OFFICE NUMBER

305-271-3300

 

 

 

Ductal Carcinoma In Situ (DCIS)

 

 
     
This illustrates a breast duct with a single layer of normal breast epithelial cells. These cells line the entire ductal system and breast lobules.   Various layers of cancer cells fill up the affected ducts. These cells stay within the lumen and do not invade the basement membrane of the duct. Ductal carcinoma in situ refers to cancer cells that stay in place. They remain within the duct. They do not have the potential of spreading to other parts of the body.

 

Definition:
DCIS or ductal carcinoma in situ refers to cancer cells that are located inside a breast duct without stromal invasion. DCIS, which is also known as noninvasive or preinvasive breast cancer, is characterized by the proliferation of malignant ductal cells confined within the ductal system of the breast.

Incidence:
DCIS is the fastest growing subtype of breast cancer with approximately 60,000 new cases diagnosed in the United States in 2005. Its incidence increased from 3,000 patients per year in the early 1990’s to 20,000 per year in recent years. This is the result of the implementation of screening mammography. Breast Magnetic Resonance Imaging (MRI) is a relatively new diagnostic tool that can assist in the diagnosis and evaluation of DCIS.

Diagnosis:
Generally DCIS is diagnosed by routine mammogram although it can present as a palpable mass in a minority of cases. It is typically seen as abnormal microcalcifications on mammography.

Treatment:
The primary goals in the diagnosis and treatment are to rule out concurrent invasive cancer and to prevent progression of invasive carcinoma. DCIS is considered a precursor of invasive carcinoma, and as such, complete resection with a negative margin is recommended. These abnormal cells by definition do not have the potential of spreading to distant organs. They do not metastasize and for this particular reason do not fulfill the entire criteria of a cancer.

Stage 0:
DCIS represents stage zero breast cancer and has an excellent prognosis. Stage zero is the earliest stage we can diagnose a breast cancer. The natural course of DCIS is not well understood, some patients will have an indolent disease if untreated while others will progress to invasive carcinoma and could subsequently develop metastasis. It also represents a risk factor for developing cancer in the opposite breast.

Grading:

  Low grade DCIS
  Intermediate grade DCIS
  High grade DCIS


Types of DCIS:

Usual Types:
  Cribiform
  Micropapillary
  Solid
  Comedo

Special Types:
  Apocrine
  Cystic hypersecretory
  DCIS with associated mucocele-like lesion
  Endocrine
  Mucinous
  Papillary
  Pure micropapillary


Surgical Pathology Report:
It should include:

  Surgical procedure; mastectomy or lumpectomy
Location of tumor
Type of DCIS
Grade of DCIS
Size of DCIS
Distance to closest margin
Presence of calcifications if documented by mammogram
Any other studies performed, such as, tumor biomarkers