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Intraductal Carcinoma In Situ

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Intraductal carcinoma in situ is a non-invasive form of<a href="https://merisehat.pk/disease/breast-cancer"> breast cancer </a>that is present inside a milk duct in the breast. 
&nbsp;

Carcinoma means cancer,&rdquo; while &quot;in situ&quot; means &ldquo;in the original place.&rdquo; It&rsquo;s estimated that 1 in 5 new cases of breast cancer is intraductal carcinoma in situ or ductal carcinoma in situ (DCIS).<a href="#accordion">[1]</a>

Since it is a stage 0 breast cancer, DCIS is a pre-invasive or noninvasive breast cancer. Almost all women diagnosed with DCIS can be cured.<a href="#accordion">[1]</a>&nbsp;This is because only the cells in the ductal lining have become cancerous at this point; they have not spread into the nearby tissue and, therefore, cannot metastasize beyond the breast. 
&nbsp;

There are several subtypes of DCIS, each with distinct characteristics and growth patterns: 
&nbsp;

<ul>
	<li>Comedo DCIS: This type involves the presence of necrotic material (dead or dying cancer cells) within the ducts, leading to a characteristic appearance resembling comedones. It often indicates a higher grade and increased risk of progression.</li>
	<li>Cribriform DCIS: This subtype is characterized by a cribriform (sieve-like) pattern of growth, with the cancer cells forming small spaces resembling glands. It generally has a more favorable prognosis.</li>
	<li>Papillary DCIS: Papillary growth patterns involve the formation of finger-like projections of cancer cells within the ducts. It is less common and usually has a good prognosis.</li>
	<li>Solid DCIS: This subtype features dense, uninterrupted growth of cancer cells within the ducts, lacking the spaces seen in other subtypes. It can be of a higher grade and may carry a higher risk of recurrence.</li>
	<li>Micropapillary DCIS: Micropapillary growth involves small, delicate projections of cancer cells, resembling papillary growth but on a smaller scale. It might indicate a higher risk of invasion. 
	&nbsp;</li>
</ul>

Sign and Symptoms

DCIS often does not cause noticeable symptoms. It is typically detected through routine mammograms or other breast imaging studies. However, in some cases, individuals may experience:<a href="#accordion">[3]</a>

<ul>
	<li>Bloody <a href="https://merisehat.pk/article/nipple-discharge">nipple discharge</a></li>
	<li>Breast pain or discomfort</li>
	<li>A palpable lump or thickening in the breast 
	&nbsp;</li>
</ul>

Causes

The exact causes of DCIS are not fully understood, but several factors are believed to contribute:

<ul>
	<li>Genetic: Certain mutations, such as BRCA1 and BRCA2 mutations, are associated with an increased risk of developing DCIS and other breast cancers.</li>
	<li>Lifestyle: Prolonged exposure to estrogen without the counterbalance of progesterone can promote the growth of abnormal cells within the breast ducts.</li>
	<li>Environment: Previous radiation therapy to the chest, especially during childhood, increases the risk of developing breast cancer, including DCIS. 
	&nbsp;</li>
</ul>

Screening is crucial for early detection, as it allows for timely intervention before the condition progresses to invasive breast cancer. Regular mammograms are the primary method for screening for DCIS. Mammography uses X-rays to detect abnormalities in breast tissue.

Doctors may recommend additional breast imaging if the mammogram shows microcalcifications of irregular shapes or sizes clumped together in a cluster. 
&nbsp;

Diagnosis

A tissue sample (biopsy) is taken from the affected area for examination. Sometimes, an X-ray, an ultrasound, or a breast MRI are used to confirm the presence of DCIS. 
&nbsp;

It can be categorized into:<a href="#accordion">[4]</a>

<ul>
	<li>Low-Grade Or Grade I &ndash; Looks a little bit different from healthy breast cells, grows slowly, and is less likely to spread and recur; tends to be ER-positive and PR-positive</li>
	<li>Moderate-Grade Or Grade II &ndash; Grows faster compared to low-grade but slower than a grade III cancer</li>
	<li>High-Grade Or Grade III &ndash; Looks much different from healthy breast cells, grows quickly, and has a higher risk of coming back&nbsp;&nbsp; 
	&nbsp;</li>
</ul>

Results from the diagnostic scans are used to describe the stage of cancer according to the TNM staging system:<a href="#accordion">[6]</a>

