situ, DCIS) is the most common type of noninvasive breast cancer in women. Carcinoma in situ (CIS is an early form of Carcinoma defined by the absence of invasion of surrounding tissues Ductal carcinoma refers to the development of cancer cells within the milk ducts of the breast. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Mammary glands are the organs that in Mammals produce Milk for the sustenance of the young In situ means "in place" and refers to the fact that the cancer has not moved out of the duct and into any surrounding tissue. In situ (ɪn siːˈtuː is a Latin phrase meaning in the place.
As screening mammography has become more widespread, DCIS has become one of the most commonly diagnosed breast conditions. It is often referred to as "stage zero breast cancer. " In countries where screening mammography is uncommon, DCIS is sometimes diagnosed at a later stage, but in countries where screening mammography is widespread, it is usually diagnosed on a mammogram when it is so small that it has not formed a lump. DCIS is not painful or dangerous, and it does not metastasize unless it first develops into invasive cancer.
DCIS is usually discovered through a mammogram as very small specks of calcium known as microcalcifications. Mammography is the process of using low-dose X-rays (usually around 0 Microcalcifications are tiny specks of Mineral deposits ( Calcium) that can be scattered throughout the Mammary gland, or occur in clusters However, not all microcalcifications indicate the presence of DCIS, which must be confirmed by biopsy. DCIS may be multifocal, and treatment is aimed at excising all of the abnormal duct elements, leaving "clear margins", an area of much debate. After excision treatment often includes local radiation therapy. With appropriate treatment, DCIS is unlikely to develop into invasive cancer. Surgical excision with radiation lowers the risk that the DCIS will recur or that invasive breast cancer will develop.
DCIS patients have two surgery strategy choices. They are lumpectomy (most commonly followed by radiation therapy) or mastectomy.
Lumpectomy is surgery that removes only the cancer and a rim of normal breast tissue around it. Lumpectomy is a common Surgical procedure designed to remove a discrete lump usually a Tumor, benign or otherwise from an affected man or woman's Breast For women with only one area of cancer in their breast, and a tumor under 4 centimeters that was removed with clear margins, lumpectomy followed by radiation is often equivalent to mastectomy for mortality related to their cancer, albeit at the higher risk of local disease recurrence on the breast/chest wall. The addition of radiation therapy to lumpectomy in DCIS reduces the risk of local recurrence by about 58% as compared to excision alone. Lumpectomy with radiation is estimated to carry between a 12-19% chance at 15 years for local recurrence of breast cancer (approximately a 0. 5% to 1. 0% risk per year), which would require a "salvage mastectomy". Patients with family history of breast cancer and those presenting with breast cancer who are less than 40 years old face higher risks of local recurrence with breast conservation techniques. Extensive DCIS of high grade, large size, and resected with minimal surgical margins, even with radiotherapy, results in recurrence rates of at least 50% and would be better served with a mastectomy procedure.
Mastectomy may also be the preferred treatment in certain instances:
The system for analysing the suitability of DCIS patients for the options of breast conservation without radiation, breast conservation with radiation, or mastectomy is called the VanNuys Prognostic Scoring Index (VNPI). This VNPI analyzes DCIS features in terms of size, grade, surgical margins, and patient age and assigns "scores" to favourable features.
Tamoxifen or another hormonal therapy is recommended for some women with DCIS to help prevent breast cancer. Hormonal therapy further decreases the risk of recurrence of DCIS or the development of invasive breast cancer. However, they have potentially dangerous side effects, such as increased risk of endometrial cancer, severe circulatory problems, or stroke. In addition, hot flashes, vaginal dryness, abnormal vaginal bleeding, and a possibility of premature menopause are common for women who were not yet menopausal when they started treatment.
Unlike women with invasive breast cancer, women with DCIS do not undergo chemotherapy and have traditionally not been advised to have their lymph nodes tested or removed. Some institutional series reporting significant rates of recurrent invasive cancers after mastectomy for DCIS, have recently endorsed routine sentinal node biopsy (SNB) in these patients. , while other have concluded it be reserved for selected patients. Most agree that 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 patients undergoing mastectomy after a core or excisional biopsy diagnosis of DCIS.   Experts are not sure whether all women with DCIS would eventually develop invasive breast cancer if they live for a long time and are not treated.
Invasive Ductal Carcinoma (IDC) is the most common form of invasive breast cancer. It accounts for 80% of all types of breast cancer. On a mammogram, it is usually visualized as a mass with fine spikes radiating from the edges. Mammography is the process of using low-dose X-rays (usually around 0 On physical examination, this lump usually feels much harder or firmer than benign breast lesions. Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs On microscopic examination, the cancerous cells invade and replace the surrounding normal tissues. Microscopy is the technical field of using microscopes to view samples or objects IDC is divided in several histological subtypes. Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and
The prognosis of IDC depends, in part, on its histological subtype. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the Mucinous, papillary, cribriform, and tubular carcinomas have longer survival, and lower recurrence rates. The prognosis of the most common form of IDC, called "IDC Not Otherwise Specified", is intermediate. Finally, some rare forms of breast cancer (e. g. sarcomatoid carcinoma, inflammatory carcinoma) have a poor prognosis.
Regardless of the histological subtype, the prognosis of IDC depends also on its staging, histological grade, expression of hormone receptors and of oncogenes like HER2/neu. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread In Pathology, grading is a measure of the progress of Tumors and other Neoplasms Some pathology grading systems apply only to Malignant neoplasms A Hormone receptor is a Receptor protein on the surface of a cell or in its interior that binds to a specific Hormone. An oncogene is a protein encoding Gene, which — when deregulated — participates in the onset and development of Cancer. HER2/neu (also known as ErbB-2) stands for "Human Epidermal growth factor Receptor 2" and is a protein giving higher aggressiveness in Breast cancers It is a
Treatment of IDC usually starts with surgery to remove the main tumor mass and to sample the lymph nodes in the axilla. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. The stage of the tumor is ascertained after this first surgery. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread Adjuvant therapy (i. e. treatment after surgery) usually includes chemotherapy, radiotherapy, hormonal therapy (e. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant g. Tamoxifen) and targeted therapy (e. Tamoxifen is an orally active Selective estrogen receptor modulator (SERM that is used in the treatment of Breast cancer and is currently the world's largest g. Trastuzumab). Trastuzumab (more commonly known under the Trade More surgery is occasionally needed to complete the removal of the initial tumor or to remove recurrences.
The treatment options offered to an individual patient are determined by the form, stage and location of the cancer, and also by the age, history of prior disease and general health of the patient. Not all patients are treated the same way.