Ductal carcinoma in situ, or DCIS for short, is a form of breast cancer detected very early. The breast cancer tumor is still confined to the milk ducts and could not metastasize. Therefore, ductal carcinoma in situ always curable and has good prognosis.
What is ductal carcinoma in situ?
Not all lumps in the breast, indicate breast cancer. Nevertheless, they should be clarified in mammography. Ductal carcinoma in situ is not a true breast cancer, but the precursor of breast carcinoma. Since DCIS has not broken the separation layer to the tissue, the affected area does not grow into the surrounding area and no metastases have been formed. One finds ductal carcinoma in situ mostly in the milk ducts. These may be completely or partially lined with the atypical cells, and the tissue change may occur at one or more sites in the breast. In rare cases, however, the tumor has nevertheless spread to the adjacent tissue, in which case it is referred to as invasive growth. In particular, DCIS foci larger than 2cm often have invasive areas, but they remain so small that they can be found only with minute histologic preparation.
Causes
The exact causes of ductal carcinoma in situ have not been exhaustively elucidated scientifically. One could observe, as with breast carcinomas, spontaneous cases of disease in which no medical cause could be identified. However, the risk factors known to favor breast carcinoma appear to be present. These are:
- Childlessness and late pregnancies after the age of 30,
- The early onset of menstruation and late onset of menopause,
- A persistently unhealthy, fat-heavy diet,
- Smoking and alcohol consumption
- And long-term use of female sex hormones.
In particular, taking the pill and hormone replacement therapies for menopausal symptoms increase the risk of breast cancer, albeit slightly. Although it is now more common to speak of genetic predisposition, but only in 5 to 10% of those affected, a genetic component could be identified. Genetic testing for women in high-risk groups is nevertheless recommended.
Symptoms, complaints, and signs
Since this disease is a tumor, it is always associated with the usual complaints and risks of a tumor disease. Often, early treatment cannot be given in this case either, because the disease is not associated with certain symptoms and discomforts. Only in very few cases it can cause pain in the breast, so that late treatment is necessary. A dark secretion may also emerge from the nipple itself, which indicates the disease. However, the further symptoms depend strongly on the extent of the tumor, so that a general prediction is not possible. If no treatment is given, the tumor will spread to different regions of the body, and metastasis may occur. This significantly reduces and limits the life expectancy of the affected person. The affected person suffers from severe fatigue and exhaustion, and his or her ability to cope with stress also decreases significantly. The tumor also attacks the internal organs, so that the patient may die of kidney disease or cirrhosis of the liver. In this process, severe psychological discomfort also occurs, so that many affected persons and their relatives suffer from depression or other psychological upsets.
Diagnosis and course
Because ductal carcinoma in situ rarely presents with symptoms such as breast pain, palpable tumors, or bloody secretion from the nipple, early diagnosis is difficult. Usually, DCIS is not discovered until a mammogram is performed. For more accurate diagnosis, the radiologist takes small tissue samples, which are analyzed by a pathologist. To determine the aggressiveness of the tumor, one uses a three-grade WHO scheme. The higher the nuclear grade, the more aggressive the tumor and the more uncertain and risky its course. In principle, ductal carcinomas in situ can develop into true carcinomas, but they do not have to.
When should you see a doctor?
If chest pain is noticed, a doctor should be consulted.Although ductal carcinoma in situ rarely presents with definite symptoms, complaints in the area of the breasts should be clarified in any case. If the tumor is detected during a routine examination, treatment is recommended. Affected women should consult an expert for this. Based on the severity of the ductal carcinoma in situ, the physician can then determine an individual treatment that minimizes radiation exposure and surgical risks. After successful removal of the tumor, regular consultations with the physician should be made. If bleeding or serious after-effects of radiation therapy occur, a visit to the physician is indicated. If there are signs of a breast tumor, the clinic should be visited promptly so that the suspicion can be dispelled or, in the case of carcinoma, the necessary steps can be taken immediately. Since a serious disease may also place a psychological burden on those affected, therapeutic counseling is also recommended to accompany medical treatment.
Complications
Ductal carcinoma in situ is a relatively common invasive early carcinoma of the female breast. It occurs mostly in the mammary ducts but leaves the basement membrane intact because its spreading properties are markedly low. With timely intervention, ductal carcinoma in situ has an excellent chance of cure. However, if the tissue nodules are not detected in time by the affected person or are ignored, the carcinoma may grow and develop negatively as a complication within a few years. If the growths have already taken on a variable shape, they grow and even extend to the lymph nodes. The skin and nipple change in the process and sometimes a central necrosis forms. In case of hardship, the breast must be amputated. For this reason, regular mammography screening is extremely important in the event of a suspicion or infestation. Furthermore, in order to keep the complication risk of a malignant cancer stage low, surgical measures are rapidly targeted. Here, the ductal carcinoma in situ is removed with sufficient safety margin. The operation is generally well tolerated. In some cases, anti-hormonal therapy or chemotherapy is recommended after the operation. Depending on the condition and acceptance of the symptom, affected persons react with psychological and physical problems, which are taken into account in the course of holistic diagnostics and are included in the therapy plan.