<ul>
	<li>Tumor (T) &ndash; Describes the tumor size and location</li>
	<li>Node (N) &ndash; Describes the spread of the tumor to regional or distant lymph nodes</li>
	<li>Metastasis (M) &ndash; Describes whether the cancer spread to other parts of the body</li>
</ul>

There are 5 major stages of breast cancer: stage 0 (non-invasive ductal carcinoma in situ) to stages 1-4 (invasive breast cancer). 
&nbsp;

Specific tumor stage information for intraductal carcinoma in situ includes:

<ul>
	<li>TX: The primary tumor cannot be evaluated.</li>
	<li>T0: There is no evidence of cancer in the breast.</li>
	<li>Tis: Refers to carcinoma in situ, i.e., cancer that has not spread to the surrounding breast tissue. There are two types of breast carcinoma in situ:</li>
</ul>

1.Tis (Paget&rsquo;s Disease) &ndash; Paget&rsquo;s disease of the nipple occurs rarely. It&rsquo;s restricted to the skin cells of the nipple. Sometimes, patients may present with invasive breast cancer, in which case it will be classified according to the stage of that tumor.

2. Tis (DCIS) &ndash; This means there are cancer cells in the breast ducts but they have not spread. However, it can develop into invasive breast cancer if it&rsquo;s not removed.

<ul>
	<li>NX: The lymph nodes cannot be evaluated.</li>
	<li>N0: There is either no cancer in the lymph nodes or the lymph nodes have cancerous cells that are less than 0.2 mm. 
	&nbsp;</li>
</ul>

Treatment

Treatment options for DCIS depend on factors such as the subtype, grading, and staging of the cancer, as well as individual patient characteristics:<a href="#accordion">[5]</a>

<ul>
	<li>Surgery: Lumpectomy (removal of the tumor and a margin of normal tissue) or mastectomy (removal of the entire breast) may be recommended.</li>
	<li>Radiation Therapy: After lumpectomy, radiation therapy may be used to reduce the risk of recurrence.</li>
	<li>Hormone Therapy: For hormone receptor-positive cases, hormonal treatments such as tamoxifen or an aromatase inhibitor may be prescribed.<a href="#accordion">[1]</a> 
	&nbsp;</li>
</ul>

These include:

<ul>
	<li>Invasive Cancer: Untreated DCIS can evolve into invasive breast cancer, spreading to nearby tissues and potentially metastasizing to distant organs.<a href="#accordion">[2]</a></li>
	<li>Recurrence: Even after treatment, there&#39;s a risk of recurrence of DCIS or the development of invasive cancer.</li>
	<li>Psychological Impact: A DCIS diagnosis can cause emotional distress and anxiety related to cancer diagnosis and treatment decisions.</li>
	<li>Side Effects Of Treatment: Surgical procedures, radiation, and hormonal therapies may lead to discomfort, pain, scarring, and other side effects. 
	&nbsp;</li>
</ul>

Several risk factors increase the likelihood of developing DCIS.

<ul>
	<li>Age And Gender: Women over the age of 40 are at higher risk.</li>
	<li>Family History: A history of breast cancer in close relatives increases the risk.</li>
	<li>Personal History: A history of benign breast disease, like atypical hyperplasia, can increase the risk of DCIS.</li>
	<li>Other: First period before 12, first pregnancy before 30, or beginning menopause after 55 are also risk factors. Additionally, women who have never been pregnant may be more susceptible to DCIS. 
	&nbsp;</li>
</ul>

While DCIS cannot always be prevented, several measures can reduce the risk, including:

<ul>
	<li>Routine mammograms for early detection and intervention</li>
	<li>Maintaining a healthy weight, being physically active, and following a balanced diet</li>
	<li>Limiting hormone therapy</li>
	<li>Genetic counseling for individuals with a family history of breast cancer or known genetic mutations</li>
	<li>Breastfeeding 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Intraductal carcinoma in situ is a non-invasive form of breast cancer confined to breast ducts.</li>
	<li>DCIS has subtypes including comedo, cribriform, papillary, solid, and micropapillary.</li>
	<li>Symptoms are often absent, and detection and diagnosis rely on mammography and biopsy.</li>
	<li>Genetic mutations, hormonal factors, and age contribute to DCIS development.</li>
	<li>Treatment includes surgery, radiation, hormone therapy, and clinical trials.</li>
	<li>Complications include progression to invasive cancer, recurrence, and side effects of treatment.</li>
</ul>