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Ductal Carcinoma In Situ DCIS

Ductal Carcinoma In Situ, or DCIS, is a condition in which the cells lining the milk ducts are cancerous, but stay contained within the ducts without developing through into the surrounding breast tissue. DCIS may affect just one area of the breast, but can be more widespread and affect different areas at the same time. Sometimes, DCIS may be described as pre-cancerous, pre-invasive, non-invasive, or intraductal cancer.

The term, ductal carcinoma in situ (DCIS), pertains to a family of cancers that occur in the breast ducts. There are two categories of DCIS: non-comedo and comedo. The term, comedo, describes the visual aspect of the cancer. When comedo type breast tumors are cut, the dead cells inside of them (necrosis) can be expressed out just like a comedo or blackhead on the skin.

The most common non-comedo types of DCIS are:

Solid DCIS: cancer cells completely fill the affected breast ducts.
Cribiform DCIS: cancer cells do not completely fill the affected breast ducts; there are gaps between the cells.
Papillary and micropapillary DCIS: the cancer cells arrange themselves in a fern-like pattern within the affected breast ducts; micropapillary DCIS cells are smaller than papillary DCIS cells.

Comedo type DCIS (also referred to as Comedocarcinoma) tends to be more aggressive than the non-comedo types of DCIS. Pathologists are able to easily discern between comedo type DCIS and other non-comedo types when studying the cells under a microscope because comedo type DCIS tends to plug the center of the breast ducts with necrosis (dead cells). When necrosis is associated with cancer, it often means that the cancer is able to grow quickly. Necrosis is often seen with microcalcifications.

If DCIS is left untreated, it may, over a period of years, spread into the breast tissue bordering the ducts. It is then known as invasive breast cancer. It is important to recall that although DCIS should be treated to prevent it developing into an invasive breast cancer, it is not destructive at this stage. Not every woman with DCIS will go on to develop breast cancer if it is left untreated, but it isn't possible to anticipate when DCIS will develop into breast cancer.

There are three grades of DCIS: low, intermediate, and high. The grade relates to how the cells look under the microscope, and gives an idea of how quickly the cells may develop into an invasive cancer (or how likely it is that the DCIS will come back after surgery). Low-grade DCIS has the lowest risk of developing into an invasive cancer, and high-grade carries the greatest risk.

The most important part of treatment is the surgical removal of the affected breast tissue, together with an area (margin) of normal breast tissue around it, to ensure that all affected tissue is reomved. This operation is called a wide local excision (WLE).

Wide local excision is an example of breast-conserving therapy (only the area of DCIS is removed, rather than the whole breast).

If the area of DCIS is large, and especially if it is large and high-grade, removal of the breast (mastectomy) may be recommended. Mastectomy is also advised as treatment if the DCIS is affecting more than one area of the breast. This cures the condition in virtually all women and often no further intervention is necessary, although it is important for the other breast to be checked at least yearly by mammogram.

DCIS does not generally spread to the lymph nodes in the armpit (axilla), but sometimes, if the area of DCIS is large or widespread, the lymph nodes may be removed during the surgery and checked for cancer cells. This is because, for some women, there may be an area of invasive cancer cells within the DCIS which could spread into the lymph nodes. Before your operation, your doctor will discuss with you whether it is necessary to remove any of your lymph nodes.