Treatment and therapy
Physicians generally advise women affected by ductal carcinoma in situ to undergo treatment to eliminate the risk of developing into true carcinoma. Modern research doubts the wisdom of this approach, particularly because of radiation exposure and surgical risks, and suggests regular observation. If the patient decides to undergo treatment, she should definitely have it performed by an expert. Only this expert can determine the right individual treatment, which must be based, among other things, on the severity of the ductal carcinoma in situ. The standard therapy is surgical removal of the affected tissue. This is done with a safety margin of five to ten millimeters from the healthy tissue. Normally, preservation of the breast is possible, but depending on the extension and size of the tumor, removal of the entire mammary gland may be necessary. Unlike breast cancer surgery, the axillary lymph nodes can usually be left in place. Although science has not been able to prove any healing benefit from chemotherapy, postoperative radiation is now an integral part of therapy. After a thorough individual risk assessment, the physician and patient can also decide in favor of anti-hormonal therapy. This is usually carried out with tamoxifen, the most important side effects of which are the absence of menstrual periods, hot flushes, nausea and headaches and bone pain. If the ductal carcinoma in situ has been completely removed, the prognosis is considered very good.
Outlook and prognosis
Ductal carcinoma in situ has a good prognosis. The breast cancer form is detected in the early stages and can be well treated as well as therapized with current medical options. In a surgical procedure, the tissue changes are completely removed. Since there is no formation of metastases in this form of carcinoma, the patient is normally considered cured after the operation. There is no further risk to health from cancer.In most cases, however, cancer is followed up as a precautionary measure. Radiation or chemotherapy is administered to prevent the formation of further carcinomas. These forms of therapy are associated with numerous side effects and sequelae. The quality of life is greatly reduced during the period of cancer therapy. After completion of the therapy, the patient needs several months or years until he or she has fully recovered and can resume his or her everyday life without worries. Ductal carcinoma in situ may recur at any time despite cancer follow-up. The prognosis is good even if it recurs. The recovery path becomes problematic for patients who develop a psychological disorder due to ductal carcinoma in situ. Anxiety disorder or depression may result in further decreased quality of life. Nevertheless, the prognosis of ductal carcinoma in situ is unaffected.
Prevention
Other than avoiding DCIS risk factors, women cannot currently take preventive measures because of insufficient research.
Follow-up care
Good and high-quality follow-up by a physician is very important for ductal carcinoma in situ; it is important to detect recurrences or even metastases in time and also to treat them. For this purpose, the patient is visited every three months during the first three years after therapy and questioned about her current situation. The breast is examined clinically, and blood analyses and imaging procedures are also used. Examination of the contralateral breast is also necessary, and tumors of other organs must be excluded. In addition, the patient must examine herself regularly and, if there are any abnormalities, present herself to her gynecologist. This will ensure an improvement in quality of life and performance after the therapy. In addition, the possible side effects of the treatment must be closely monitored and also treated. It is also helpful to join appropriate support groups for community sharing and help. A very important goal is a healthy lifestyle, including weight reduction, abstinence from alcohol and nicotine, and cardiac exercise. It is also important to reduce stress, for which psychosocial counseling can be helpful. Overall, the prognosis for ductal carcinoma in situ is very good, as it can be completely treated by surgery, but patients should still remain vigilant and adopt a healthy lifestyle.
Here’s what you can do yourself
Ductal carcinoma in situ is a tumor disease that is mostly curable without severe complications if diagnosed early. Numerous self-help options are available to patients to positively support the process of healing. Ductal carcinoma in situ has a low tendency to spread due to its nature, but this depends a priori on the physical condition, the surgical measures applied and the age of the affected person. Depending on the degree of the syndrome, the patient should change his lifestyle habits as a first self-help measure. This includes a diet rich in vitamins and low in fat, avoiding sugar, alcohol, cigarettes and drugs, as well as avoiding stress and extreme physical strain. During the radiotherapy as well as the subsequent anti-hormone medication, it is advisable to manage one’s daily life in peace and quiet. In case of severely restricted condition, the patient is provided with assistance. Therapeutic measures and self-help groups can mitigate and even avoid the risk of depression caused by possible pain. Artistic occupation in the context of self-help or rehabilitation is also a great support. Light physical activities such as walking, yoga and meditation to cope with the disease can release new vital energy and strength. Even after a positive course of treatment, a healthy lifestyle should be maintained and regular check-ups should be taken.
