“What is Ducal Carcinoma in Situ?”
Ductal carcinoma in situ, also know as DCIS or intraductal carcinoma, is a breast cancer that has been found before it has spread outside of the breast duct. This is in contrast to invasive breast cancer which is no longer confined to the milk duct and has spread to adjacent tissue and potentially to the lymph nodes and other sites in the body.
“How is the diagnosis of DCIS made?”
DCIS is usually diagnosed on a mammogram. It is often identified by calcifications (calcium deposits) on a mammogram. Rarely an area of DCIS can be felt on a breast exam or seen with the ultrasound. If DCIS is suspected we must first confirm the diagnosis by getting a sample of the area. This can be done in the office with either a stereotactic or mammotome biopsy or in the hospital as an outpatient surgery.
“How is DCIS treated?”
DCIS can be treated with either a wide excision of the area of DCIS or with a mastectomy. Some women will also benefit from receiving radiation therapy after their surgery. The type of surgery a woman has is determined by many factors such as a woman’s preference, the size of the tumor, and the type of DCIS she has. Some types of DCIS are known to be more aggressive and more likely to progress on to invasive cancer. Women who have had DCIS are considered at higher risk for an invasive breast cancer later in life and your doctor may discuss medications to decrease your risks after you have completed your surgery. Women with DCIS do not need chemotherapy.
Because DCIS is not visible to the naked eye and the extent of it can only be determined by the pathologist when looking under a microscope it is usually not possible to tell if all of the abnormal cells are removed during surgery. If any of the surgical margins or “edges” are positive for abnormal cells it is recommended that women have a second re-excision or a mastectomy.
Because DCIS is confined to the duct and has not spread women with DCIS do not usually need evaluation of their lymph nodes. If the area of DCIS is very large or if high grade DCIS is present on your biopsy however, your surgeon may recommend a sampling of your lymph nodes in case a small area of invasive cancer is present.
“How will I be followed after I have completed my treatment?”
Women who have had DCIS are at higher risk for invasive breast cancer than someone who has not had it. Depending on which surgery you have, initially you may have mammograms every 6 months; you will then have them on a yearly basis. Your doctor will also want to see you for regular exams and examine your breasts every 6 months.