Ductal carcinoma in situ (DCIS) breast cancer is a condition in which the milk ducts in the breast that supply milk to the nipple, become cancerous.
Did You Know?
DCIS accounts for 20% of total number of breast cancer cases that are diagnosed every year.
Ductal carcinoma in situ (DCIS) is a type of breast cancer in which the cancer cells remain confined to one place within the breast. ‘In situ’ literally means ‘in place’. The cancerous growth is usually observed in the breast ducts. Ducts are tiny tubes that are responsible for bringing milk from where it is produced (in the lobules) to the nipple. The cancer cells that originate in the breast ducts do not have the ability to invade the tissues.
In case of DCIS, the cancer cells stay inside the ductal system. At the most, the cancerous growth may spread and cover a large area of the breast. But the cancer cells do not move outside the duct or to other parts of the body.
Stage 0 Cancer
DCIS also known as stage 0 cancer is contained within the ductal system. This form of cancer is non-invasive. Studies have shown that many women suffering from DCIS can lead a normal life for years, without any treatment. In fact, women with DCIS usually do not have any idea that they are living with this cancer. This happens because the DCIS sufferers do not show any symptoms.
Causes
- The exact causes of DCIS are still not known. However, certain women are at an increased risk of developing it. These include women who experienced a late menopause or women who started their periods very early in their life.
- Women with a family history of breast cancer are also susceptible to this condition.
- People born with defective genes BRAC1 and BRAC2 may also suffer from breast cancer. Both these genes play a key role in preventing formation of breast cancer. Hence, undesired change in the genetic structure of BRAC1 and BRAC2 (which is often inherited from parents) makes a person vulnerable to breast cancer.
Symptoms
Most women suffering from DCIS do not show any signs or symptoms. However, a small percentage of women with DCIS may have a lump in the breast. Occasionally DCIS may cause a discharge of fluid from the nipple. The fluid oozing out of the nipple may actually be blood or appear yellowish pus-like discharge. Puckered skin around the breast area is yet another symptom of DCIS. In other words, dimples might be seen over the breast and the skin may also look unusually red and inflamed.
Risk Factor
- Too much alcohol consumption and conceiving for the first time after crossing 30 are some of the factor that put women in the risk zone of DCIS.
- DCIS is often detected in women who have passed 50 years of age. Thus, one can say that increasing age also raises the risk of this non-invasive cancer development.
- It is also observed that DCIS development is gender biased as women are at much higher risk of getting cancer than men.
Another major factor responsible for the development of DCIS is hormone replacement therapy (HRT). As we all know, during and after menopause, fluctuations in progesterone and estrogen levels is common. These unwanted hormonal changes can trigger a number of physical issues including hot flashes and vaginal dryness. To combat post menopausal symptoms, it is often advised to use HRT. Patients put on HRT are required to take synthetically prepared hormones in the prescribed dosage. Studies suggest that women who have been taking estrogen as part of HRT therapy, for quite some time (approximately 5 years) have chances of getting affected with DCIS.
Diagnosis
A test used to diagnose DCIS involves the usage of mammograms. Mammography is a procedure that uses low dose amplitude X-rays for examining the breast tissue. Microscopic breast changes associated with DCIS can be easily identified using mammography. Suspicious areas may contain calcium deposits known as microcalcifications, which can be easily detected through X-rays. For further evaluation, the doctor may recommend a breast biopsy. To confirm a suspected DCIS, a breast biopsy is performed in which a small sample of tissue is taken out and observed under the microscope. Biopsy can be done by either using a very small needle or a large needle, to remove a sample of breast tissue.
Treatment
- If left untreated, DCIS may progress to invasive cancer where the abnormal cells attack the breast tissue that is outside the duct.
- The treatment depends on the size of the breast area affected by the cancerous growth.
- If the area is small, then doctors recommend lumpectomy, which involves removal of the cancerous mass and the healthy tissue surrounding it. This is called breast conserving surgery, in which only the area containing the cancer is removed.
- People undergoing this surgery experience minimal pain and within a week, they can resume their normal daily routine.
- If the cancerous growth is large or detected in several places throughout the breast, then doctors are likely to perform a breast removal surgery (mastectomy). This form of treatment cures all cases of DCIS.
- Many doctors also perform radiation therapy after lumpectomy. This is done to kill any remaining cancer cells.
- If the doctor determines that the cancer cells are estrogen receptive (need estrogen for growth), then a drug, tamoxifen, is administered to prevent these cancer cells from absorbing the estrogen. The drug also helps reduce the possibility of developing an invasive form of cancer in the future.
Recurrence
A point to note here is that a new type of breast cancer may show up in people who suffered from DCIS in the past. Experts say that there are chances of cancer coming back in a period of 10 years from the time DCIS is diagnosed. Although the risk of breast cancer returning is minimal (less than 30%), one cannot overlook the fact that DCIS patients are susceptible to cancer redevelopment. Breast cancer may also come back in patients who did not undergo radiation therapy after lumpectomy. The recurrence risk in the absence of radiation therapy is around 25%.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.
