Ductal Carcinoma In Situ (or DCIS)

• DCIS is early breast cancer which grows within the breast ducts. Part of the lining of the duct acts as a natural envelope or barrier for this very early cancer.
• Whilst it is “cancer” the fact it is contained within or insitu the body’s natural envelope, means it cannot do the nasty things we associate with cancer.
• DCIS cannot spread to other places and you cannot die from DCIS unless it changes into invasive cancer.
• Doctors cannot yet accurately predict which DCIS will change into invasive cancer. For that reason, currently all women with DCIS are recommended to have treatment.
• DCIS treatment is aimed at preventing the development of invasive carcinoma, and preventing the DCIS coming back.
• DCIS usually is picked up on screening mammograms and can be seen as calcifications.
• It is rare for DCIS to be felt, as it is uncommon for it to cause a lump.
• DCIS is treated with surgical excision – usually wide local excision.
• Uncommonly mastectomy is needed, especially if there is a very large area of DCIS or if a woman has previously received radiation to that breast.
• Sometimes radiotherapy is needed after surgery. This decision depends on the grade and other features on the histology (microscope assessment) of the tissue removed at the operation

Invasive Carcinoma

• Known by many names such as:
  • Invasive ductal carcinoma (abbreviated to IDC)
  • Invasive lobular carcinoma (ILC)
  • Invasive carcinoma not otherwise specified (NOS)
  • Or plain “Breast cancer”
• Breast cancer can be picked up on routine screening or the person may have noticed a change in their breasts which caused them to see their doctor.
• These changes can include a lump, skin retraction, nipple inversion or a change in shape or size of the breast, nipple discharge or a lump in the armpit.
• The treatment of breast cancer has many different aspects – surgery, radiotherapy, chemotherapy and endocrine treatment.
• Not all treatments are required in all patients – this depends on your individual situation – both tumour and patient factors.
• All treatment aimed at cure includes surgery.
• Surgery for invasive breast cancer always includes treatment of the lymph nodes and the breast.
• The breast can be treated with either mastectomy or wide local excision (lumpectomy).
• The lymph nodes are be treated with either a surgical biopsy (a sentinel lymph node biopsy) or an axillary dissection.

Other

There are less common forms of breast cancer which can be associated with a better or poorer outcome from disease.

Inflammatory breast cancer
This is a rare form of breast cancer where the cancer cells have spread into the lymphatics of the skin. Inflammatory cancer rarely presents with a discrete breast lump. It more commonly initially looks like mastitis and can sometimes be mistakenly treated with antibiotics. It is a more aggressive form of breast cancer, and its treatment is different from the usual regimen.

Paget’s disease of the nipple
This is breast cancer of the ducts at the nipple. The cancer migrates along the duct to involve the skin at the nipple. The nipple might be red, develop sores or ulcers and weep and/or bleed. It can be mistaken for dermatitis or eczema. Diagnosis involves a biopsy of the nipple and breast imaging. Mammogram and ultrasound can be normal in Paget’s disease. The treatment depends on how much of the breast is affected. Treatment involves surgery with/without radiotherapy.